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Home My WebLink AboutFriends of Denise Gembusia - 2015 2nd Friday Pre-Election III ILII Reset Form Print Form Commonwealth of Pennsylvania-Campaign Finance Report (Note:This report must be clear and legible. It should be typed) Filer Identification Report Filed By Candidate ❑ Committee Lobbyist Number (Mark X) IX Name of Filing Committee,Candidate or Lobbyist Friends of Denise Gembusia Street Address PO Box 53' City Mt.Holly Springs State PA Zip Code 17065 Type of Report(Place x under report type) 1.6t" Tuesday 2- 2nd Friday 3.30 Day Post 4-6th Tuesday S-tad Friday 6-30 Day Post 7-Annual Special 2 Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Electio Pre-Election Election Pre-Election Post-Election ❑ ❑ ❑ ❑ ❑ ❑ Date Of Election Year Amendment ❑ Termination (MM/DD/YYYY) 05/19/2015 2015 Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures 06/09/2015 Cr 5 7 rJ A.Amount Brought Forward From Last Report $ 1,262.8 On O B.Total Monetary Contributions and Receipts $ r m (From Schedule 1) 450 1 C.Total Funds Available .,$ 0 (Sum of Lines A and B) 1,712.8 CD D.Total Expenditures $ n 3 (From Schedule 111) 1'712'8 C? W E.Ending Cash Balance $ ^C`r (Subtract Line D from Line C) 0 N F.Value of In-Kind Contributions Received $ (From Schedule 11) 0 G.Unpaid Debts and Obligations $ �,r,., (From Schedule IV) ]�'— Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. 1 swear(or affirm)that this report,including the attached schedules on paper,is to the best of my knowledge and belief true,correct and complete. Sworn to and subscribed be re me this ii day of 20 Signature of P son Submitting report OTA TIAL SEAL Jennifer L.Varner Signature IMOTHY STQU Printed Name My Commission expires ubNC 717 258-4224 O Z;;j ..CUMBERLAND 2 COUNTY Area Code Daytime Telephone Number My Commission Expires Apr 27,2016 Part II-If this is a report of a Candidate's Authorized Committee,candidate shall sign here. I swear(or affirm)that to the best of my knowledge and belief this political committee has not violated any provisions of the Act of June 3,1937(P.L.1333,NO.320)as amended. Sworn to and subscribed before me this f G A day of 0 Signature of Candidate Denise Gembusia signature Printed Name r n_ My Commission expires " oW G 717 554-3482 -. Area Code Daytime Telephone Number ARIAL�S§IAIJ TIMOTHY SOUTH MIDOLETON TWP.,CUMBERLAND COUNTY My Commission Expires Apr 27,2016 SCHEDULE Contributions and Receipts Detailed Summary Page Filer Identification Number Friends of Denise Gembusia 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 2.Contributions o 50.01 to $250.00 From Part A and Part B) Contributions Received from Political Committees(Part A) $ 250 All Other Contributions(Part B) $ 200 Total for the reporting period (2) $ 450 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ o All Other Contributions(Part D) $ 0 Total for the reporting period (3) $ 0 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) $ Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,Z 3 and 4;also enter this amount on Page 1,Report Cover Page,Item B) PART A Contributions Received From Political Committees $50.01 TO$250.00 Use this Part to itemize only contributions received from Political Committees With an aggregate value from$50.01 TO$250.00 in the reporting period. Filer Identification Number Friendsof Denise Gembusia Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee McNees,Wallace&Nurick,LLC 250 06/os/zols House# Street Address Date[MM/DD/YYYY] $ PO Box 1166 City State Zip Code Date[MM/DD/YYYY] $ Harrisburg PA 17108-1166 Full Name of Contributing Date[MM/DD/YYYY] $ Committee House f! Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House ft Street Address Date[MM/DD/YYYY) $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House p Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House ff Street Address Date[MM/DD/YYYY] $ city State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART B All Other Contributions $50.01 TO$250 Use this Part to itemize all other contributions with an aggregate value from $50.01 TO$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number: Friends of Denise Gembusia Full Name of Contributor Date]MM/DD/YYYY] $ Charles Courtney 06/09/2015 200 House# Street Address Date[MM/DD/YYYY] $ 324 Southview Drive City I State .Zip Code Date[MM/DD/YYYY] $ Mechanicsburg PA 17055 Full Name of Contributor Date[MM/DD/YYYY] $ L # Street Address Date(MM/DD/YYYY] $ State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date]MM/DD/YYYY] $. City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY]. $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ city State F Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ SCHEDULE III Statement of Expenditures Filer Identification Number: Friends of Denise Gembusia To Whom Paid Date[MM/DD/YYYY Denise Gembusia 06/16/20157178 House ri 1402 Bradley Drive,Apt.A211 Street Address Description of Expenditure City State Zip Carlisle RA Code 17013 Repayment of candidate's expenses from committee To Whom Paid Date[MM/DD/YYYY] 1 $ House ri Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House If Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House ft Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House N Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House A Street Address Description of Expenditure City state Zip Code To Whom Paid Date[MM/DD/YYYY]d $ House# Street Address Description of Expenditure City State Zip Code SCHEDULE IV Statement of Unpaid Debts Use this Section to itemize all unpaid debts and obligations which are outstanding at the end of the reporting period. Filer Identification Number: Name of Creditor Denise Gembusia Outstanding Balance of Debt House# Street Addres DATE DEBT INCURRED $ 1402 Bra y Drive,Apt A211 [MM/DD/YYYY] 06/09/2015 1 City State Zip 3C (A7 Carlisle PA Code 17013 Description of Debt ... post office box r t Name of Creditor IOutstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] city State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House It Street Address DATE DEBT INCURRED $ [MM/DD/YYYY] City State Zip Code Description of Debt y I o I colaoc5 1