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Home My WebLink AboutFriends of Jim Hertzler - 2015 30-Day Post Election III�I III T Reset Form Print Form Commonwealth of Pennsylvania ai n Finance Report Y P B P (Note:This report must be clear and legible.It should be typed) Filer Identification Report Filed By Candidate ❑ Committee \ Lobbyist Number I (Mark X) n Name of Filing Committee,Candidate or Friends of Jim Hertzler Lobbyist Street Address P.O.Box 43 Cry Enola State I PA Zip Code 17025 Type of Report(Place x under report type) 1-6" Tuesday 2- 2n°Friday 3-30 Day Post 4-6'h Tuesday 5-2"4 Friday 6.30 Day Post 7-Annual Special 2" Friday Special 30 Day Pre-Primary Pre-Primary Primary Pre-Election Pre-Election Election Pre-Election Post-Election ❑ ❑ ❑ ❑ ❑ a ❑ ❑ ❑ Date Of Election Year Amendment Termination (MM/DD/YYYY) 11/03/2015 2015 Report ❑ Report ❑ Summary of Receipts and From Date To Date For Office Use Only Expenditures 10/20/2015 11/23/2015 A.Amount Brought Forward From Last Report $ 6,073.83 B.Total Monetary Contributions and Receipts $ C No (From Schedule 1) 800.53 EZ car C.Total Funds Available $ (Sum of Lines nes A and B) M o D.Total Expenditures $ a I (From Schedule 111) 4,900 E.Ending Cash Balance $ Q –0 (Subtract Line O from Line C) 1,974.36 n O F.Value of In-Kind Contributions Received C — (From Schedule II) C„1 G.Unpaid Debts and Obligations $ IG (From Schedule IV) Affidavit Section Z _m w Part 1-If this is a Committee report,treasurer sign here.If this Is a Candidate report,candidate sign here. w o 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. y z Sworn to and subscribed before me this h M ;2 day of 1.CLf'mUP/Y 20 l�� d O d q {ignature of Person ubmitting re-rt Z -A 'n CI i I` 10.1� hEW (=fGtViCl�a1�, OQe : Signature y� Printed�QNla/RmCe /� H Q m •, My Commission expires 05 Q/ �� 17 (� 0_oep qG w,Z`' '^ '•� MO. DAY YR. Area Code Daytime Telephone Number = E 'u _ o .1 Part 11-If this is a report of a Candidates Authorized Committee,candidate shall sign here. U u 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 Dias w amended. 2 i Sworn toiand subscribed�before //mee this day of.{�L,j(I20 Signature qf qandl a e L`fs� S nat r Printed Name 1 fAMMONWEAI OF pEfNiSYLVANA 17 g -g/ S 17 M L BETHANWBALZARUDBY YR. Area Code Daytime Telephone Number Notary Public CARLISLE BORO:A BERLAND CNTY My commission x . i SCHEDULE Contributions and Receipts Detailed Summary Page Filer Identification Number 1.Unitemized Contributions and Receipts-$50.00 or Less per Contributor Total for the reporting period (1) $ 50 2.Contributions o $50.01 to $250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ 0 All Other Contributions(Part R) $ 250 Total for the reporting period (2) $ 250 3.Contributions Over$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ 500 All Other Contributions(Part D) $ 0 Total for the reporting period (3) 500 4.Other Receipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) Total for the reporting period (4) $ 0.53 Total Monetary Contributions and Receipts during this reporting period(Add and $ enter amount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Page,Item B) 800.53 Y 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: Full Name of Contributor Date[MM/DD/YYYY] $ William Unger 10/22/2015 150 House N Street Address Date[MM/DD/YYYY] $ 1103 Sherwood Drive City IC arlisle PA 17013 State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ William Walters III 10/26/2015 100 HouseN et StreAddreTV, Date[MM/DD/YYYY] $ 645 sta Drive City State Zip Code Date[MM/DD/YYYY] $ Camp Hill PA 17011 Full Name of Contributor Date[MM/DD/YYYY] $ House q Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/Y" $ House# Street Address Date[MM/DD/YYYY] $ city State Zip Code Date[MM/DD/YYYY] $ Full Name of Contributor Date[MM/DD/YYYY] $ House p Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYVY] $ Full Name of Contributor - Date[MM/DD/YYYY] $ House b Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ r PART C Contributions Received From Political Committees Over$250.00 Use this Part to itemize only contributions received from Political Committees with an aggregate value over$250.00 in the reporting period. Filer Identification Number: Full Name of Date[MM/DD/YYYY] $ Contributing Committee Rhoads&Sinon LLP 10/22/2015 500 House# Street Address Date[MM/DD/YYYY] $ �PO Box 1146 city State Zip Code Date[MM/DD/YYYY] $ Harrisburg PA 17108 Full Name of Date[MM/DD/YYYY] $ Contributing Committee House Street Address Date[MM/DD/YYYY] - $ LILI State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# StreetAddress Date[MM/DD/YYYY] $ City I State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee ,use# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] $ Contributing Committee jHoue# Street Address Date[MM/DD/YYYY] $ State Zip Code Date[MM/DD/YYYY] $ r PART E Other Receipts REFUNDS,INTREST INCOME, RETURNED CHECKS,ETC. Use this Part to report refunds received,interest earned,returned checks and prior expenditures that were returned to the filer. Filer Identification Number: Full Name Americhoice Federal Credit Union House# 2175 Street Address Bumble Bee Hollow Road CityState Zip Date[MM/DD/YYYY] $ Mechanicsburg PA Code 17055 10/31/2015 0.53 Receipt Description Dividend Full Name House# Street Address City State Zip Date[MM/DD/YVYY] 1 $ Code Receipt Description Full Name House# Street Address City State Zip Date[MM/O!n $ Code Receipt Description Full Name House# Street Address city State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address city State Zip Date[MM/DD/YYYY] $ Code Receipt Description Full Name House# Street Address city State Zip Date[MM/DD/YYYY] $ Code Receipt Description • SCHEDULE 111 Statement of Expenditures Filer Identification Number: To Whom Paid Date[MM/DD/YYYY] $ Citizens for Hertzler and Rovegno 4,400 11/11/2015 House# Street Address PO Boz 8 Description of Expenditure - City Enola State PA Z Ae 17025 nation To Whom Paid Date[MM/DD/YYYY] $ Citizens for Hertzler and Rovegno - - 500 11/12/2015 House# treet Address Description of Expenditure PO Baz 8 City State Zip Enola PA Code 17025 Donation To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of Expenditure City State Zip Code To Whom Paid I Date[MM/DD/YYYY] 1 $ House# Street Description of Expenditure Address City State Zip Code To Whom Paid Date[MM/DD/YYYY]77 House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date(MM/DD House# Street Address Description of Expenditure City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House# Street Address I Description of Expenditure I City State Zip Code To Whom Paid Date[MM/DD/YYYY] $ House#1 Street Address Description of Expenditure City - State Zip Code