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HomeMy WebLinkAboutBosha for State Senate - 2016 Annual Report 31 Reset Form I 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 QI( QZ l :( MarkX) Name of Filing Committee,Candidate or. ��, Lobbyist 65h -C: Street Address .156 6-11-1. ((' C ,City State Code Type of Report(Place x under report type) 1-6th Tuesday 2- 2nd.Friday, 3-30 Day Post 4-60 Tuesday 5-2o4 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 Date Of.Election Year .Amendment. Termination (MM/DD/YYYY) „ / .g. v I co Report Report Summary of Receipts and From Date To Date For Office Use Only Expenditures ( 9 (( 127/3i. IL, A.Amount.Brought Forward.Fro Last R port $ / B.Total Monetary Contributions and Receipts $ (From Schedule I) 0 . . C.Total Funds Available $ � �• ,,fig (Sum of Lines A and B) 2�2, •n 2 co,p • ••1+ ,/ivy D.Total Expenditures . $ iIft'tt �,,, .- oil (From Schedule ill) 2 -Z?.1 2- X11-13 1213 • +'' 0 E.Ending Cash Balance $ tin © O� (Subtract Line D.from Line C) 0 C~'t7 «w» F.Value of In-Kind Contributions Received $ C?itn "V (From Schedule 1I) G.Unpaid Debts and Obligations $ fil (From Schedule)V) . .Cie 3'--'m t,►7• Affidavit Section Part 1-If this is a Committee report,treasurer sign here.If this is a Candidate report,candidate sign here. I swear(or affirm)that this report,including the attached schedules on paper,is to the best of my knowled and b-li= ue,correct and complete. Sworn to and subscribed before me this / ( _k.11 V day of Nr,k.1.\ _ 20 1� �' i % Signat e o ers ubm g report e Q a Signature Printed N My Commission expires `1\vQ\\% 15) —6 t�MO. DAY YR. Q._1_9 CDaytime Telephone Number Part Il-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 day of 20 Signature of Candidate Signature Printed Name My Commission expires MO. DAY YR. Area Code Daytime Telephone Number COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL Rae Rider,Notary Public Middletown Boro,Dauphin County My Commission Expires Dec.2,2018 MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES • • • • SCHEDULE I Contributions and Receipts Detailed Summary Page Filer Identification Number ' Z G S c=6 7 1L., ^ rc:s n ' 11.Unitemized Contributions and Receipts-$50.00 or Less per Contributor' ' Total for the reporting period (1) $ 2.Contributions of$50.01 to$250.00(From Part A and Part B) Contributions Received from Political Committees(Part A) $ All Other Contributions(Part B) $ Total for the reporting period (2) $ 13.Contributions Over.$250.00(From Part C and Part D) Contributions Received from Political Committees(Part C) $ All OtherContributions(Part D) $ 4 a =:fir. Total for the reporting period (3) $ 4.OtherrReceipts-Refunds,Interest Earned,Returned Checks,ETC.(From Part E) C-.. ',- - ; Total for the reporting period (4) $ c:Total Monet Contributions and Receipts during this reporting period(Add and $ enter oii'nount totals from Boxes 1,2,3 and 4;also enter this amount on Page 1,Report Cover Plage ,Item B) r f- 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 I 2a( L62`t(, --- &lc() I Amount Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address Date[MM/DO/MY] $.: 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] $: Full Name of Contributing Date[MM/DD/YYYY] $ Committee House# Street Address`• Date.[MM/DD/YYYY] $ City State Tip 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]' $ Full Name of Contributing - Date[MM/DD/YYYY] : $ Committee House# Street Address Date[MM/DD/YYYY] $ City I 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$250 in the reporting period. (Exclude contributions from political committees reported in Part A.) Filer Identification Number; 2Cif CG,O7_9 - ane Full Name of Contributor Date[MM/DD/YYYY] -$ House# Street Address Date[MM/DD/YYYY] $ City State 4pCode•.. Date[MM/DD/YYYY] :.$ Full Name of Contributor Date MM DD. 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 Tip Code ,: Date[MM/DD/YYYY] $ Full Name of Contributor' Date'[MM/DD/YYYY] - "$ House# Street Address 'Date jMM/DD/YYYYJ' aty State: Zip•Code Date[MM/DD/YYYY] -$ • Full Name of Contributor Date[MM/DD/YYYY] $ Nouse# Street Address 'Date"[MNI/DD/YYYY] $ City State "Zip Code.: Date JMM/DD%YYYY]. $ • Full Name of.Contributor- Date[MM/DD/YYYYJ $ House# Street Address Date[MM/DD/YYYY] $ City State. Zip:Code •- Date[MM/DD/YYYY] $ • 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. I Filer Identification Number: " 26 ► (.i:›o ?.`1cc) --- (Nc.)02 ) Full Name of Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date M,DD City State Zip Code Date jMM/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 jMM/DD/YYYY]. $ Contributing Committee House# 'Street Address Date LMMJDD/YYYY] $ City State lip Code Date jMM/DD/YYYY] $ Full Name of Date[MM/DD/YYYY] " '$ Contributing Committee House# Street Address Date IMM/DD/MY] ' City State Zip Code " Date jMM/DD/YYYY] $ Full.Name of ( Date[MM/DD/YYYY] $ Contributing Committee House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date jMM/DD/YYYY] $ Full Name of ' Date tMM/DD/YYYY]' $ Contributing Committee House# ; Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ PART D All Other Contributions Over$250.00 Use this Part to itemize all other contributions with an aggregate value over$250.00 in the reporting period. (Exclude contributions from political committees reported in Part C) Filer Identification Number. I Z a 4 CO O 2 - kia0e Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date.[MM/DD/YYYY] $ Gty State Zip Code: Date[MM/DD/YYYY] $ Employer Name Occupation Employer.Mailing Address/Principal Place of Business , Full.Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY]. $ City State .ZipCode :Date[MM/DD/YYYY] $ Employer Name Occupation. Employer Mailing Address/ Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ Gty State TLp;Code ' : Date[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/ ' Principal Place of Business Full Name of Contributor Date[MM/DD/YYYY] . $ House# Street Address Date[MM/DD/YYYY]. $ City 'State'' Zip Code.. Date[MM/DD/YYYY]' $ Employer Name Occupation Employer Mailing Address/ Principal Place of Business 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. I Filer identification Number. I ZCI (o6 Z_ cl� I i ne_ Full Name House# Street Address City - State p+. Date IMM/DD/YYYY] $ Code Receipt Description - Full Name House# Street Address City-. State Tip Date[MM/DD/YYYY] $ • Code .' Receipt Description Full Name ' House# Street Address City State" bp' Date[MM/DD/YYr'' $ Code Receipt Description Full Name House# Street Address City State Trp: Date[MM/DD/YYYY]. $ :Code Receipt Description Full Name House#1 Street Address City. State 'Tip Date.[MM/DD/YYYY] $ Code Receipt Description - - Full Name House# Street Address City :State Tip Date[MM/DD/YYYY] ` .$ Code - Receipt Description SCHEDULE II IN-KIND CONTRIBUTIONS AND VALUABLE THINGS RECIEVED USE THIS SCHEDULE TO REPORT ALL IN-KIND CONTRIBUTIONS OF VALUABLE THINGS DURING THE REPORTING PERIOD DETAILED SUMMARY PAGE Filer Identification Number. 2 0 J Co ? rc n q I 1. .UNITEMIZEU IN-KIND CONTRIBUTIONS RECEIVED-VALUE OF,$50 00 OR LESS PER CONTRIBUTOR _ . TOTAL for the reporting period (1) $ . 2. 1N-KIND:CONTRIBUTIONS RECEIVED-VALUE{3F$50:01 TO$250.00(FROM"PART Fj TOTAL for the reporting period (2) $ 3. 1N-.KIND CONTRIBUTION'RECEIVED-VALUE OVER$250:00(FROM PARTE) TOTAL for the reporting period (3) $ TOTAL VALUE OF IN-KIND CONTRIBUTIONS DURING THIS REPORTING $ PERIOD(Add and enter amount totals from boxes 1,2,and 3;also enter on Page 1,Report Cover Page,Item F) SCHEDULE II PART F In-Kind Contributions Received VALUE OF$50.01 TO$250 Filer Identification Number: 2,Q ( ce) o Z_9 --kid() -e__ Full Name of Contributor Date[MM/DDJYYYY] ,$ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYYJ $ Description of Contribution Full Name of Contributor Date[MM/DD/YYYY] $ House#1 Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY] $ Description of Contribution FUJI Name of Contributor Date IMM/DD/YYYY) $ House# Street Address Date IMM/DD/YYYY] $ City I State I Zip Code .Date IMM/DD/YYYY] $ ; Description of Contribution Full Name of Contributor , Date[MM/DD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date jMM/DD/YYYY] $ Description of Contribution SCHEDULE II Part G In-Kind Contributions Received VALUE OVER$250 Filer Identification Number: Full Name of Contributor Date[MM/DD/YYYY] House# Street Address Date[MM/DD/YYYY] $: City State Ziip.Code Date[MM/DD/YYYY] • $ Employer Name Occupation Employer Mailing Address/ Description Place of Business of Contribution Full'Name of Contributor Date I MM DD /, JYYYYj $ House# Street Address Date[MM/DD/YYYY] . $ City State : ZIp Code Date;[MM/DD/YYYY]• Employer Name • Occupation Employer Mailing Address/Principal. -Description Place of Business Contribution Full Name of Contributor Date[MMIDD/YYYY] $ House# Street Address Date[MM/DD/YYYY] $ City State Zip Code Date[MM/DD/YYYY]` $ Employer Name Occupation; Employer Mailing Address/Principal. _Description Place of Business. • cf,.. Contribution., Full Name of Contributor Date[MM/DD/YYYY] $'- House# Street Address Date[MM/DD/YYYY] .,$ City State, Ziip.Code Date.[MM/DD/YYYY] $ Employer Name Occupation Employer Mailing Address/Principal Description Place of Business of Contribution SCHEDULE III Statement of Expenditures filer Identscation;Number. Za ( c,....6Z `f S. I To Whom Paid ��� 7( ���� 17at2MM/DD/YYYY] $ (� )66 . House# L 2 Street Address/5��� ^ £c /� Descn iw f !� I j 3�— p Expenditure" Gty, /� State Q/tel Th,Code I 1 hyo To Whom Paid� _ Za � 66,s D(�MM/DD Yly� ,,$ � /, House# � a L� I 132�Z I l Street Address 4�f 0rc1� Descripti n of end'rture•... �{-� 1_ L J ` ret S-v 6Vcnn) City • sate (24.,„ TSP ��4f� Code ( 7 () L . To Whom Paid Date[MM/DD/YYYY] $ House# Street Address Description of p Expenditure City " State. Tp . . Code 'To Whom Paid, Date[MM/DD/YYYY] S. House# Street Address ;Description of Expenditure ` • City • State Tip, Code To Whom Paid: Date[MM/DD.JYYYY]. '$ House# Street Address `Description of Expenditure : ; City State Zip Code To Whom Paid , pate[MM/DD/YYYY],.. $ House# 'Street Address Description of Expenditure ' city_i State Zip Code . To Whom Paid Date[MM/DD/YYYY]. $ House# Street Address Description of - p' Expendrture City State 'Tip Code To Whom Paid Date[MMJDD/YYYY] $ House# Street Address Descr1-tion of ' p" Expenditure - City , State . Tip 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. I Filer Identification cation Number: ' f Z-(J 1 (.,6 7.C1 k)d(1� 1 Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED • $ jMM/DD/YYYYJ City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# 'Street Address DATE DEBT INCURRED $ jMM/DD/YYYYI City I State Zip Code Description of Debt - Name of Creditor Outstanding Balance of Debt House# Street Address . DATE DEBT INCURRED $ [MMJDDJYYYY] City State Zip Code Description of Debt Name of Creditor Outstanding Balance of Debt House# Street Address DATE DEBT INCURRED $ {MM/DDJYYYY] City . State Tip. - 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. Tip Code _ Description of Debt