Campaign Finance Report (NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.)

Transcription

1 PAGE 1 Commonwealth of Pennsylvania Campaign Finance Report (NOTE: This report must be clear and legible. It may be typed or printed in blue or black ink.) Filer Identification Number : Report Filed By : CANDI COMMITTEE LOBBYIST Name of Filing Committee, Candidate or Lobbyist: PAC 205 Street Address: PO BOX 1066 City: SCRANTON State: PA Zip Code: TYPE OF REPORT 6TH TUES PRE-PRIMARY 1. 2ND FRI PRE-PRIMARY POST-PRIMARY 3. AMENDMENT REPORT? Yes No (place X to the right of report type) 6TH TUES PRE-ELECTION 4. 2ND FRI PRE-ELECTION 5.X 30 POST-ELECTION ANNUAL REPORT 7. Year 2003 FILING METHOD ( ) CHECK ONE 6. TERMINATION REPORT? PAPER Yes No DISKETTE Name of Office Sought by Candidate: OF ELECTION District Number Office Code Party Code County Code (SEE INSTRUCTIONS FOR CODES) Summary of Receipts and Expenditures from: TO FOR OFFICE USE ONLY A. Amount Brought Forward From Last Report B. Total Monetary Contributions And Receipts (From Schedule I) C. Total Funds Available (Sum Of Lines A and B) D. Total Expenditures (From Schedule III) E. Ending Cash Balance (Subtract Line D From Line C) F. Value Of In-Kind Contributions Received (From Schedule II) G. Unpaid Debts And Obligations (From Schedule IV) AFFIDAVIT SECTION PART I - 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 filed on paper or by electronic medium, are to the best of my knowledge and belief, true, correct and complete. Sworn to and subscribed before me this day of 20 Signature of Person Submitting Report My Commission Expires Signature Printed Name YR Area Code Daytime Telephone Number 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 day of 20 Signature of Candidate Printed Name My Commission Expires Signature YR Area Code Daytime Telephone Number

2 PAGE 2 SCHEDULE I S AND RECEIPTS Detailed Summary Page PAC /20/ Unitemized Contributions Received - 5 or Less Per Contributor TOTAL for the (1) 2. Contributions Received To 25 (From Part A and Part B) Contributions Received From Political Committees (Part A) All Other Contributions (Part B) TOTAL for the (2) 3. Contributions Received Over 25 (From Part C and Part D) Contributions Received From Political Committees (Part C) All Other Contributions (Part D) TOTAL for the (3) 4. Other Receipts, Refunds, Interest Earned, Returned Checks, Etc. (From Part E) TOTAL for the (4) Total Monetary Contributions and Receipts During this (Add and enter amount totals from Boxes 1,2,3 and 4; also enter this amount on Page1, Report Cover Page, Item B.)

3 PAGE 3 PART A S RECEIVED FROM POLITICAL COMMITTEES TO 25 Use this Part to itemize only contributions received from political committees with an aggregate value from to 25 in the reporting period. AUNT Full Name of Contributing Committee Enter Grand Total of Part A on Schedule I, Detailed Summary Page, Section 2.

4 PAGE 4 PART B ALL OTHER S TO 25 Use this Part to itemize all other contributions with an aggregate value from to 25 in the reporting period. (Exclude contributions from political committees reported in Part A) AUNT Full Name of Contributor Enter Grand Total of Part A on Schedule I, Detailed Summary Page, Section 2.

5 PAGE 5 PART C Contributions Received From Political Committees OVER 25 Use this Part to itemize only contributions received from Political committees with an aggregate value from Over 25 in the reporting period. AUNT Full Name of Contributing Committee Enter Grand Total of Part C on Schedule I, Detailed Summary Page, Section 3.

6 PAGE 6 PART D ALL OTHER S OVER 25 Use this Part to itemize all other contributions with an aggregate value of over 25 in the reporting period. (Exclude contributions from political committees reported in Part C.) AUNT Full Name of Contributor Mailing Address Employer Name Occupation Employer /Principal Place of Business City State Zip Code (Plus 4) Enter Grand Total of Part C on Schedule I, Detailed Summary Page, Section 3.

7 PAGE 7 PART E OTHER RECEIPTS REFUNDS, INTEREST INCOME, RETURNED CHECKS, ETC. Use this Part to report refunds received, interest earned, returned checks and prior expenditures that were returned to the filer. AUNT Full Name Receipt Description Enter Grand Total of Part E on Schedule I, Detailed Summary Page, Section 4.

8 PAGE 8 SCHEDULE II IN-KIND S AND VALUABLE THINGS RECEIVED USE THIS SCHEDULE TO REPORT ALL IN-KIND S OF VALUABLE THINGS DURING THE REPORTING PERIOD. Detailed Summary Page PAC /20/ UNITEMIZED IN-KIND S RECEIVED - VALUE OF 5 OR LESS PER CONTRIBUTOR TOTAL for the (1) 2. IN-KIND S RECEIVED - VALUE OF TO 25 (FROM PART F) TOTAL for the (2) 3. IN-KIND RECIEVED - VALUE OVER 25 (FROM PART G) TOTAL for the (3) TOTAL VALUE OF IN-KIND S DURING THIS REPORTING PERIOD (Add and enter amount totals from Boxes 1,2, and 3; also enter on Page 1, Reports Cover Page, Item F.)

9 PAGE 9 SCHEDULE II PART F IN-KIND S RECEIVED VALUE OF TO 25 AUNT Full Name of Contributor Description of Contribution: Enter Grand Total of Part F on Schedule II, In-Kind Contributions Detailed Summary Page, Section 2.

10 PAGE 10 SCHEDULE II PART G IN-KIND S RECEIVED VALUE OVER 25 AUNT Full Name of Contributor City State Zip Code(Plus 4) Employer of Contributor Occupation Employer /Principal Place of Business City State Zip Code(Plus 4) Description of Contribution Enter Grand Total of Part G on Schedule II, In-Kind Contributions Detailed Summary Page, Section 3.

11 PAGE 11 SCHEDULE III STATEMENT OF EXPENDITURES PAC 205 From 10/20/2003 AUNT COMMITTEE TO ELECT CARL ZAWATSKI C/O STEEL/CON INC. 401 LAUREL ST HUGHESTOWN PA GOLF TOUR. HOLE SPONSOR 30 PIG ROAST BOB CASEY FOR STATE TREASURER C/O PAT CASEY 321 SPRUCE ST SCRANTON PA MAX BAER FOR SUPREME COURT ALLEGHANY COUNTY COURTHOUSE PITTSBURGH PA COMMITTEE TO RETAIN JUDGE CONAHAN 1089 WYOMING AVE FORTY FORT PA FRIENDS OF SKREPENAK & VONDERMEID C/O LEZA GEIB 309 WYOMING AVE W. PITTSTON PA 18643

12 PAGE 12 COMMITTEE TO ELECT MICHAEL TOOLE-JUDGE 63 W. RIVER ST WILKES-BARRE PA LIBERMAN FOR PRESIDENT C/O BALLARD, SPAHR ET AL 1735 MARKET ST., 51ST FL PHILADELPHIA PA CASEY FOR STATE TREASURER C/O PAT CASEY 321 SPRUCE ST SCRANTON PA Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D. 660

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