Commonwealth of Pennsylvania
CAMPAIGN FINANCE REPORT
(COVER PAGE)
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My Commbsten Expires JuffieMgiffilrit fit State • Building DSEB-502 (7-93)
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Bureau of Commissions, Elections and Legislation Harrisburg, PA 17120-0029 • 17171 787-5280
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PAGE 1 OF
CAMPAIGN FINANCE REPORT (NOTE. Filer Identification Number
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Tammte L. Caruso, Notary Public City of Bsthtehem, Northampton County My Commission Expire* Juffldfel&iW of State * Bureau of Commissions, Elections and Legislation 210 North Office Building • Harrisburg. PA 17120-0029 • (717) 787-5280 DSEB-502 !7-9
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D. Total Expenditu es (From Schedule 11!)
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SCHEDULE I
PAGE 2 OF
7
CONTRIBUTIONS AND RECEIPTS Detailed Summary Page Name cm Filing Committee or £sndipiat
Reporting Period
To to '
1.
UNITEMIZED CONTRIBUTIONS AND RECEIPTS - $30.00 OR LESS PER CONTRIBUTOR TOTAL for the Reporting Period
2.
(1}
CONTRIBUTIONS $50.01 TO $250.00 (FROM PART A AND PART B)
Contributions Received from Political Committees (Part A)
$
All Other Contributions (Part B)
5
TOTAL for the Reporting Period
3.
$
(2)
CONTRIBUTIONS OVER $250.00 (FROM PART C AND PART 0}
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Contributions Received from Political Committees (Part C! All Other Contributions (Part D) TOTAL for the Reporting Period
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(3!
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OTHER RECEIPTS - REFUNDS, INTEREST EARNED, RETURNED CHECKS, ETC. (FROM PART E) TOTAL for the Reporting Period
TOTAL MONETARY CONTRIBUTIONS AND RECEIPTS DURING THIS REPORTING PERIOD (Add ana enter amount totals rram Soxes f , 2, 3 and <3; a/so enter fhi's amount or, Page ?, Report Cover page. Item B.)
D5EB-502 17-99!
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PART B
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All OTHER CONTRIBUTIONS $50.01 TO $250,00 Use this Part to itemize ali other contributions with an aggregate value from $50.01 to $250.00 In the reporting period. {Exclude contributions from political committees reported in Part A.) Narti = of Filing Committee or Candidate Lj* u.
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PAGE TOTAL
Enter Grand Total of Part B on Schedule 1, Detailed Summary Page, Section 2. DSES-5Q2 (7-99)
PAGE
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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. 'sporting
Name eft Filing Committee ,or Candidate
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Mailing Address|
Full 'Name of Contribuling Committe
Full Nome of Contributing Co
PAGE TOTAL Enter Grand Total of Part C on Schedule I, Detailed Summary Page, Section 3. DSEB-502 (7-99)
PART D
PAGE
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OF
ALL OTHER CONTRIBUTIONS OVER
$250.00
Use this Part to Itemize all other contributions with an aggregate value of over $250.00 in the reporting period. {Exclude contributions from political committees reported in Part C.)
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DAY
YEAR
WO.
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Empioyer Name
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State
Zip Code [Pius A)
DAY
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MO.
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MO.
DAY
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$
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Occupation
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MO.
DAY
YEAR
Mailing Address
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DAY
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City
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Enter Grand Total of DSEB-502 17-99)
Part D on Schedule 1
Detailed Summary Page, Section 3.
PAGE TOTAL
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. Name o^ Filing Committee or Candidat
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$
Full Nome
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Recent Description -u!l Name Meiling Address City
MO.
Stele "! '
DAY
YEAR "
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Receipt Description
Mailing Address City
WO-
DAY
' VEAfi' " Amount
$
Receipt Description PAGE TOTAL
Enter Grand Total of Part E on Schedule J Detailed Summary Page, Section 4. DSEB-502 (7-99)
_
PAGE
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OF
SCHEDULE III
STATEMENT OF EXPENDITURES Name (frf Filing Committee or Candidat
MO-
DAY YEAR: | Amount.
Description of Expen
State
Zip Code (Plus 4i
s«t«
Zip Cod, (Pius 41
Luimnv ue VEAR
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of
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Meiling Addre
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- DftY . ' YEAR. -1 Amount
gj i t I p? l^ Description nf Expsndit
TCr ft. Meiling Addre
Stele,
Zip Code IPius 41
MO,
DAY.......YEAH
MO.
DAY
1 Amount
Z i p Code ( P l u s A!
YEAR. ;|AmOLJnt
_JL MO.
- DAY
YEAR
I Amount
Ma ilijig .Ad
MO-
-DAY
YYt.
- \ R | Amount
oT|j__
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D,
DSEB-502 <7-93)
PAGE
<=
OF
SCHEDULE III
STATEMENT OF EXPENDITURES Name cjf Filing Committee or Cariaidate,
TSAR: [Amount ,
e>e Is
HCH o Whom Paid
MQ, •
DAY • YEAR' | Amount
WO.
_WQi
• DAY
J
. YEAR
|Amo
OAT
TEAR' ••|Arnou
MO.
DAY
YEAR1 •:
MO.
' DAY
"ib_
To Whom Paid
Y£.\R- -| Amount
PAGE TOTAL
Enter Grand Total of Expenditures on Page 1, Report Cover Page, Item D.
DSEB-502 (7-99)
PAGE SCHEDULE IV
STATEMENT OF UNPAID DEBTS Use this Section to itemize all unpaid debts and obligations which are outstandins at the end of the reporting period.
Enter Grand Total of Unpaid Debts on Page 1, Report Cover Page, itam G.
DSEB-502 <7-9
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