CampaignFinanceReport Public 38e54101 1c43 42cc 98a9 E701983e14fe

Maryland State Board of Elections
Name of Entity : Gardner, Jan for Frederick County Entity Number : 01009393
Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017
Campaign Finance Report Summary Sheet
Part 1
Transaction Period This Report covers transactions beginning 01/14/2016 and ending 01/11/2017 .
Date Date
Final Report (Check if you intend to close the account. This cannot be a final report if a cash balance or outstanding obligation remains)
Amendment # (Date amendment is being filed .)
Part 2
Bank Account Name Bank Account Number Bank Account Balance*

*As of the report transaction ending date. $20,075.29
Total
Part 3
Receipts Expenditures
Contributions Schd 1, Col A $10,860.00 Salaries & Other Compensation Schd 2, Col N $0.00
Ticket Purchases Schd 1, Col B $0.00 Rent & Other Office Expenses Schd 2, Col O $0.00
Federal Committees Schd 1, Col C $0.00 Field Expenses Schd 2, Col P $0.00
Political Clubs Schd 1, Col D $0.00 Media Schd 2, Col Q $0.00
MD Candidate and Slate Accounts Schd 1A, Col $100.00 Printing & Campaign Materials Schd 2, Col R $0.00
E
Direct Mailing by Mail House Schd 2, Col S $0.00
MD Party Central Committees Schd 1A, Col F $0.00
Postage Schd 2, Col T $0.00
MD Political Action Committees Schd 1A, Col G $250.00
Purchase of Equipment Schd 2, Col U $0.00
Non-Federal Out-of-State Committees Schd 1A, $0.00
Fundraising Expenses Schd 2, Col V $0.00
Col H
Other Schd 1B, Col I $0.91 Transfers Out Schd 2, Col W $0.00
Loans Schd 3, Col K $0.00 Loan Repayment Schd 2, Col X $0.00
Other Schd 2, Col Y $121.85
Enter Total in Part 4 (Total Receipts)
Returned Contribution Schd 2, Col Z $0.00
Enter Total in Part 4 (Total Expenditures)
Current Amended Deleted

Failure to provide all the information required by this form will be regarded as a FAILURE TO FILE.
Page 1 of 16
Part 4 Part 5
Prior Balance $8,986.23 Report calculated cash Value of In-Kind Contributions Schd 1B, Col J $1,886.13
balance from Part 4 of your
prior report.
Value of In-Kind Expenditures Schd 2, Col AA $0.00
+ Part 6
Total Receipts $11,210.91 Total of Part 3 Receipts
Outstanding Loan Balance Schd 3, Col L $0.00
- Outstanding Bills Due Schd 3, Col M $0.00
Total Expenditures $121.85 Total of Part 3 Total Outstanding Obligations $0.00

Expenditures
Cash Balance $20,075.29 This is your report

calculated cash balance.
Carry forward this balance
to your next report.
Part 7
Under penalty of perjury, we declare that we have examined this report, including the accompanying schedules, and to the best of our
knowledge and belief they are complete and accurate.
WORLEY, SHARLA (Date) 01/18/2017 Warning

Signature of Treasurer
Failure to provide all information required by
GARDNER, JAN HRINYA (Date) 01/18/2017 this form will be regarded as a failure to file.
Signature of Chairman

Page 2 of 16
SCHEDULE - 1
Contributions
A - Contributions other than ticket purchases from Individuals, Corporations, etc.
(see schedules 1A and 1B for other types of Income)
Received From
Date Name and Address of Contributor ADMIN Aggregate to Paid by Contributions
Received 9 Date Amount
01/09/2017 Agar-Hendrix, Linda C $50.00 Electronic Fund $50.00
2723 Loch Haven Drive, Ijamsville, MD Transfer
21754
11/14/2016 Andrex, Ann $50.00 Check $50.00

9131 Liberty Village Way, Union
Bridge, MD 21791
11/14/2016 Berman, J I $200.00 Check $50.00

8405 Legg Road, Frederick, MD 21704
01/10/2017 Berman, J I $350.00 Check $150.00

8405 Legg Road, Frederick, MD 21704
11/14/2016 Beutler, John $100.00 Cash $100.00

9131 Liberty Village Way, Union
Bridge, MD 21791
10/21/2016 Bickel, Karl W $50.00 Electronic Fund $50.00

11830 Browningsville Rd, Monrovia, Transfer
MD 21770
01/08/2017 Bickel, Karl W $150.00 Electronic Fund $100.00

11830 Browningsville Rd, Monrovia, Transfer
MD 21770
11/14/2016 Boffman, Daryl A $350.00 Check $100.00

5403 Lott Street, Adamstown, MD
21710
10/31/2016 Breiling, Annette $125.00 Electronic Fund $50.00

3300 Lowell Lane, Ijamsville, MD Transfer
21754
11/14/2016 Bunitsky, Michael G $100.00 Check $100.00

134 W Church Street, Frederick, MD
21701

Page 3 of 16
11/15/2016 Burrell, Edward $50.00 Electronic Fund $50.00

1702 Fletchers Drive, Point of Rocks, Transfer
MD 21777
01/09/2017 Burrell, Edward $100.00 Electronic Fund $50.00

1702 Fletchers Drive, Point of Rocks, Transfer
MD 21777
11/14/2016 Burruss, Ellis $50.00 Check $50.00

310 Souder Road, Brunswick, MD
21716
11/12/2016 Colby, Gail $225.00 Electronic Fund $100.00

411 Cranberry Ct, Frederick, MD 21703 Transfer
03/09/2016 Comcast $500.00 Check $500.00

49 S Market Street, Frederick, MD
21701
11/14/2016 Comprehensive Neurology Services $250.00 Check $250.00
P O Box 1806, Frederick, MD 21702
11/09/2016 Concept C Marketing & Design LLC $100.00 Check $100.00
1910 Chamberlane Drive, Frederick,
MD 21702
10/24/2016 Conklyn, Elizabeth $50.00 Electronic Fund $50.00
38 S Bentz Street, Frederick, MD Transfer
21701
11/14/2016 Crosby, Harriet $250.00 Check $250.00

6515 79th Place, Cabin John, MD
20818
Foxhaven Farms Agriculture
10/24/2016 Dale, Valerie $425.00 Check $300.00
6901 Wimbledon Ct, New Market, MD
21764
Volunteer Other
11/14/2016 Daniels, John L $250.00 Check $250.00
335 E 3rd Street, Frederick, MD 21701
11/14/2016 Dearmon, Donald MCC $225.00 Check $100.00

108 W. College Ter, Frederick, MD
21701
11/06/2016 Dirks, Melissa $50.00 Electronic Fund $50.00

340 S Cleveland Ave, Hagerstown, MD Transfer
21740

Page 4 of 16
11/14/2016 Doggett, Sandra L $100.00 Check $100.00

3752 Bittle Rd, Myersville, MD 21773
11/14/2016 Dolan, Darlene $40.00 Check $40.00

301 Upper College Terrace, Frederick,
MD 21701
11/14/2016 Fair, Kristopher $50.00 Check $50.00

435 Delaware Road, Frederick, MD
21701
11/14/2016 Fink, Diane $50.00 Check $50.00

11025 Graymarsh Place, Ijamsville, MD
21754
11/03/2016 Follmer, James $100.00 Electronic Fund $100.00

21 W 3rd Street, Frederick, MD 21701 Transfer
11/14/2016 Forrence, Catherine $50.00 Cash $50.00

8857 Briarcliff Lane, Frederick, MD
21701
10/24/2016 French Jr, Dana P $125.00 Electronic Fund $50.00

105 College Avenue, Frederick, MD Transfer
21701
11/03/2016 Gallagher, Patrice $50.00 Electronic Fund $50.00

115 E 5th Street, Frederick, MD 21701 Transfer
10/23/2016 GARDNER, JAN HRINYA $499.05 Electronic Fund $50.00

6102 Fieldcrest Drive, Frederick, MD Transfer
21701
01/10/2017 GARDNER, JAN HRINYA $1,029.64 Electronic Fund $100.00
21701
01/09/2017 Gardner, Mallory M $150.00 Electronic Fund $150.00
21701
01/08/2017 Gardner, Rachel $150.00 Electronic Fund $150.00

21701

Page 5 of 16
11/14/2016 George, Harry $50.00 Cash $50.00

301 Upper College Terrace, Frederick,
MD 21701
11/14/2016 Gill, Thomas S $100.00 Check $100.00

2511 Waterside Drive, Frederick, MD
21701
11/14/2016 Glen Ellen Farm $50.00 Check $50.00

4940 Mussetter Road, Ijamsville, MD
21754
11/14/2016 Groth Ttee, Kathryn B $200.00 Check $200.00
7509 Oakmont Drive, Frederick, MD
21702
11/14/2016 Hagen, Kai John $125.00 Check $50.00

13150 Mink Farm Road, Thurmont, MD
21788
11/14/2016 Hamda Realty, LLC $250.00 Check $250.00

700 Monteclaire Avenue, Frederick,
MD 21701
11/14/2016 Hattery, Tom $50.00 Cash $50.00
7101 Woodville Road, Mt Airy, MD
21771
11/14/2016 Himes, Rick $50.00 Cash $50.00

2 Tobias Run Court, Middletown, MD
21769
11/14/2016 Hogan, Kevin $100.00 Cash $100.00

120 W 3rd Street, Frederick, MD 21701
10/21/2016 Jafari, Mark $50.00 Electronic Fund $50.00

4106 Celtic Way, Frederick, MD 21704 Transfer
01/09/2017 Judd, Mary $100.00 Electronic Fund $100.00

8955 Indian Springs Rd, Frederick, MD Transfer
21702
11/14/2016 Kaslick, Mary Elizabeth $150.00 Check $150.00

9239 Ridgefield Circle, Frederick, MD
21701

Page 6 of 16
11/11/2016 Kearney, Michael B $50.00 Electronic Fund $50.00

3926 Skyview Drive, Mt. Airy, MD Transfer
21771
11/14/2016 Kearney, Michael B $100.00 Check $50.00

3926 Skyview Drive, Mt. Airy, MD
21771
01/09/2017 Klosky, Tim $50.00 Electronic Fund $50.00

6123 Cornwall Terrace, Frederick, MD Transfer
21701
11/14/2016 Kresslein, Robert J $250.00 Check $250.00

1721 Dahlgren Rd, Middletown, MD
21769
11/14/2016 Kuzemchak, Donna $50.00 Check $50.00

111 Holling Drive, Apt 204, Frederick,
MD 21701
11/14/2016 Ladner, Robert C $100.00 Cash $100.00

3827 Green Valley Road, Ijamsville,
MD 21754
12/08/2016 Lanier, Ivan $500.00 Electronic Fund $500.00

247 Concerto Avenue, Centreville, MD Transfer
21617
Greenwill Consulting Other
11/14/2016 Lawrence, Mark $50.00 Cash $50.00
139 W All Saints Street, Frederick, MD
21701
11/14/2016 Laxton, Dan $50.00 Cash $50.00

8745 Treasure Avenue, Walkersville,
MD 21793
11/15/2016 Linton, Donald C $200.00 Check $200.00

2631 Mill Race Road, Frederick, MD
21701
LSWG Service Industry
11/13/2016 Long, Mark $50.00 Electronic Fund $50.00
800 Frailey Road, Emmitsburg, MD Transfer
21727

Page 7 of 16
11/14/2016 McDermott, Ann $50.00 Check $50.00

603 Fairview Avenue, Frederick, MD
21701
11/14/2016 McDonald, Shirley $20.00 Check $20.00

3677 Ridgeview Road, Ijamsville, MD
21754
11/14/2016 Mordan, Dorothea $100.00 Check $100.00

305 N Main Street, Woodsboro, MD
21798
11/14/2016 Nash, Meta S $100.00 Check $100.00

300 Rockwell Terrace, Frederick, MD
21701
11/14/2016 Nielsen, Jan A $175.00 Check $50.00

6123 Cornwall Terrace, Frederick, MD
21701
11/01/2016 Nusbaum, Margaret L $300.00 Check $300.00

802 Shawnee Drive, Frederick, MD
21701
11/14/2016 Orr, Elizabeth $100.00 Check $100.00

305 E Main Street, Burkittsville, MD
21718
11/14/2016 Poteat, Blanca $100.00 Check $100.00

1340 Sugarloaf Mountain Rd,
Dickerson, MD 20842
11/18/2016 Racheff, James R $1,300.00 Electronic Fund $500.00

414 W Patrick Street, Frederick, MD Transfer
21701
DMS, Inc Science and Technology
11/14/2016 Raff, Dorothy $100.00 Check $100.00
5808 Hollys Way, New Market, MD
21774
01/10/2017 Raff, Dorothy $150.00 Electronic Fund $50.00

5808 Hollys Way, New Market, MD Transfer
21774
11/14/2016 Reynolds, Deborah $50.00 Check $50.00

110 Fairview Ave, Frederick, MD 21701

Page 8 of 16
01/05/2017 Richardson, Nancy $750.00 Check $500.00

6530 Olney Laytonsville Rd,
Gaithersburg, MD 20882
Bar T Ranch Other
11/13/2016 Richmond, Mary Jo $50.00 Electronic Fund $50.00
3868 Maryland Manor Drive, Monrovia, Transfer
MD 21770
11/14/2016 Rossen, Kathy L $50.00 Check $50.00

227 E 5th Street, Frederick, MD 21701
11/14/2016 Rudy, George $50.00 Check $50.00

7 E Frederick Street, Walkersville, MD
21793
11/13/2016 Schaefer, Mary $50.00 Electronic Fund $50.00

9056 Brookhaven Court, Frederick, MD Transfer
21701
10/22/2016 Shopland, Jamie $250.00 Electronic Fund $250.00

3637 Islington Street, Frederick, MD Transfer
21704
10/22/2016 Slater, Thomas G $175.00 Check $50.00

129 W Patrick Street, Ste 9, Frederick,
MD 21701
11/04/2016 Sovereign Enterprise, LLC $500.00 Check $500.00

1 Baglyos Circle, Bethlehem, PA 18020
11/14/2016 Sowell, Michael $50.00 Check $50.00
5603 Kara Circle, Frederick, MD 21703
11/14/2016 Spencer, Barbara $100.00 Check $100.00

2104 Garfield Court, Frederick, MD
21702
11/14/2016 Spiegel, Janice P $50.00 Check $50.00

4342 Deer Spring Rd, Middletown, MD
21769
11/12/2016 Strnad, M V $150.00 Electronic Fund $100.00

3883 Gibbons Road, Point of Rocks, Transfer
MD 21777

Page 9 of 16
11/14/2016 Tome, Karin $50.00 Check $50.00

206 4th Avenue, Brunswick, MD 21716
01/08/2017 Tome, Karin $150.00 Electronic Fund $100.00

206 4th Avenue, Brunswick, MD 21716 Transfer
11/14/2016 Warfield, Jeanne M $50.00 Cash $50.00

20 E 9th Street, Frederick, MD 21701
10/31/2016 White, Robert $100.00 Electronic Fund $100.00

4837 Reels Mill Road, Frederick, MD Transfer
21704
Retired
01/08/2017 White, Robert $600.00 Electronic Fund $500.00
4837 Reels Mill Road, Frederick, MD Transfer
21704
Retired
11/12/2016 Whitworth, Myrna $150.00 Electronic Fund $50.00
9721 Woodcliff Ct, New Market, MD Transfer
21774
11/14/2016 Wilson, Stacey $50.00 Cash $50.00

1816 Rivermist Court, Frederick, MD
21701
11/03/2016 Wood, Frederick Gerry $175.00 Check $100.00

22 Pleasant Acres Dr, Thurmont, MD
21788
11/13/2016 Yoho, Karen A $50.00 Electronic Fund $50.00

4003 Bill Moxley Rd, Mt. Airy, MD Transfer
21771
11/11/2016 Yourick, Lynne K $50.00 Electronic Fund $50.00

1431 Hunting Horn Lane, Frederick, Transfer
MD 21703
Total $10,860.00

Page 10 of 16
SCHEDULE - 1A
Transfers in
E - From MD Candidate Campaign Finance Entities
Date Name of the Campaign Finance Entity from which the transfer is Aggregate to Amount
Received received. Date
11/14/2016 Young, Karen L. Friends of $50.00 $50.00
11/14/2016 Young, Ron Friends of $100.00 $50.00
Total $100.00

Page 11 of 16
SCHEDULE - 1A
Transfers in
G - From MD PACs
Date Name of the Campaign Finance Entity from which the transfer is Aggregate to Amount
Received received. Date
11/08/2016 MSEA's Fund For Children And Public Education PAC $375.00 $250.00
Total $250.00

Page 12 of 16
SCHEDULE - 1B
Other Receipts and In-Kind Contributions
I - Other - Refunds, Rebates, Items sold, interest or misc. income.
(Describe in Remarks)
Date Complete Name and Address of Payer ADMIN Amount

Received 9
12/30/2016 Branch Banking and Trust Company $0.91
1303 E Patrick St, Frederick, MD 21701
Remarks: Annual Interest on Campaign Account
Total $0.91

Page 13 of 16
SCHEDULE - 1B
Other Receipts and In-Kind Contributions
J - In-Kind Contribution - Fair Market Value of In-Kind Contribution Received.
(Describe in Remarks)
Date Complete Name and Address of Payer ADMIN Aggregate to Amount

Received 9 Date
11/14/2016 Flying Dog Brewery $1,455.54 $1,455.54
4607 Wedgewood Blvd, Frederick, MD 21703
Remarks: Staffing, Food, and Beverages for Blews and Brews Fundraiser Event
11/13/2016 GARDNER, JAN HRINYA $554.64 $55.59
6102 Fieldcrest Drive, Frederick, MD 21701
Remarks: Purchase of thank you cards and name badges

11/13/2016 GARDNER, JAN HRINYA $929.64 $375.00
6102 Fieldcrest Drive, Frederick, MD 21701
Remarks: Purchase of Graphic DesignServices for Blews and Brews Publicity

Total $1,886.13

Page 14 of 16
SCHEDULE - 2
Expenditures
Y - Other
Date Payment Name and Address of Payee Name and Address of ADMIN Amount
Method (The payee is the person Reimbursee 9
who is the ultimate recipient (The reimbursee is the
of campaign funds) person who received the
campaign check as a
reimbursement for the
expenditure. The reimbursee
must be a campaign worker.)
11/19/2016 EFT PayPal $63.15
2211 NORTH FIRST STREET,
SAN JOSE, CA 95131
Expenditure Purpose: Credit Card Service Processing Charges
Remarks: Pay Pal Processing Fees
12/08/2016 EFT PayPal $14.80
SAN JOSE, CA 95131
Remarks: Pay Pal Processing Charges
01/10/2017 EFT PayPal $38.95
SAN JOSE, CA 95131
Remarks: PayPal Processing Fees
01/10/2017 EFT PayPal $4.95
SAN JOSE, CA 95131
Remarks: Pay Pal Processing Charges
Total $121.85

Page 15 of 16
Amendments Summary
Report No Filed date Report Type Filer

1 01/18/2017 Original WORLEY SHARLA

Page 16 of 16

CampaignFinanceReport Public 38e54101 1c43 42cc 98a9 E701983e14fe

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

CampaignFinanceReport Public 38e54101 1c43 42cc 98a9 E701983e14fe

Uploaded by

Copyright:

Available Formats

Maryland State Board of Elections

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

Campaign Finance Report Summary Sheet

Bank Account Name Bank Account Number Bank Account Balance*

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

Total Expenditures $121.85 Total of Part 3 Total Outstanding Obligations $0.00

Cash Balance $20,075.29 This is your report

WORLEY, SHARLA (Date) 01/18/2017 Warning

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

11/14/2016 Andrex, Ann $50.00 Check $50.00

11/14/2016 Berman, J I $200.00 Check $50.00

01/10/2017 Berman, J I $350.00 Check $150.00

11/14/2016 Beutler, John $100.00 Cash $100.00

10/21/2016 Bickel, Karl W $50.00 Electronic Fund $50.00

01/08/2017 Bickel, Karl W $150.00 Electronic Fund $100.00

11/14/2016 Boffman, Daryl A $350.00 Check $100.00

10/31/2016 Breiling, Annette $125.00 Electronic Fund $50.00

11/14/2016 Bunitsky, Michael G $100.00 Check $100.00

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

11/15/2016 Burrell, Edward $50.00 Electronic Fund $50.00

01/09/2017 Burrell, Edward $100.00 Electronic Fund $50.00

11/14/2016 Burruss, Ellis $50.00 Check $50.00

11/12/2016 Colby, Gail $225.00 Electronic Fund $100.00

03/09/2016 Comcast $500.00 Check $500.00

11/14/2016 Crosby, Harriet $250.00 Check $250.00

11/14/2016 Dearmon, Donald MCC $225.00 Check $100.00

11/06/2016 Dirks, Melissa $50.00 Electronic Fund $50.00

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

11/14/2016 Doggett, Sandra L $100.00 Check $100.00

11/14/2016 Dolan, Darlene $40.00 Check $40.00

11/14/2016 Fair, Kristopher $50.00 Check $50.00

11/14/2016 Fink, Diane $50.00 Check $50.00

11/03/2016 Follmer, James $100.00 Electronic Fund $100.00

11/14/2016 Forrence, Catherine $50.00 Cash $50.00

10/24/2016 French Jr, Dana P $125.00 Electronic Fund $50.00

11/03/2016 Gallagher, Patrice $50.00 Electronic Fund $50.00

10/23/2016 GARDNER, JAN HRINYA $499.05 Electronic Fund $50.00

01/08/2017 Gardner, Rachel $150.00 Electronic Fund $150.00

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

11/14/2016 George, Harry $50.00 Cash $50.00

11/14/2016 Gill, Thomas S $100.00 Check $100.00

11/14/2016 Glen Ellen Farm $50.00 Check $50.00

11/14/2016 Hagen, Kai John $125.00 Check $50.00

11/14/2016 Hamda Realty, LLC $250.00 Check $250.00

11/14/2016 Himes, Rick $50.00 Cash $50.00

11/14/2016 Hogan, Kevin $100.00 Cash $100.00

10/21/2016 Jafari, Mark $50.00 Electronic Fund $50.00

01/09/2017 Judd, Mary $100.00 Electronic Fund $100.00

11/14/2016 Kaslick, Mary Elizabeth $150.00 Check $150.00

Current Amended Deleted

Filing Period Name : 01/11/2017 Annual Report Due Date : 01/18/2017

11/11/2016 Kearney, Michael B $50.00 Electronic Fund $50.00

11/14/2016 Kearney, Michael B $100.00 Check $50.00

01/09/2017 Klosky, Tim $50.00 Electronic Fund $50.00

11/14/2016 Kresslein, Robert J $250.00 Check $250.00

11/14/2016 Kuzemchak, Donna $50.00 Check $50.00

11/14/2016 Ladner, Robert C $100.00 Cash $100.00

12/08/2016 Lanier, Ivan $500.00 Electronic Fund $500.00