Professional Documents
Culture Documents
Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A O 10 -- 8 ~t REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR.
(report date) Indicate one
CCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election
[~ Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a Notice of Dissolution is filed .) which Election is held
SUB-TOTAL . .. .. $
f
'7'3
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ('"also see debts and loans below) . . . . 02.0, 6 -7 9 . 41,1
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
A I MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN
(Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
o
CK# ~' & i Fle.Ur ar.
57A
ID#
/~ CK#
64 rlu,,~v -
a
CK# ~CoU . .~-~yr
.5-2- 00 1 - (o h ~~. t70
CK# -3 sw . -2 . . i .
.JOd Z l~o . do
CK#
0 vv
' ID#
Frli~ C i s
I ~
/'-Y7-'L
ma~y'r
Jc,~ CK# .~ .w' .
0q 5zaq~" ~:OG
ID#
a ~7 Oc~tC ~o,~-~ ~retire
CK#
a /o -10 wch 1 sz~ifs" : 0 .00
t ID#
o
as- o ~ CK#
' ID#
.,
CK# -T _
S ay l r -C-.,s .Qn .CG
_V_ - a o. oO
SUB-TOTAL
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page -~ of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
I
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN
(Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# 1,C3 pt,!
1o
f
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
-
ID#
CK#
ID#
CK#
I D#
CK#
ID#
CK#
SUB-TOTAL
$ ..5 ^
044.
TOTAL (iflast page of this schedule)
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page c of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Forth ,
SCHEDULE
4_
4 A~ i o/C Se~ wtl, ° i:
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID#
lV .
CK# &_,'r_ 93o
w ~,_, 06 _2
0
CK#
S p -- f.L u~.c GcF
bZO~fs / 0,u. 70
ID#
.boa ,
~
/lS D~ ' .SLoo~ ad
ID#
&16~ P, 51 uu2+iJ x'.1.5, ro z-
lo~ CK#
1737 ~~ .~ .
50 3 !L Zv2~ . q0
/o ID#
yyl ., P ,
as 3 t~r . maw
~s CK#
jTA 7z-0S l7S; .2.0
I D#
Ave E
CK#
~5 7A 5-zoyo l ~y . 7s
ID#
/v
~ok l91 Q
CK#
92- 3 i a ~ 0 Y*7/, 60
SUB-TOTAL $-
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i).)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE
ID# ~
J' l o . I'yl / /
CK#
D ~~ 30
ID# ~~-14_)
~.c. Ytti
CK# Po f3Cy, Ixg'
A3 ,
V4
a :~ , ~ SZ
6~4 z-5 `
I D#
41.11a.C_rC.
CK# "AA
~Zo D Z SZeO
ID#
l )/4076"
CK# I3czi I9 I
oa /0
61 --Z& .5 _ 3 io I QO
D ID#
CK#
a2 loy ~TA 5zo ,,Lo 2,Yo . Do
/D ID# ~'{2a n CAS- ,Jc.e
.2 a3
CK#
szo s ~~{3C1 D
t ID# Z(. 6 . ~~
OU
CK# _T a
SUB-TOTAL
TOTAL (iflast page of this schedule) $
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i) .)
Page "3?, of 3
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 07/03) EXPENDITURES
CK#
02.x' .TA Zen $ ~~, v11
" ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
1D#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i) .)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN KIND
I COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 06/97)I CONTRIBUTIONS
rn
01404 X LL A
Al 7 7.6b
nLG
p~
/k .~ 3
~u~ .i,L(" ~0 309 Al
19r°
` '. so .3 o nr i'2 w
e
at, ,
~~9 'T .A s6 Bc /j4 0
CO/ u v~-~-t-' 11-5 ,
1q16 M
lc.~ El
a
I q-C u ~ 5
a 3oq 'LA 2U . QC~
-wm
1\
;A
li o
, ~. so3a- 5- 7
16
140 8~
563 v
"Z g
b :3'--A Sv 3v ~o~o .
R
~vtc
/ Rio Lu.c A F-1
O Jc7 3 v IV A
V
Jot,,,, k.0,_M Su4tvt. I'_Jtt~
,q
10 f ~,x- .~ 5 3 v `I ( f~ ~OD~r ~0
SUB-TOTAL
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page / of
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage). (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .
FOR INSTRUCTIONS, SEE BACK OF FORM
f o -. So 3~~ ~w 7 7.50
zz
/6+f
lk-U~
_rA
A~lA 00
op F-1
Co/
1~t08
lU/ I
~yv8
el_
E:1
F-1
F-1
F-1
F-1
F-1
F-1
SUB-TOTAL
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page :?,/ of
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage). (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .
IF R STRUCTIONS, SEEBACK OFFORM
R
CHECK THIS BOX
F AMENDING
NOTE : Debts previously reported that remain unpaid must be included on this
Schedule, as well as any new obligations incurred in this period .
FORM
l~q. ~2.v
1~p60~
Ta vh ~4ai-i In.O '-~1r1 IY~~ ,
Zip f` .
1= DID j :V4 ~5ZO
1arm ozohCcoz-
ol~~l -(J 3 to E-ka4l' z~. t
Jp.wa v4j~ , :nA 5ZV4
-T'- '' I r-1-5
$ o) - Zl<D P_-h a-f v0.
or1:f)
f,
SUB-TOTAL $
s~ 3i-(, -7'
"If actual figure is unknown, show "estimated" beside the figure . Page I of ^~~
(for Schedule D)
yt4m,)f4-
v, ,
1
SUB-TOTAL $
0. Irl
TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD $
Z10t0
*If actual figure is unknown, show "estimated" beside the figure . Page I of
(for Schedule
4- w4
fiU 4-y B' SZt ~'~
5)412z,,o4 ia ,. 5~ :ga
Lv o r
SUB-TOTAL $
*If actual figure is unknown, show "estimated" beside the figure . Page I of _ I
(for Schedule D)