associated general contractors of iowa6004scanned

8/7/2019 Associated General Contractors of Iowa__6004__scanned

1/12

COMMI r ~EE NAME ( Mu s t b e same a s o n S t a t e me n t o f O r g a n i z a t i o n )~~SSG r 1 r ' . ~ ? / / C' P / / i L I t / 5 cI MPORTANT : I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e l L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o m m i t t e e( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s

I AM F I L I NG A

GSL ,J. ' 1 ' 4 z e 6 I\9DI SCLOSURE SUMMARYP/Il uAFORI NSTRUCTI ONS, SEEBACKOFFORMPe n a l t i e s Du e F o r L a t e F i l e d Re p o r t s Range f r o m $ 1 0 t o $ 4 0 0

S EE I N S TRUCT I ON S ON BACK AND COMPLETE THE FOLL OWI NG SENTENCE :

( r e p o r t d a t e )[ ] CHECK I F AMENDMENT TO REPORT DATED

[ ] Ch e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Yo u mu s t c o n t i n u e t o f i l e r e p o r t s u n t i l a N o t i c e o f D i s s o l u t i o n i s f i l e d . )

CASH

REPORT FOR AN/ A ( 1 ) ELECT I ON / ( 2 ) NON - EL E CT I ON YEAR .

STATEMENT OF CAS H ON HAND

I n d i c a t e o n e

ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a lo f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s amo u n t MUST b e t h esame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a s t r e p o r t i n g p e r i o d ,o r mus t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PERI ODS ch e du l e A: Cash C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h ed u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc he d u l e C : F u n d - r a i s i n g E v e n t s t o t a l ( A t t a c h S ch ed u l e C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc he d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h S ch ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S ch ed u l e H : T o t a l S a l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h ed u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc he du l e H a p p l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODS ch ed u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc he d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc he d u l e F : L o a n Re p ay me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b a l a n c e mus tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 1 DI SCLOSURE( R e v . 0 2 1 9 6 ) REPORT

0L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

C o u n t y & L o c a l C o m m i t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

44 C7 _ ?

UN P AI D BI L L S ( F r o m S ch ed u l e D - A t t a c h Sc he d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m S ch e du l e E - A t t a c h Sc he d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m S ch ed u l e F - A t t a c h Sc he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSUL TANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc he du l e H - A t t a c h Sc h ed u l e H ) $


2/12

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mus t be s ame as o n St a t emen t o f Or g an i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATEPAC ( POL I T ICA L ACTI ON COMMI TTEE) , L I ST THE PACI DENT I F I CAT I ONNUMBER ANDTHEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L A B L E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 6SB . 3 2 A( 6 ) , I o wa Code, p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

Di s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . Re l a t i o n s h i p mus t b e shown t o t h e t h i r d d e g r e e o f c on s an g ui n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e) ( Se e P a g e 2 o f f o r ms p a ck et . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n di d a t e , b u t t h e r e i s n o P a g e-,~o f _f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a pp l i c ab l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h ed u l e A )

SCHEDUL EA MONETARY( Re v . 0 2 1 9 6 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNTRECEI VED ( i f a pp l i c ab l e ) TOCANDI DATE' RECEI VED( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a bl e )NUMBER

~Cf ` pL' CK# P~ . I g ~k 1 4 - ~ c` . L sUG v d v rI D# L ~ J ~ l i s ~t -. ~ dCK# GI D#CK# 53 / l l r l G. ~ " l

A1 ` 7 .I D#

'6 CK# c ga , t r - . 2 0 / 4 _C0- , 3 -d7~gI D# Po p , ~l l o ~ c - rG CK# e j 1 4+ n a r c iI D #

1 wc 2 9 - 0 6 , CK#

n l c r ' n , . r i C . 5OCK#

_

1 t3 7 c 1 7 ' ? c , / c l u e . r. SU vI D #

C ~~; 1 Sh;J 1 , CK#

I D # _CK# _ . 2

SUB- TOTAL 7 9TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )


3/12

F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g an i z a t i o n)

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E N T I F I C A T I O NNUMBER AND THE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r any c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y 1 7m a r r i a g e ) ( Se e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s no P a g e o ff a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A)

SCHEDUL EA MONETARY( Re v . 0 2 / 9 6 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNTRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECE I VED( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e )NUMBER

I D#/

~i s ~ JWI D#

I D# /fCK# C, p

7 r - - 3 rI D# /CK#

7 r a , . . . f sI D# - s - 0 r' , - ; , - j/ e

I D# _. L i . , . S r ' ~ s s . t 4)/ CK#

I D#

I D#CK# , s ~ 1 - _ S , .I D# . - . ~ /

/ j t - 07

I D#

SUB- TOTAL 3~ ' r (TOTAL ( i f l a s t page o f t h i s s c h e du l e )


4/12

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g an i z a t i o n)

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r any c omme r c i a l p u r p o s e by any p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

AMOUNTRECE I VED- - -

, ~ ) fLC_ , ~-C

SUB- TOTALTOTAL ( i f l a s t page of t h i s s c h ed u l e )

- D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r n s p a c k e t . ) . I f su r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s no P a g e o ff a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l umn . ( f o r Sc h e d ul e A)

SCHEDULEA MONETARY

( Re v . 0 2 1 9 6 ) RECE I PTS[ ] CHECK T HI S BOX I F

AMENDI NG FORM

1 , ~ ~ - J - l 1 G CK# l ~l V Sr . ~ r < . . / ~ V ' PL ) - 4' . / l r e lI D#

/ , ~ - ` e~ CK# 1307 ~J ^ G ~C/ ~, f ~r . 1. ~ 5 . . ~73zI D #CK# S1 6 r -C/I D#

y r CK# 2Cc%y - ~ 0I D# / 1 5 2 7 . l l e ~ n . 1 1 1 , 1 7 f s r . ,_ 1 i S CK# - . ~ , , 7~. s r I f , c -. . : UCHI D#

G CK# / GCj - ,J6~Ev ~U/ / n s ~U 1Z/ 3I D# d ~ " G 5 r . r / j- , ) , / , , " " s C . ' 7

6( , " ; ~ CK#77 . "~

I D# 6CA / / 7rCK# s


5/12

Fo r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 6 8B . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o pi e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p ur p os e by a n y p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

AMOUNTRECEI VED

r

CK# / 13 . C~J l e C

l r I ' U 4 CK# < . . . 4 * . - 5 n ? C iSUB- TOTAL

. l . 2 Z, ~ 2 03

GCrFS~u

STOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Pa g e 2 o f f o r m s p a c k e t . ) . I f s umame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e 4: ~ o f7f a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d ul e A)

SCHEDULEA MONETARY( Re v . 0 2 1 9 6 ) RECEI PTS

CHECK THI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI PRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE'( MMI DDYR) AND PAC CHECK I ( i f a p p l i c a b l e )NUMBER _ - . _ 1 . .

I D# 1 - 7 Sam`CK#

I D#CK# S T 3 , J 7 ;s e c - / Gr L1 D#CK# - 7 ' , 1 - , f i ~l < - . . ~ C t .~~ C o C i I l _ . . ~d t S~ J - 5 /I D # l ~c~ Cl t y ~ c - ~

1 , 2 " c - Gv CK#I D # L4 t l c . _ ,

a d ' ~ 7 . - / - s CK#I D # . ' - 4 . 3 . 1 , 6

r ~ 1 5 o s CK# ~" f C r e ~J rI D #

4 1 ' , - ~ y 0 i , CK#I D #

i l De l y a f CK#I D #


6/12

Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame as o n St a t e me n t o f Or g a n i z at i on )

STATE CANDI DATES NOTE . I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D E N T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a Code, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e _


7/12

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)

s / t 1 4 4 6 r t / 0jSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E N T I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c o mme r c i a l p u r p o s e by a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTAL 3 G ' c 1TOTAL ( i f l a s t page o f t h i s s c h e du l e )

" D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e. R e l a t i o n s h i p must b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y rma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s no P a g e~,-o ff a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c he d u l e

SCHEDULEA MONETARY( Re v . 0 2 1 9 6 ) RECEI PTS

[ ] CHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VED( MM/ DDYR)PAC I D NUMBER( i f a p p l i c a b l e )AND PAC CHECK

NUMBER

NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNTTO CANDI DATE ' RECEI VED( i f a p p l i c a b l e )I D# e. - . a C c L o a ' SCK#I D#

CK# J ' / . . _ 5U~JU

I D# ~~~ , r l / SG r c. (c K# G/ / , . / . / S / .I D#

/. . 1 > 5 , - 4 CK# / t r , / / , ' S ~ - .G, l ~ ' 4 r . ' e . . . " L- f l ? / 06>I D#

- d y ' UG CK# SCVI " l u - < < . . . ~ h, . S~G3 vI D# l s , S r ,~. ~ 1 - O 0 CK# 7 cl _ C' ,- AI D #

51 4 " ) : 1 5q CK# GG 3 - 4 / J


8/12

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i on )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED F RO M A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T TH E PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c omme r c i a l p u r p o se b y a n y p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

- D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e _ o ff a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d ul e A )

SCHEDULEA MONETARY( R e v . 0 2 1 9 6 ) R E CE I P T S

[ ] CHECK T HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR R EL A TI O NS HI P AMOUNTR E CE I V E D ( i f a p p l i c a b l e ) T O C AND I DA T E' R E CE I V E D( MMI DDI Y R) AND PAC CHECK ( i f a p p l i c a b l e )NUMBER

I D#_ ~GJG

I D # ( v ~ s ~CK# - T / d G r. . La . - , v - ~ 1 Z.I D# ~r / ~ J r qi 3 ~ j~i ~- ~yGy CK# ~' A~r I ~ 4 vI D #CK#D#CK#D#

CK#I D#CK#I D#CK#I D#

CK#I D#CK#

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i s s c h ed ul e ) $


9/12

T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :Ca mp a i g n f u n d s may b e u se d o n l y f o r( 1 ) c a mp a i g n p u r p o s e s ,( 2 ) c o n s t i t u e n c y e x p e n s e s , a n d( 3 ) e d u c a t i o n a l a n d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .P l e a s e i n s e r t t h e a p p l i c a b l e n umb e r i n t h e p ur p o s e c o l u mn f o r each e x p e n d i t u r e .P ur c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 1 ] 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g . f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e dSc h e d u l e G b y t h e am o u n t . p u r p o s e , a n d d a t e o f e a c h t y p e o f e x pe n d i t u r e made b y t h e p e r s o N e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e fSc h e d u l e G i n s t r u c t i o n s a n d I o wa C o d e 5 6 . t 3 ( 3 ) ( ~ . ) -_-

FOR I NSTRUCTI ONS , SEEHACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 2 / 9 6 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES . L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0 CHECK T HI S BOX I FP AC CHECK NUMBER FOR EACH EXPENDi TURE . A L I ST OF I O NUMBERS I S AVA I LABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( Di s b u r s e me nt ) WASMADE ( CANDI DATES SEE EXPENDEDEXPENDED ( i i a p p l i c a b l e ) BELOW3 ENTER( MM/ OOI YR) AND PAC 1 , 2 , 3 )CHECK NUMBERI D# : 5 1 1 )CK# l a o . x l I ( $

j 7 : 7 C" i, ,

I D# , ~ 5 , - 3 ( d . ~ , . . , F I . r T e Ll r " ` N. c I 4 +~, 1 4 2 L , -, 2 t e l l

10# , j - 7 / c w. , 3 l ll C . . / L c 4 CK# e . , a , * " T61 9 l daEi

Z , 4 2 1 CI D#

I o#z

r i cSUB- TOTAL G

TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )


10/12

FORI NSTRUCTI ONS . SEE SACK OF FORM

AI > 1 u4

EXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNTSTATE PAC COMMI TT EES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DEOR LEGI SLAT I VECANDI DATES . L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )

DATEEXPENDED( MM10 01 YR)

, ! J~LCLI , I CCANDI DATEI D NUMBER( i f a p p l i c a b l e )AND PAC

CHECK NUMBER

NAME AND ADDRESS TOWHOMEXPENDI TURE( D i s b u r s e me n t ) WAS MADE

THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Campa i g n f u n d s may b e u s e d o n l y f o r .( 1 ) c amp a i g n p u r p o s e s ,( 2 ) c o n s t i t u e n c y e x pe ns e s , a nd( 3 ) e d u c a t i o n a l a n d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .P l e a s e i n s e r t t h e a p p l i c a b l e numbe r i n t h e p ur p o s e c o l u mn f o r e a c h e x pe n d i t u r e .

PURPOSE AMOUNT( CANDI DATES SEE EXPENDEDBELOW3 ENTER1 , 2 , 3 )

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) l $

_ ,Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u k i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e dSc h e d u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n l e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e fSc h e d u l e G i n s t r u c t i o n s a n d I o wa Co d e

SCHEDULEB MONETARY( Re v . 0 2 1 9 6 ) EXPENDI TURE

CHECK THI S BOX I FAMENDI NGFORM

I D#

CK#i f . 53~1

I D#

. O Ac

~ r ~C1 . i . c A .ZS~i a1 , / c / l a . . F

3 6 " , ' 7 J0071A

G4 6 C- / - t ll 1 . ~7 S t om. _ . . _I D#

CK# 0 , o 13 , A, c: ~ e Gr S r - L-. ce . 1I D#

CK# 0 414

- 3 7Gr " C1 OI D# /CK# . 3 . k %i o UI D# / , o r c i vCK# s

./ Oc~cJ


11/12

FOR I NSTRUCTI ONS. SEE BACK OF FORMEXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES . L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n )

DATEEXPENDED( MMI D01 YR)

CK# i e , * _ 12 r5 ' 7A ~~ , ' r ( )r 7U p . n ~ r - . l i . a ~r

7 , Z- 4 r. h3 r

CANDI DATE1 0 NUMBER( i f a p p l i c a b l e )AND PAC

CHECK NUMBER

NAME AND ADDRESS TOWHOMEXPENDI TURE( D i s b u r s e me n t ) WAS MADE

CK# s u e /CK #

_ - ~ - y4Z

p k , ~ / c . , , , , 77

PURPOSE( CANDI DATES SEEBELOW& ENTER1 . 2 , 3 )

AMOUNTEXPENDED

D# F0 C . J . " . . 1 . 1

S- / G i r a A 4 h / , / - I , - C I / , 4 I ", .~- Yo- 3 V Fc.

112 , 1 1 ~ l s CK# i 1~ 4 Nr , t , c , , . > , ~ . _ . PS r i r

1 r f 4C) -

SUB- TOTAL $l . i s7s1TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) l $T H I S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :Camp a i g n f u n d s may b e u s e d o n l y f o r .( 1 ) c a mp a i g n p u r p o s e s ,( 2 ) c o n s t i t u e n c y e x p e n s e s , a n d( 3 ) e d u c a t i o n a l a n d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .P l e a s e i n s e r t t h e a p p l i c a b l e number i n t h e p u r p o s e c o l u mn f o r e a c h e x p e n d i t u r e .Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y C o s t i n g $ 5 0 0 o r mo r e must a l s o be i n v e n t o r i e d o n Sc h e d ul e H . ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s must a l s o be d e t a i l i t e m i z e dSc h e d u l e G by t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x pe n d i t u r e mad e b y t h e p e r s o n l e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e frs c h ed u l e G i n s t r u c t i o n s a nd I o wa Code 5 6 . 6 ( 3 ) 0 . )

SCHEDULEB MONETARY( R e v . 0 2 / 9 6 ) EXPENDI TUREC CHECK THI S BOX I FAMENDI NG FORM

(( ' s - r " 1 1 i 1 . 1 I ). _

61 " , r X1 4 r , .


12/12

FOR I NS TRucT16NS , SEE BACK OF FORMEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DEOR LEGI S LAT I VECANDI DATES . L I ST THE CANDI DATE I DENTI F I CAT I ON NUMBER I N THE DES I GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

CANDI DATE NAMEANDADDRESS TOWHOMEXPENDI TUREI D NUMBER ( Di s b ur s e me n t ) WAS MADE( i f a p p l i c a b l e )AND PACCHECK NUMBER

PURPOSE( CANDI DATES SEEBELOW3 ENTER1 , 2 , 3 )

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n )

T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :Camp a i g n f u n d s ma y b e u s e d o n l y f o r ,( 1 ) c a mp a i g n p u r p o s e s ,( 2 ) c o n s t i t u e n c y e x p e n s e s , a n d( 3 ) e d u c a t i o n a l a n d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .P l e a s e i n s e r t t h e a p p l i c a b l e n u m b e r i n t h e p ur p o s e c o l u mn f o r e a c h e x pe n d i t u r e .Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g 5 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S ch e d ul e H .

TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

( R e f e r t o S c he d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a gi n g , o r g a n i z i n g s e r v i c o s mu s t a l s o b e d e t a i l i t e m i z e dS ch e d u l eGb y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x pe n d i t u r e m a d e b y t h e p e r s o n l e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c ommi t t e e . ( R e fS ch e d u l e G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) 0 . )

SCHEDULEB MONETARY

( Re v . 0 2 / 9 6 ) EXPENDI TURESE ] CHECK THI S BOX I FAMENDI NG FORM

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