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FOR I NSTRUCTI ONS,. SEE BACK OFF ' M
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CCNTRI BUTI CNS - - MCNE' l TAKEN I N( I n c l u d i n gc an d i d a t e ` s p e r so n alf u n d s )
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( R e v. 0 6 1 5 7 )
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CAUTI ON: S e c t i o n6 8 B. 3 2 A ( t 3 ) ,I o wa Co d e,p r o h i b i t st h eu s e o f i n f o r m a t i o nc o p i e df r o mr e p o r t san d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i oof o ra n yc o mme r c i a lp u r p o s e b y an y p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.
D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pm u s tb e s hownt o t h et h i r dd e g r e eo fc o n sa n gu i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e )( S e e P a g e2 o ff o r m sp a c k e t ). I f s u r n ameo f c o n t r i b u t o ri s t h es ame a s c an d i d a t e ,b u tt h e r ei sn o Page - o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i n t h er e l a t i o n s h i pc o l u mn. ( f o rS c h e d u l eA )
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T H I SBOXA PP L I E STOCAND I DATE S 'COMMI TTEE SONLY:
P ur c h a s e s o f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o r mo r e must a l s ob e i n v e n t o r i e do n S c h ed u l e H . ( R e f e rt o S c h ed u l e H i n s t r u c t i o n s. )
E x pe nd i t u r e st o p e r s o n s l e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d ve 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 an i z i n gs e r v i c e smust a l s ob e d e t a i li t e mi z e donS c h ed u l e G b y t h eamo u n t , p u r p o s e , a nd d at e o f e a c h t y p eo f e x pe nd i t u r emade b y t h e p e r s o n / e n t i t yo n b e h a l fo f t h e c an di d at e ' sc o mmi t t e e. ( R e f e rt oS c h ed u l e G i n s t r u c t i o n sa n d I o wa Code 5 6 . 6 ( 3 ) ( 1 ). )
( f o rS c h ed u l e B)
FOR I NSTRUCT I ONS ,SEE BACK OF FORM SCHEDULE
EXPENDI TURES B- - MONEY SPENT FROM COMMI TTEE ACCOUNT MONET ARY( Re v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TT EES : NOTE : FOR CONTRI BUT I ONSMADE TO STATEWI DE OR L EGI S LAT I V ECANDI DATES,L I S TTHE CANDI DATE I DENT I F I CAT I ONNUMBER I NTHE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S TOF I DNUMBERS I SAVA I LABLEFROMTHE I OWA AMENDI NG FORMETHI CS& CAMPAI GN DI SCLOSURE BOARD . -
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THI SBOXAPPL I E STO CANDI DATES 'COMMI TTEES ONLY:
P u r c h a s e so fc e r t a i nc a mp a i g np r o p e r t y c o s t i n g$ 5 0 0o rmo r emu s ta l s ob e i n v e n t o r i e do nS c he d u l eH. ( R e f e rt oS c h e d u l eH i n s t r u c t i o n s. )
E x p e n d i t u r e st op e r s o n s / e n t i t i e sp r o v i d i n gc 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 gs e r v i c e smu s ta l s ob ed e t a i li t e m i z e d oS c he d u l eG b yt h ea mo u n t ,p u r p o s e ,a n dd a t e o fe a c ht y p eo fe x p e n d i t u r emadeb yt h ep e r s o n / e n t i t yo nb e h a l fo ft h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c he d u l eG i n s t r u c t i o n sa n dI o w aCode5 6. 6 ( 3 ) ( i ). )
( f o rS c he d u l eB )
FOR I NSTRUCTI ONS ,SEE BACK OF FORM SCHEDUL E
B MONETARYEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATEPAC COMMI TTEES: NOTE: FORCONTRI BUTI ONSMADETO STATEWI DEOR L E GI S L ATI V ECAND I DATE S ,L I S TTHE CANDI DATEI DENT I F I CAT I ONNUMBERI NTHEDESI GNATEDCOLUMNAND THE 0 CHECK THI S BOX I FPACCHECKNUMBERFOREACH EXPENDI TURE. AL I S TOF 1 0NUMBERSI SAVAI L A BL EFROMTHEI OWA AMENDI NGFORME T H I C S&CAMPAI GNDI SCLOSUREBOARD.
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THI SBOX APPL I E STOCANDI DATES'COMMI TTEE SONLY:
P u r c h a s e so fc e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0o rmo r e mu s ta l s ob e i n v e n t o r i e do nS c h e d u l eH. ( R e f e rt oS c h ed u l eH i n s t r u c t i o n s. )
E x p e n d i t u r e st op e r s o n s / e n t i t i e s p r o v i d i n gc 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 smu s ta l s ob ed e t a i li t e m i z e do nS c h ed u l eGb yt h ea mo u n t ,p u r p o s e ,a n dd a t e o fe a c ht y p e o f e x p e n d i t u r emadeb yt h ep e r s o n / e n t i t yo n b e h a l fo ft h ec.: n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c h ed u l eGi n s t r u c t i o n sa n dI o w aC o d e5 6. 6 ( 3 ) ( i ). )
P a g e
( f o rS c h ed u l eB )
FOR I NSTRUCTI ONS ,SEE BACK OF FORM SCHEDUL E
EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATEPACCOMMI TTEE S: NOTE: FORCONTRI BUTI ONSMADETOSTATEWI DEORL E GI S L ATI V ECANDI DATE S ,L I S TTHECANDI DATEI DENT I F I C AT I ONNUMBERI NTHEDESI GNATEDCOLUMNAND THE 0 CHECK THI SBOX I FPAC CHECKNUMBERFOREACH EXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI L A B L EFROMTHE I OWA AMENDI NGFORME T H I C S&CAMPAI GNDI SCLOSUREBOARD. -
COMMI TTEENAME ( M u s tb e same a s o nS t a t e m e n to fO r g a n i z a t i o n )
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FOR I NSTRUCTI ONS,SEE BACKOF FORM
COMMI TTEE NAME ( Mu s tb e s ame a s o n St a t emen t o fO r g a n i z a t i o n )
Z' Z
SUB- TOTAL1 $
TOTAL ( i fl a s t $
p a g e o f t h i s
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' D i s c l o s u r el awr e q u i r e sc a n d i d a t e st o d i s c l o s e t h er e l a t i o n s h i p o fan y r e l a t i v ema k i n g a n i n k i n d c o n t r i b u t i o nt o t h e Page I o fc ommi t t e e. R e l a t i o n s h i pmu s t be s h own t o t h et h i r dd e gr e e o f c o n s a n gu i n i t y( b l o o dr 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 ( f o rSc h e d u l eE )b y ma r r i a g e ). ( S e ePage 2 o f f o r msp a c k e t. ) I fs u r n ameo f c o n t r i b u t o ri s t h es ame a s c a n di d a t e ,b u tt h e r ei s n of a m i l i a lr 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 er e l a t i o n s h i pc o l u mn.
DATERECEI VED( MM/ DD/ YR)
NAME AND ADDRESSOF CONTRI BUTOR
RELATI ONSHI PTO CANDI DATE' ( i fa p p l i c a b l e )
DESCRI PT I ONOF I NK I ND
CONTRI BUTI ON
ESTI MATEDFAI RMARKET
VALUE
4 I FFORFUND- RAI S
CONTRI BUTI ON
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