kramer mary605scanned

8/7/2019 Kramer Mary__605__scanned

1/24

FOR I NSTRUCT I ONS, SEE BACKOF - ' 9M

COMMI TT E NAME ( Mu s t b e s ame a s o n

a t e e n t o f O r g a n i z a t i o

I MPORTANT : I n d i c a t e t y p e o f c o mmi 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 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 mmi t t e e( 8 ) Su p p o r t S l a t e o f C a n d i d a t e s

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REPORT FORANNA ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON_ YEAR .

( r e p o r t d a t e )

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I AM F I L I NG

DI SCLOSURE SUMMARY PAGE

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TELEPHONE

DATE S I NED

OCh e c k i f t h i s i s f i n a l ( t e r m i 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 or 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 . )

CASHON 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 mon i e s h e l d b y t h e c o mmi t t e e . T h i s amou n t MUST b e t h es ame 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 mu s 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 T HI S PERI OD

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Pe na l t i e s Du e F o r La t e F i l e d Re po r t s R a n g e f r o m $ 1 0 t o $ 4 0 0

STATEMENT OF CASH ON HAND

FORMDR- 2I DI SCLOSURE( Re v . 1 1 / 9 7 )REPORTL 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 nC o u n t y b L o c a l C o mm 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

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE : J A N 2 2 2 0 2


2/24

Sc h e du l e A: Ca s h 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 e d u l e A

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 m_CONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d ' I n p 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 ni 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 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 BOARDCAUTI ON : S e c t i o n 6 8 8 . 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 p 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 n y c o mme r c i a l p u r p o s e by a n 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 e s .

SCHEDULEA MONETARY( Re v . 0 6 / 8 7 ) RECE I PTS[ ] CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECE I V ED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI D # v

D/ CK3~pz mo o , I FA. $~G_ i odI D#

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TX 7~7~ i~l I D# / SOSCK#


3/24

F o r F n s t r u c t i o n s , S e e B a c k o f F o r m_ C O N T R I B U T I O N S - 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 k m d a )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me nt o f Or g a ni z a t i on)

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) I

RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

STATE 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 DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A UST OF I D NUMBERS I S A V AI L A B L E 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 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 op i e d f r o m r e p o r t s a n d 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 n y c ommer c i a l p u r p os e b y a ny p er s on 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 .

DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECE I VED FUND-( MM/ DD/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMEI D #

I D# ~, qCK#I D#

O aCK# 156 Few 7. S ' 7/A~

_ . 3 7 5 8h I D# ~~9~ L~~EcP ~G1Y 0 ~ :WC'Z2 7V

I D#C l CK#~~CK#


4/24

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 mI CONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a r l d k h 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 n i 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 A L ACTI ON COMMI TTEE) . L I S T THE 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 UST 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 8 . 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 m a t i o n c o p 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 n y c o mme r c i a l p u r p os e b y a ny 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 .

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) I RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D# dg> 1V6~4- ~~a S~ ~ I~~0~~~ ~daCK# o0CK#~~/ ~f O. ~ I PS5/5

A 0 7 6 - rCK# 2 / Z3 A e o , o aI D# d a mCK# h o , 06I D #CK#


5/24

A

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 m-CONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n f l c a n d i d a t e ' s p e r s o n a l f u n d s )COMMt 1 TEE NAME (

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 )-t e _47 1 ~yz~ Ta ~~r ; ~~; ~SCHEDUL EA MONET ARY( Re v . 0 6 / 9 7 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

STATE 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 DE NT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A UST 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 88 . 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 m a t i o n c o p 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 n y c omme r c i a l p u r p o s e b y a n 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 e s .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECEI VED ( I f a p p l i c a b l e ) TO CANDI DATE' RECEI V ED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D #

CK# S / 1 3 L ~ , o 03

CK# / Z o o , o aI D #

^_~~~t ~BGO' yt~~) 7I D # ~ v~c K#

l ~ z t o ~ ~~ z 63 I D #CK#


6/24

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 m; CONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d ' m g c a r l d l d a t e ' s p e r s o n a l l u r 4 a )COMMI TTEE NAME ( M u s t b e s ame 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 )

STATECANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( POL I T I C A L ACTI ON COMMI TT EE) . L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . AUST OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 688 . 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 a nd 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 a ny 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 .

. SCHEDULEA MONETARY( Re v . 0 6 1 9 7 ) IRECEI PTSQCHECK T HI S BOX I FAMENDI NG FORMDATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR

RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c ab l e ) RAI SERI NCOME

I D#NUMBER

t / ~ rc K# 3 ~~~ ' ~ 1 , 00I D #CK# S ' - ~ ' S~ ~2 S l , o aI D#CK# ~~vX~oS7 / ZSD. DDZ , 2 , -; A 1 ' ~ ~ , So 3Q3I D#I D#CK#I DN

CK# 7dS


7/24

F o u r i n s t r u c t i o n s , See Bac k o f Fo r m; CONTRI BUTI ONS - MONEYTAKENI N

( I n c l u d i n g c a nd da l e ' s p e t s o r t a l f u n ds )COMMI TTEENAME ( Mu s t b e s ame a s S t a t e en t o f Or g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( POL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CAT I ONNUMBER ANDTHE PACCHECKNUMBER I N THE DES I GNATED COLUMN. AUSTOF 1 0 NUMBERS I S A VA I L A BL E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa C o d e , 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 bu 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 by any 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 .

SCHEDUL EA MONETARY

( Re v . 0 6 / 9 7 )RECEI PTSCHECK T HI S BOX I FAMENDI NG FORMDATE P A C I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RE L A T I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOMED# ~l C~I " d~. ~ 1 ' t -~-~~nC7f f ~J' d7LJCK# e , ~ ; ~Z / Z- S~fsSt ~ " oa/ y p / f 7 Z 6 * !CK#I D #

14 1CK#-

- D#CK#I D# bpd ~ , ~T~ , S~ C rCK#

l d l "l D / m i l


8/24


9/24


10/24

Fa r I n s t r u c t i o ns , Se e Back o f F or mCONTRI BUTI ONS - MONEYTAKENI N

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

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM ASTATE PAC( POL I T I C AL ACTI ON COMMI TTEE) . L I S T THEPAC I DENT I F I CAT I ONNUMBER ANDTHE PACCHECKNt UBER I N THEDES I GNATED COLUMN AUST OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON- S e c t i o n 6 8 8 . 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 m a t i o n c o pi ed f r o m r e p o r t s a n d 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 an y c o mme r c i a l p u r p o s 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 es .

SCHEDULEA MONETARY( R e , 0 6 1 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL A T I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOME

CK# 0 Z )I D# ~Z. ~~. ~sE~~f i r OCK# l ~~l W~ ' ' r Do- 7 - Sd~lCK# ODI D#c K#~~TZ

d/ CK#~~S v E T~ So~z. ~ 'I D#CK# , a dd/ e. - o o "~~fOr n P ~ ~ ~ y 'DZ I o , ~ o a


11/24

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 h K l d a )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 n i 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 A L ACTI ON COMMI TTEE) . L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A UST OF 1 0 NUMBERS I S A V AI L A B L E FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 8 . 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 m a t i o n c o p 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 n y 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 .

SCHEDULEA MONETARY( Re , 0 6 1 9 7 ) RECEI PTSO CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEt D#

ei c K#~1~9 ~~ , ~ o z 6 sI D#~> CK# 5 Gv . 1 0 ( ' s I / r ~~c f ' ~ ' o va / ~~/ D / ~ f ~ r E _ Z ' Z bo a 7~I D #

CK# 60

CK # daI Dpc K# ~1~a~~. r o r E . ? O~ o aCK# 57~Z / ~. e ` ~ ~r ZS' o a


12/24

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 d u d r n y c a n d i d a t e ' s p e r s o n a l t u n d s )COMMI TT EE NAME ( Mu s t b e same a s

S t a t e me n t o f O r g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED F ROM A STATE PAC ( P OL I T I C A L 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 GNATEDCOLUMN . A L I S T OF 1 0 NUMBERS I S AVAI LABLE FROMTH E I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 8 . 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 p 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 n y c o mme r c i a l p u r p o s e b y a n 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 e s .

SCHEDULEA MONETARY( Re v . D 6 / 9 7 ) RECEI PTSCHECK TH I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED F UND-( MM/ DO/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#CK# Cl ~%F 60I D# ~v ~ ~ ~ ~ / Er 11'CK# ~;~~~ , D/ lT Z6. ~ ~~aoCK# Do

3 CK# o0CK#I D#c K# 60


13/24

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 l d e l e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s b e s ame a _ f o n St a t e me n t o f O r g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE ) . L I S T THE PAC I DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . AUST OF I D NUMBERS I S AVA I LA B LE FROM THE I OWA ETHI CS AND CAMPAI GND I SCLOSURE BOARDCAUTI ON : Se c t i o n 688 . 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 a nd s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y any 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 .

SCHEDULEA MONETARY( Re v . 1 ) 6 / 9 7 ) RECEI PTS

[ ] CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i t a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI D# IGCl~~~~~E~L $

CK# SoZGSl 3 7CK# ' 7-

I D# t ~~c~Fw ~C~/ CK#I D#l lCK# / 3 " 2 9 l d l J a a

I D#CK#


14/24

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 - MONEYTAKEN I N

( i n c l u d i n g c a n d l d a l e ' s p e r s o n a l t u n d s )COMMI TTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n )

x e _ . : o ~ W ' 4 , ~ t p v d , C V1, 4 4 4 S 2~~ " ~

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) 1 RECEI PTSO CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) . L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A US T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t 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 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 e s .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOME

CK#I r a P E A * A X3. 5 n / yYyvl ~~u~9Qoi l / c K i l l 7Z0p

f l I D# ECK# - y Z"4 5 1 , 5 o 3 Z~

1/ ~ CK# r1z~- /S' ~ , , 1 J , o a


15/24

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 m- CONTRI BUTI ONS - MONEY TAKEN I N

-

( I n c l u d i n g c a r x i l d o t e ' s p e r s o n a l f u n d s )

COMPI TTEE NAME ( Mu s t b e s ame a s o n S t a f

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 A L 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 UST OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t 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 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 n y c o mme r c i a l p u r p o s e b y a n 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 e s .

SCHEDULEA MONETARY( Re 7 ) RECEI PTSCHECK TH I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME_ I D#

l ~~/ l ~ Di l l , . So 3oI D #Arl CK#Z/ ~ 9 Gvo z l o 6I D #C K #

/ Z I D # ~ r r 0 , p ~ i t l ~ i Cc K# i 3 . ~ Gv / y r ' v ~. ~ ' . Me, 00I D #CK#

r ~D3 /7 z

~~~~~ aof c K# / l a m /


16/24

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 k I Ms s p e r s o n a l h i n d s )COMMI TTEE NAME ( M u s t b e same 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 )

~ . E. C O/ c , S~ ~/

r 1 / S~

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( POL I T I C AL ACTI ON COMMI TTEE) . L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 688 . 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 or t s and 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 ut 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 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 .

SCHEDULEA MONETARY( Re v . 0 6 1 9 7 ) RECEI PTS

[ ] CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a pp l i c ab l e ) RAI SER

NUMBER I NCOMEI D#$o / CK# t ~~ ~0 , ~ modI D# ~Z~Z. ~ ~CO~ / 1l l 11! i Pt

J ~~ O~~ Po . E , O r P. ~. JD~ 0Y7CK# o / . ewev Y~ " 4/wAVAlC4 2 7 0 l fI D# r `CK#I D#CK#I D#CK#I D #CK#


17/24

FOR I NSTRUCTI ONS, SEE BACK OF FORMEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI S LAT 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 S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

Dm o w , ,~~So3a~ i i r i + d y c 1El e r F ~' / C~o- t ~

COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e p e n t o f Or g a ni z a t i on)

SCHEDUL EB MONETARY( Re v . 0 9 / 9 7 )EXPENDI TURESO CHECK T HI S BOX I FAMENDI NG FORM

AMOUNTEXPENDED

$l x

' 9 7

/ 7 9 ' 0 7

7 1 6 . 6 -e

c K#l o/~ ~-I D #

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSEDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON)EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER


18/24

- FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROM COMMI TTEE ACCOUNT MONETARY( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I 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 CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a m e 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

CAND I DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

I D# ! - 5I D# r

Jl / z 1 , e%V&wI D#l /

CK9 4Z 2 , ZF DI D# ~/ ~1~~ 1 u 6C K # ~Ozo

7~ CK#Aoz iI D#


19/24

' FOR I NSTRUCTI ONS, SEEBACKOFFORM

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI S LAT 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 THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI 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 Or g an i z a t i o n)

I N

I N ' y

I N

I N

I N

cK#/~z9I N

AMOUNTEXPENDED

l ~aa~ l EZy~~E~~~

~~oo

DATE

EXPENDED( MM/ DD/ YR)

EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNTSCHEDULEB MONETARY( Re v . 0 9 / 9 7 ) 1EXPENDI TURES

CHECK THI S BOX I FAMENDI NG FORM

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSEI D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON)( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADEAND PACCHECKNUMBER


20/24

FOR I NSTRUCTI ONS, SEE BACKOF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

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 CAT I ON NUMBER I N T HE DESI GNATED COLUMN AND THE 0 CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI 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 Or g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

I D # G, r E~c K#

/ Z~~ ~~ ~a~ l E sf / Q

1 a 3 ~ c v Oh?~~S~z6~/ CK#

I D #CK#I D #


21/24

CANDI DATE' S COMMI TTEE NAME ( L_ e s ame 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 )' l e e

SCHEDULEI I N - K I N DE CONTR I BUT I ONSCAND I DATEF o r o f f i c e u s e o n i v

DATERECE I VED NAME AND ADDRESSOF CONTR I B U TOR REL AT I ON SHI PT O CAND I DATE 'DAI fAI DESCR I P T I ON OFI N - K I N D CONTRI BUT I ON EST I MATED F AI RMARKET VALUE$


22/24


23/24

1 2/ 1 0/ 0 1 MON 10 : 5 3 FAX 5152817349Pr e s . o f Se n at e1 r . / 1 U~ v iMON 1 0 : 4 7 FAI 5 1 51 1 8245WAXONUA CLUBWAKONDACLUB

Amou nt shown I t s du e upon r e c ei p t o f ' t t f s i r f v o i c e . Pl e a s e r e h a n t h e e nc l o se d c o p y o f t h i s i n v oi c e wi t h your r e mi t t a nc e t oi n su r s p r o p e r c r e di t . Paymen t o f t h i s b i l l i n g does no t q ua l i f y as a c h ar t f a b l e c o nf t f Wu t i o n f i a t F e d er a l Ta x p u r p o s e s _ 9 0 1 1 1 1 9I n q u i r i es ( 5 1 5 ) 28S4965 Ex t. , -- t o

0 0 2QQ02I NVOI CEMr s B e c k y B e a c h 0 0 7 54 0 2 0 J o h n L y nde RoadDe s Mo i n e s , l A 5 0 3 1 2

J u l y 2 5 , 2001J u l y 13 , 2001Round t a bl e . Me e t i n gDi n n e r $300 . 0 0Wi n e $4Q_~0Be v e r a g e $28_75Se r v i c e Ch a r g e $7 3 . 7 5Sa l e s T a x $ 26 - 5 5To t a l Amount Due $469 . 05

FOR I NSTRUCT I ONS , S EE BACK OF FORM


24/24

T HI S FORM I S USED BY CANDI DATES ' COMMI TT EES ONLYCOMMI TT EE NAME ( M u s t b e s ame a s o n S t a t e m e n t o f O r g a n i z a t i o n )

PART I - ONGOI NG I NVENTORYOF CAMPAI GN PROPERT Y

PART I I - SALES OR TRANSFERS OF CAMPAI GN PROPERT Y * *

T OT A L V AL U E CAMPAI GN PROPERTY T HI S REPORT~

p~

* * PROPERTY SALES & TRANSFERS TOTAL

TOTALS

$

$

( TRANSFER T O SU MMARY PAGE) $

( TRANSFER TO SUMMARY PAGE) $

i* I f e s t i m a t e d , s h o w e s t . b e s i d e f i g u r e .

( A t t a c h A d d i t i o n a l S c he d u l e s i f N e e d e d )

Page --- r

o f

_ _ P a g e s

( F o r S c he d u l e H )

SCHEDULEH I CAMPAI GN( R e v . 0 2 / 9 6 ) PROPERTYATTACH SCHEDULE H TOEACH REPORT, MAKI NG

CHANGES AS REQUI RED.

0 CHECK T HI S BOX I FAMENDI NG FORM

D a t e( MM/ DD/ YR)

Name a n d Ad d r e s s o f Pu r c h a s e r / Do n e e D e s c r i p t i o n o f P r o p e r t y S o l d ?YI N S a l eP r i c e V a l u e o fDo n a t i o nDa t e P ur c h a s e d( S c h e d u l e B )o r Da t e Re c e i v e d( S c h e d u l e E )MM/ DD/ YR

D e s c r i p t i o n o f P r o p e r t yPu r c h a s eP r i c e o r E s t .V al u e Wh e nA c q u i r e d *

C u r r e n tV a l u e a t F a i rMa r k e t T hi sR e p o r tl d /

l l , E. f i vw

6/ 7 3 , x / f 7 3. ' o

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