murphy patrick564scanned

8/7/2019 Murphy Patrick__564__scanned

1/15

FOR I NSTRUCTI ONS. SEE BACK OF FORM i ! { 7 0 ,

. DI SCLOSURE SU# , ,. i AARYPAGE

I MPORTANT : I n di c d t 6 t y pe o fc o mmi t t e ey o u a r e r e p o r t i n gf o r:

~, t ) S t a t e w i d e / L e g i s l a t i v eCa n d i d a t e ( 2 ) S t a t e wi d ePAC : 3 ) S t a t eP a r t y( a ) Co un t y / L o c alCa n di d a t e5 ) Co u n t yPAC ( 6 ) B a l l o tI s s u e/ F r a n ch i s eCommi t t e e , 7 ) C o u n t y / C i t yC e n t r a lCommi t t e eL 8 ) Su p p o r t Sl a t eo f Ca n d i d a t e sl 2 l e. , L &3 F ~~~ - ~ ~ l9 t h

SI GNATURE OF TREASUR ( o rp er s o n f i l i n gt h i sr e p o r t ) TEL EPHONE

I AM F I L I NGA

Rou t i n eP e n a l t i e sDu e Fo r L a t eF i l e dRe p or t s Rang e f r o m$ 20 t o$ 8 0 0

SEE I NSTRUCTI ONSON BACK AND COM PLETE THE FOL L OWI NG SENTENCE :

I REPORT FOR AN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR .( r e p o r tdd e ) I n d i c a t eon e

CHECK I FAMENDMENT TO REPORT DATED

El Check i ft h i si s f i n a l( t e r m i n a t i o n )r e p o r ta n d a t t a c h No t i c eo fD i s s o l u t i o nF o r m DR- 3.( Yo umus t c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo fD i s s o l u t i o ni s f i l e d. )

STATEMENT OF CASH ON HAND

CASH ON HAND a t t h eb e g i n n i n go f t h er e p o r t i n g p er i o d. ( T h i si st h et o t a lo f a l lmon i e s h e l db y t h ec ommi t t e e. T h i samoun t MUST b e t h es ame a s t h ec a s hon h a n da t t h een d o f t h el a s tr e p o r t i n gp e r i o d ,o r mus t b e z e r oHt h i si s f i r s tr e p o r tf i l e d. ) . . . . .. ... . . . .. . . . .. .. . . . . . .. .. .. .. .. .. .. . .. .. . .. . .. .. . . . .. . . . .. . .. .. . . . . . . .. $

ADD TOTAL MONEY TAKEN I NTHI SPERI OD

Sc h e d u l eA: Ca s h C o n t r i b u t i o n st o t a l( A t t a c hSc h ed u l e A). . .. .. .. .. . . .. . . . .. ... . .. . . .. .. . .. .. .. .. . . .. . . . . .Sc h e 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 hS c h e d u l eF ) .. .. .. .. .. .. .. . . . . . .. . .. . . . .. . . . .. . . . .. . . . . . . .. .. .. .. . .

Sc h e d ul eH: T o t a lSa l e so fCampa i g nP r o p e r t y( A t t a c hSc h e d u l eH) . .. . . . . . . . . . . . .. . . . .. . . . .. . . . . . . ..

( Sc h ed u l eH a wl i e s t o Ca n d i d a t e s 'Commi t t e e sOn l v )

SUB- TOTAL. .. .. .S

SUBTRACT TOTAL MONEY SPENT THI SPERI OD

Sc h e d u l eB: Ex p e nd i t u r e st o t a l( A t t a c hS c h e d u l eB ) . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . .. . . . .. .. . . . . . .

Sc he du l e F: L o a nRep ay men t s t o t a l( A t t a c hS c h e du l eF ) . . . . . . . . . .. .. . . . . . . . . .. . . . .. . . . .. . . . . . . .. . . . . . .. .. .

CASH ON HAND a t t h een d o f t h i sr e p o r t i n gp e n o d ( i ff i n a lr e p o r t ,b a l a n ce mu s tb e z e r o )( A t t a c hDR- 3 ). . . . .. . . . .. . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . .. $

UNPAI DBI L L S( F r omSc h e d u l eD - A t t a c hS c h e d u l eD ) . . .. . .. . . . . . .. . . . . .. . . . . . . . . . . . . . . . . .. . .. . . . .. . . . .. . .. . . . . . .. . . . . .. $

I NK I NDCONTRI BUTI ONS( F r o mSc h e d u l eE - A t t a c hS c h e du l eE ) . . . . . . . . . .. . . . . . .. . . . . . . .. . . . . . . . . . . . .. . . . .. . . . . . $

OUTSTANDI NG LOANS ( F r o mSc h e d u l e F - A t t a c hS c h e d u l eF ) . . . .. . . . . .. . . . . .. . . . . . . . . . .. . . . .. . . . .. . .. . . . . . . . . . . .. $

CANDI DATE COMMI TTEESONLY :

CONSULTANT BREAKDOWN ( Sc h e du l eG A t t a c h e d ? )

VALUE OF CAMPAI GN PROPERTY ( F r o mS c h e d u l eH - A t t a c hSc h e d u l eH)

DI SCL OSUREREPORT

L o c a lCo mmi t t e e s ,e n t e rD a t eo fE l e c t i o n

C o u n t y&L o c a lCo mmi t t e e s ,e n t e rCo u n t yi nw h i c hE l e c t i o ni sh e l d

YES W ONO


2/15

Fo r I n $ t r u c t f o s i s ,Se e B a c k o f F o r t r

' CONTRI BUTI ONS- MONEY TAKEN I N( I n c l u d i n gc a nd i d a t e ' sp e r s o n a l f u n ds )

COMMI TTEENAME ( M u s tb e same a s o n S t a t e m e n to f Or g an i z a t i o n )

STATECAND I DATENOT I FACONTRI BUT I ONI SRECE I VEDFROMASTATEPAC( P O L I T I C A LACT I ONCOMMI TTEE ). L I S TT HE PACI D E N T I F I C ATNUMBERAND T H E PACCHECK NUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVAI LABLEFROMTHEI OWAETHI CSANDCAMPA I GD I SCLOSUREBOARD.

CAUTI ON : Se ct i o n 68 B . 3 2 A( 6 ) , I o wa Cod e, p r o h i b i t st h e u s e o f i n f o r ma t i o nc o p i e d f r o mr 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 gc on t r i b ut i o n so rf o ra n y c o mme r c i a l p u r p o s eb y an y p e r s o n o t h er t h an s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

TOTAL ( i fl a s t page o f t h i ss c h ed u l e )

Di s c l o s u r el aw r e q u i r e sc a nd i d at ec o mmi t t e es t od i s c l o s et h e r e l a t i o n s h i po f an y r 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 pmus t b e s h o w n t o t h e t h i r dd e g r e e o f c o ns a ng u 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 sb yma r r i a ge ) ( Se e Pag e 2 o f f o r msp a c k e t . ). I f s u r n ame o f c o n t r i b u t o ri s t h e s ame a s c a n di d at e , b u t t h e r e i s n o P a g e - o f A0

f 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 pp l i c ab l e "i n t h e r e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l e A)

SCHEDULE

A MONETARY( R e v. 0 6 / 9 7 ) R ECE I P T

Q CHECKT HI SBOX I FAMENDI NGFORM

DATE PAC I DNUMBER NAMEAND ADDRESSOF CONTRI BUTOR R EL ATI O NS H I PAMOUNT J I FRECEI VED ( i fa p p l i c a b l e ) TOCAND I DATE 'RECEI VED FU( MM/ DD/ YR )ANDPACCHECK ( i fa p p l i c a b l e ) RA

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3/15

Fo r I n t l i t r u c t i o n s ,Se e Ba c k o f Fo r n

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a nd i d a t e ' sp e r s o n a l f u n ds )

COMMI TTEE NAME ( Mus t b e s a me a s o n S t a t eme n t o f Or g a ni z a t i o n)

STATE CANDI DJS OTE : I FA CONTRI BUTI ONI SRECEI VEDFROMA STATE PAC ( POL I T ICALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVA I LABLEFROM THE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se c t i o n68B . 3 2A( 6 ) , I o wa Code, p r o h i b i t st h e u s e o f i n f o r ma t i o nc 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 rs o l i c i t i n gc on t r i b ut i o nso rf o r a ny c o mme r c i a l p u r p os e b y a ny p e r s o n o t h e r t 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.

Di s c l o s ur el a w r e q u i r e sc a nd i d a t ec o mmi t t e e st o d i s c l o s et h e r e l a t i o n s h i po f a n y r e l a t i v ema k i n ga c o n t r ' 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 pmu s t b e s h o w n t o t h e t h i r dd e g r e e o f c o ns a ng u i n i t y( b l o o dr e l a t i v e s )a nd a f f i n i t y( r e l a t i v e sb y . ~ma r r i a g e) ( S ee P a g e 2 o f f o r ms p a ck e t. ). I f s u r n ame o f c o n t r i b u t o ri s t h e s a me a s c a nd i d a t e , b u t t h e r e i s n o P a g e - QC . - o ff a mi l i a lr e l a t i o n s h i p ,e n t e r " n o ta pp l i c a bl e "i n t h e r e l a t i o n s h i pc o l u mn. ( f o rS c h e du l e A)

SCHEDULE

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

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I FRECEI VED ( i fa p pl i c a bl e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i fa pp l i c ab l e ) RAI S

NUMBER I NC

31

I D#Ri ob v U1 U C a n e s

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4/15

Fo r I n s t r u c t l o n s , Se e Back o f Fo r n

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lk i n d s )

COMMI TTEE NAME ( Mu s tb e s ame as o n S t a t eme n t o fO r g a n i z a t i o n )

SCHEDULE

A MONETARY( R e v. 0 6 / 9 7 )I RECEI PTS

Q CHECKTHI SBOX I FAMENDI NGFORM

STATECANDI DAT Nd r F: I FACONTRI BU TI ONI SRECE I VEDFROMA STATE PAC( P O L I T I C A LACT I ONCOMMI TTEE ) ,L I S TTHEPACI D ENT I F I CAT I ONUMBERANDTHEPACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI L A B L EFROMTHE I OWAETH I C SANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aCode ,p r o h i b i t st h eu s eo 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 oo rf o ran y c o mme r c i a l p u r p o s eb yan 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 m m i 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 od i s c l o s et 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 ot h ec o m m i t t e e. R e l a t i o n s h i pmu s t b es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u 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 ePa ge 2o f f o r ms p a c k e t. ). I fs u r n ameo fc o n t r i b u t o ri st h es ame a s c a n d i d a t e ,b u tt h e r ei sn o P a g e 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 nt h e r e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA )

DATE PAC I DNUMBER NAMEANDADDRESS OFCONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PACCHECK ( i fa p p l i c a b l e ) RAI

NUMBER I NCI D#

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5/15

Fo r ' I n s t r u c t i o n s ,Se e Back o f Fo r n

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s tb e same as o n S t a t emen t o fOr g a n i z a t i o n )

STATECANDI DATES/ NOTE: I FACONTRI BU TI ONI SRECE I VEDFROMAS TATEPAC( P O L I T I C A LACT I ONCOMMI TTEE ) ,L I S TTHEPACI D ENT I F I CAT I ONUMBERANDTHE PACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVA I L ABL EFROMTHEI OWAETH I C SANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : S e c t i o n6 8 8 . 3 2 A ( 6 ) ,I o wa Code , 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 op i e d f r o mr e p o r t san d s t a t e me nt s f o r s o l i c i t i n gc o n t r i b u t i o no rf o ran y c omme r c i al p u r p o seb y an y p e r s on o t h e rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e e s.

' Di 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 et h e r e l a t i o n s h i po fa n y r 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. Re l a t i o n s h i pmu st b e s hown t ot h et h i r dd e g r e eo f c o n s a n g u i n i t y( b k ) o dr 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 sb ym a r r i a g e )( S e ePage 2 o ff o r msp a c k e t. ). I fs u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e , b u t t h e r ei s n o P a g e 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 pco l umn. ( f o rSc h e d u l eA)

SCHEDULE

A MONETARY( Re v. 0 6 / 9 7 ) RECEI PTS

CHECK T HI SBOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I FRECE I VED ( i fa p p l i c a b l e ) TO CANDI DATE ' RECE I VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI

NUMBER I NC

I D# O ~ q,f J X ~Gf: -

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6/15

Fo r i n s t r u c t i o ne ,Se s Ba c k o f Fo r -

CON TRI BUTI ONS - MONEY TAKEN I N( I n d u c t i n gc a n d i d a t e ' sp e n Vo n e lh i n d s )

COMMI TT EE NAME ( Mu s tb e s ame a s o n S t a t a ma n to f O r p s n f z e d o n )

1 1

STATECANDI DAT N TE: I FACONTR I BUT I ONI SRECE I VEDFROMASTATEPAC( POL I T I CALACTI ONCOMMI TTEE ).L I S TTHEPACI D ENTI F I CATNUMBERANDTHE CCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOF1 0NUMBERSI SAVAI LAB L EFROMTHEI OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUT I ON: S e c t i o n6 8B. 3 2 A ( 6 ). I o waCode. p r o h i b i t st h eu s eo fi n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e me n t sf o rs o l i c i t i n gc o n t r i b u t iof o ra n yc o mme r c i a lp u r p o s eb y a n yp 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 sa n d i d a t eCo mmi t t e e st od i s c l o s ef t r e l e d o n s t t 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 f tc o n v n i t t ". R e l a t i o n s h i pmu s t b es h ownt o t h et h i r dd e g r e eo fo o n s w V u l n i t y( b l o o dr e l a t i v e s )a n da" ( r e l a t i v e sb yma r r i a g e )( S e eP a g e2 o ff o m n sp a d c s t. ). I fs u r n ameo fc o n t r l b l r t o ri sf t s ams a c a n d i d a t e. b u tt h e r ei sn 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 ta p p l i c a b l e 'i nt h er e l a t i o n s h i pc o l u mn.

Pi p s o f 10( f o rSc h e d u l eA)

SCHEDULE

A MONETAR( R e v. 0W97) RECEI PT

CHECKTHI SBOX IAMENDI NGFORM

DATE PACI DNUMBER NAME ANDADDRESSOF CONTRI BUTOR RELAT I ONSH I P AMOUNT JRECE I VED ( i fa pp l i c ab l e ) TOCANDI DATE' RECEI VED F( MM/ DD/ YR) AND PACCHECK ( i fa p p l i c a b l e ) R

NUMBER I NI D#

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7/15

Fo r I r i t i i t r u c t l o n a ,See Back of Fo r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o na l f u n d s )

COMMI TTEE NAME ( Mu s t b e same a s on S t a t eme n t o f Or g a ni z at i on )

01011 . C~J , &e , 10 ~ ,

f o ra n y c omme 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 rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e es.

SUB- TOTAL

TOTAL ( i fl a s tpage o f t h i ss c h ed u l e )

SCHEDULE

A MONETARY( R ev. 0 6 / 9 7 )I RECEI PTS

CHECK THI SBOX I FAMENDI NG FORM

STATE CANDI DATE9MOTE : I FA CONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( P OL I T I C A LACTI ON COMMI TTEE) ,L I S TTHE PAC I DE NT I F I C AT I ONUMBER ANDTHE PACCHECK NUMBERI NTHEDESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : Se c t i o n6 8B. 3 2 A ( 6 ) ,I owa Code, p r o h i b i t st h eu s e o f i n f o r ma t i o nc o pi e df r o mr e p o r t san d s t a t eme n t s f o rs o l i c i t i n gc o n t r i b u t i o no r

' 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 od i s c l o s e t h er e l a t i o n s h i po f a n yr e l a t i v ema k i n g ac o n t r i b u t i o nt ot h ec o mmi t t e e. R e l a t i o n s h i pmus tbe shown t o t h et h i r dd e g r e eo fc o n s an g u 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 sb ym a r r i a g e )( S e ePage 2 o f f o r m sp a c k e t. ). I fs u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h e r ei s n o Page 6f 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 e r e l a t i o n s h i pc o l umn. ( f o rSc h e du l e A )

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P - AMOUNT J I FRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI

NUMBER I NCO

1 1 61 0 ,I D#

CK# ( ~y 0 wn_~ l kwe . ~ $ 0 0 11I D#

/

CK# 36 Cap- mg W,

i b1 3 l0

I D#

CK#

j

i~ .i o % f l f c w- n 0 0

1 1 3 1 1I R1 J. 4 oI D#

,

,

Ct &W_a ( 40 _1 1 2-

1 0 lZ~ ? CK# l 3 y 6 / 2 emr z e. U~~ n t eaJ~ ~ a ~; - S C E ,Ut

,

4 7, e

I D# 0 6t o1 7 j o wo , , 1Yj aj UZ f a i ` 1 L.

' I C 1 0 1 5 0 66~ t l ' 6w7 ?~ ~ t ~ f. ~ t i y ai no

CK#d ' 7 4. 3 Cdw I / L e a / n ok nw, J 0 L 4 I, ~ _ 61) Z l a Co - ~~ t ~ ,

I D# / '

I j oU, kl I v a, 0 CI , C~# -1 01

CK#

I D#J ~a h' A Oa k n

O CK# i t WGC,U) a

I D# 3 l ~ ~ MOA WL/ W j sW a ,

1CK# I Cj r 7 1303 - -

5b1 t h

, =- no,A L - 1 3 5 51. l

1d ~I

I D#

l O6 D e~a anl ai D r CK#


8/15

Fo r I n s t r u c t i on s; Se e B a c k o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c k m d l r gc a n dd s t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s tb e s ame as o n S t a t eme n to ( O r g a n i z a t i o n )

DI SCLOSUREBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o wa Co de ,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 sa n ds 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 o no rf o ra n yc o m m e r c i a lp u r p os e b yan y p e r s o no t h e r t 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.

SUB- TOTAL

TOTAL ( i fl a s tp a g e o f t h i ss c h &au l e )/ $

$ 45 .1 1 0

' 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 od i s c l o s et h er e l a t i o n s h i p o 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 ot h ec o mmi t t e e. R e l a t i o n s h i pmu s tb e s h o w nt o t h et h i r dd e g r e eo fc o n s a n g u 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 eP a g e2 o f f o r ms p a ck e t. ). I fs u r n ameo f c o n t r i b u t o ri st h es ame a s c a n d i d a t e ,b u tt h e r ei sn o Page o f ~~ _ _f 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 nt h er e l a t i o n s h i pc o l u mn. ( f o r c h e d u f eA )

SCHEDULE

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

CHECK THI SBOX I FAMENDI NG FORM

DATE PA C I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I FFRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA I

NUMBER I NCOM

CK# q g 1q Wat e . 2bu R o t x d j

~ aI D# ( ) pMt

~b" " t i &COt a

1 0 1 CK# ~6 6 1 - 1

aI D#

CKI a~~3 8 3 q~6&Gt t & GPJ12 ( JLCL~e f n t G1AOwwc - PAC G+~ (. -P . . Oo x ' I 5 7 p pa ~ r

'

1 x4 1 7 CK# 3 o o aI a n m- a n

~ur ar. - ao,

1 I D# an n ' T h e m ,p s o nCK# 5~ S h l L h l , ^ 2 1 U

I n j 9 ~0 1 7 J R1 GOO- C20I D# Pq c -

1 1,1 0

1

CK# 3 Ray A I 7 5t wi5 7

5630'

a1 1 -7

I D* O 7~ j 0 a ) Q. ~~Da' 0 I 7 C l Qt ~ l

~Sa y a 7 h c ~ S u ze t / I /CK#I Jb~

&Ue e ~j J

c gi i a b

1 ~I D#

Kat ht un Nai l oan,

4 11 0 (

CK# / ) u "~ndp_

e o l Y1n6 ' nJ W1 f y 1~ l D ,

iZ~

I D# A, ?) ampu .1 7

4 ~ j CK#~l 3 S ~ ~~ c r n a

l ZI D# ~Or l ~ eu . , u _ -

PQ~ .

CK# 5 ~r 5 l f aot *" Wl 5 e . ~ z1 r Jf w 4 L


9/15

Fo r I n s t r u c t i o ns , See Back o f Fo r n

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f Or g a ni z at i o n)

STATE CANDI DATNUMBER ANDTHEPDI SCLOSUREBOARD.

NOTE: I FACONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHE PACI D EN TI F I C AT I OC CHECKNUMBERI NTHE DESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GN

CAUTI ON : S e c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h e u s e o f i n f o r ma t i o nc op i e d f r o mr e p o r t san d s t a t e me nt s f o r s o l i c i t i n gc o n t r i b u t i o no rf o ra n y c o mme r c i a l p ur p os eby a n y p e r s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e es.

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 od i s c l o s e t h er e l a t i o n s h i po fa n y r e l a t i v ema ki n g ac o n t r ? t w t i o n t ot h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es hown t ot h et h i r dd e g r e eo fc o n s a ng u 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 yma r r i a g e )( Se ePage 2 o ff o r ms p a c k e t. ). I fs u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h e r ei s n of a mi 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 nt h er e l a t i o n s h i pc o l umn. ( f o rS c h ed u l e A)

SCHEDULE

A MONETARY( Re v. 0 6 t 9 7 ) RECEI PTS

Q CHECK THI SBOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P - AMOUNT J I FRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI

NUMBER I NCO

7 ~~CK# 1 7C1 7i n

~ ~&Z' L`1 " / 4 9 0 ~-

J 1 / (.fi ~ r ,o 9 7 o v \ -1~v 5 t ~j ) .

I D* Up J bi U a - Qp # r r wf a , G r r 4 u ~a ACl R

ZJ wow" !~ - -

i 2~1~~0I D# j O~r ~

CK#

-pUaQ / ~ ' Cc 1M 1

& 17 6 6 l t ) " h i t r ' nf ~ a a t z o a t oJ( Vat i o r. ~ w ~ i , 5d ~w - ^ 14 v v

I D* ~ a , 3 3 Emc1

. ~ .n .n .. ~0a Qc t 7 r m

l L t " Go o .i l 7

l ~ }JCK#

; ' 7 5 ( p 7r 7 l g at - GUl l t 4.A - i i 7 s ~ . s r.i s

I D#f v C~ ~ -a l u d U . , i n au Ai j e

C1 0 ~ ~ r J. 7

X8 - 6 , f f h C I rk . SC E

A o a` = l v d ~ UCI

v

I D#J 6W0 . A44t t a e ~

~333CK#J y ( ~~

5 1 6 5e5 t i 5 a i ~~

o r 2W a . C )

,

I D#t v b' I 3 Jowa n~, a~ . ~' ~~

CK# J f i t; ) e l Cp?ana,v v i

U&n u - - R~

i D# I I I t & TDf i r l v j v l c G-

CK# d qa 5 f l u bbe U-

4% IM a 563 i. .. _ .

l oo- 0- 0I D#

n wwl I r i mWI NN i 5pzw - 50,I D# (P

J Li bom

: 2. b ui . UbA, 0&W .

AAcI d~ ~ U CK#

90 / f f ckmat ) Road - Aw- -t z ` ( )

1355-Mo 4 -WO, 1 5 10 -33 a Ob ,

r 7 b


10/15

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a nd i d a t e ' s p e r s o n a lf 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 on)CHECK THI SBOX I FAMENDI NG FORM

A MONETARY( Re v. 0 6 / 9 7 ) RECEI PTS

STATECANDI DATM NOTE: I FA CONTRI BUTI ONI SRECEI VEDFROM ASTATEPAC ( P OL I T I C A LACTI ONCOMMI TTEE) ,L I S TTHE PACI DE NT I F I C AT INUMBER ANDTHE PAC CHECKNUMBERI NTHEDESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHEI OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : Se c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h e u s e o f i n f o r ma t i o nc o pi e df r o mr e p o r t sa n d s t a t e me nt s f o rs o l i c i t i n gc o n t r i b u t i oo rf o ra ny c omme r c i a l p u r p os eb y a ny p e r s o n o t h e rt h an s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

TOTAL ( i fl a s t p a g e o f t h i ss c h e du l e )

" 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 et h er e l a t i o n s h i po f a 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 ot h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es hown t ot h et h i r dd e g r e eo fc o n s a n g u 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 yma r r i a g e )( S e ePage 2 o f f o r m sp a c k e t. ). I f s u r n ame o f c o n t r i b u t o ri s t h es ame a s c a n d i d a t e , b u tt h e r ei s n o P a g e _~ o f 1 0f 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 umn. ( f o rSc h e d ul eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT IRECEI VED ( i fa p pl i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p pl i c a b l e ) RA

NUMBER I NC

I D# 11C . 50m616bwa .p e ml & ? r t e 12~r ~a a ~ o lCK# X1 5 J ~ v~ SOD, ~~

~-

CK# ~ ' 7 5 . ~ ~c h r ~ % l v t Ra< . z~1 0 OU` a

. I D# 2 a f l 1 . 4 r E. t ! l. L Q/ t. ~= A6

' 3 1 CK#! 0 9S -

_. , 60

2 13I D#

V I ( . C ~ ~ . l. L l l ~? g t ~i / c K# ( ~ T t t ' e r . ~-~ Ci q ct w

Al aI D# ~ P q

J_/ ~~/

( l}

r 2 1

~t l ~~CK# E - S ~ i , t. ~ f c. / Go

~0 6

t j _ 4`

F 1 , 0 , , F JZ4,

CK#

ID#

CK#

ID#

CK#

JD#

CK#

ID#

CK#


11/15

' CONTRI BUT I ONS - MONEY TA KEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b e s a m e , a so n S t a t e me n to f Or g a n i z a t i o n )

STATE CANDI dATEsNUMBERAND THE PACDI SCLOSUREBOARD.

f x ~ l ~ , gc PA P / Q - H6 6 1

SUB- TOTAL

TOTAL ( i fl a s t page o f t h i ss c h ed u l e )

CHECK THI S BOX I FAMENDI NG FORM

A MONETARY

( R e v. OW7 ) I- RECEI PTS

TE : ( I FA CONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DE NT I F I C AT I OHECKNUMBERI NTHEDESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GN

CAUTI ON : S e c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code, p r o h i b i t st h e u s e o f i n f o r ma t i o nc op i e d f r omr e p o r t sa n d s t a t e me nt s f o r s o l i c i t i n gc o n t r i b u t i o no rf o ra n y c ommer c i a l p u r p os eb y a n y p e r s o n o t h e r t h a ns t a t u t o r yp o l i t i c a lc o mmi t t e es.

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 od i s c l o s et h er e l a t i o n s h i po fa n y r 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 pmus tb e s hown t o t h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr 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 sb yma r r i a g e )( S e eP a g e 2 o ff o r m sp a c k e t. ). I fs u r n a me o f c o n t r i b u t o ri s t h es am e a s c a n d i d a t e , b u t t h e r ei sn o P a g e o ff a mi 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 nt h er e l a t i o n s h i pc o l umn. ( f o rSc he du l e A)

DATE PAC I DNUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( IRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA

NUMBER I NCOID#

CK#v I

ID#

CK#i L

ID# f

CK# a j o / l Y1206 Z _ _1D#

CK# h ,)ID#

ID# '

CK#1" l 1. ~ ~f c .r

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#


12/15

TOTAL( i f

l a s tp a g e o f t h i ss c h ed ul e )$

THI SBOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :

Pu r 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 y c o s t i n g$ 5 0 0 o rmo r e must a l s ob e i n v e n t o r i e don Sc h e d ul eH. ( R e f e rt o Sc h e d ul eH i n s t r u c t i o n s. )

Ex p e n d i t u r e st 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 dv 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 smust a l s ob e d e t a i li t e m i z e do nSc h e d ul e G b y t h eamo u n t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emade b y t h ep e r s o Ne n t i t yon b e h a l fo f t h ec a n d i d a t e ' sc ommi t t e e. ( R e f e rtSc h e d ul eG i n s t r u c t i o n sa n d I o waCode 5 6 . 6 ( 3 ) ( 1 ). )

Pag e o f

( f o rSc h e d ul e B )

' FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEYSPENTFROMCOMMI TTEEACCOUNT ( Re v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHE CANDI DATEI DENTI FI CATI ONNUMBER I NTHEDESI GNATEDCOLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. AL I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .

COMMI TTE E NAME ( Mu s tb e s am e a s o nSt a t e me n to fO r g a n i z a t i o n )

Fi vy,

r

~

i r l f !t6gJNNDIATE NAME AND A DRESS TOWHOM PURPOSE AMOUNT

DATE NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM/ DDNR) AND PAC

CHECKNUMBER

I D#' JpccCc . h " 0 0 6 t f 7c - ~IG ! n ~ ~"u . ~ u ~ f r o t v

CK# P c t i ~> z ~~- 566 . 1 Cec c 2 , ~. ~ t ~ ' $

O f Co ` ~ J ~ 1 ~a~ QC~

~

~

3Dd,Le o

, ; ~ , s1D# ~ ~ c t l ~umb ( f l Lt> ` ~ G Jl . e t ~ J2~ . c. t G~- C~ t

GU Il 5&& . 1 ) 4 &2 P b e e a u. u Ct u c k { ml `

L O E& " M

,a

3 / "I D#

_

~Sh~>~ l a ~~( 1 ( Oq

I D#

63 1 6CK# f 5 1 2 t 7 ` G t. ~ ~~ 00

c K# 7 Ca n

a-

. Q/ LGt M

I D# j i- Wk j j t 1 7 r ) d 0 a h6 r n +u b u / I m

l J y~u 1

CK#

~I a~w_ a ,

1"

n t ~ p a~ t c~ - -

5 - -

1 D# ( t y

CK# PP5z 00 ~ ( poadL

c = : ~a a .

J 4 0

SUB- TOTAL $


13/15

" FOR I NSTRUCTI ONS,SEEBACK OFFURM

EXPENDI TURES- - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I STOF I DNUMBERSI SAVAI LABLEFROM THE I OWAETHI CS&CAMPAI GNDI SCLOSUREBOARD .

SCHEDUL E

B MONETARY( Re v. 0 9 / 9 7 )I EXPENDI TURESQ CHECK THI S BOX I F

AMENDI NG FORM

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

~ h l a ww_L h o A&_&DATEEXPENDED( MM/ DD/ YR)

y

T CA1P1II D Y4UMBER( i fa p p l i c a b l e )AND PACCHECKNUMBER

CK# ~ c

NAME AND ADDRESS TO WHOMEXPENDI TURE

( D i s b u r s e me n t )WAS MADE

Z3Z p OC. ( c2. Sl u jb u h u o u a ,- c w o5Zt O7 7V . o - ~z / ~ J / )v e c c o ~ S&U&s

5 ~~~ ~Gl t i ~ 2

) ~C

Q _ Y I ! ~ ~~ C' ~ l ~ 2 C~ .

( 1GX k ^ I , ~ y -l ~h _ ' S QL D

I D#

~l Cb aa L 1. 2 d~ar A~h / J 3 rJ l 2 1 r Q' QC ~ e ~ Z c tCK#~ uG jGC. ~, A u' G f ~ "d GO

67( e 7]~ U 1 lM D i s h g c d ,0WdW~1 59 / 6wt 1h, 11 4 1" - emuSwat

1 - t t w a/ L , qM&L

PURPOSE( DESCRI BETRANSACTI ON)

L l f &_ G f =1 9 a _ e op1 1 9

,

r em d~ ~L ' 2l ?" 4144

AMOUNTEXPENDED

l ) r r. qkd ba& &am .

f 7 C ~ ' L~ ~ ~~ f Y r t

C 'f~ ~ - ~ , n d~ a uw~ ~ r , o0

j L i t t i ~ l d 2~

SUB- TOTAL $ 3~a .TOTAL ( i fl a s tp a g e o f t h i ss c h e du l e ) $

THI SBOX APPLI ESTO CANDI DATES' COMMI TT EES ONLY :

Pu r c h a s e s o f c e r t a i nc amp a i g np r o p e r t yc o s t i n g$ 5 0 0 o rmo r e must a l s obe i n v e n t o r i e don S c he d u l eH. ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )

E x pe n d i t u r e st o p e r s o n s / e n t i f i e sp r o v i d i n gc o n s u l t i n g ,a dv 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 smust a l s obe d e t a i li t e mi z e donSc h e d u l eG by t h eamou n t ,p u r p o s e ,a nd d a t eo f e a c h t y p eo f e x p e n d i t u r emade by t h ep e r s o n / e n t i t yon b e h a l fo f t h ec a n d i d a t e ' sc ommi t t e e. ( Re f e rSc h e d u l eG i n s t r u c t i o n sa nd I owaCode 5 6. 6 ( 3 ) ( i ). )

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' 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 e st o d i s c l o s et 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 n i nk i n dc o n t r i b u t i o nt o t h e Page o fc o mmi t t e e. R e l a t i o n s h i pm u s tb e s h ow nt o t h et h i r dd e g r e eo fc o n s a ng u 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 s ( f o rS c h e d u l eE )b yma r r i a g e ). ( S e ePa ge 2o ff o r m sp a c k e t. ) I fs u r n a meo fc o n t r i b u t o ri st h esame a s c a n d i d a t e ,b u tt h e r ei sn 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 ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn.

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