polk county republican womens club9628scanned

8/7/2019 Polk County Republican Womens Club__9628__scanned

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e men t o f Or g a ni z a t i o n)co

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( 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 Co mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co mmi 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

FORMDR- 2( Re v . 0 1 / 9 8 )

DI SCLOSUREREPORT

K I F AMENDMENT TO REPORT DATED

SI GNATURE OF TREASURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNEDRo u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Rep or t s Ra n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONSONBACKANDCOMPLETETHE FOLLOWI NG SENTENCE :I AM F I L I NG A O 9 - y -0i Br - 1 9 , , ? 00 j / REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

( r e p o r t d a t e ) I n d i c a t e o n eoe- , l e 6 - , , - / g , v e o J z

Ch 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 No t i c e o f Di s s o l u t i o n F o r m DR- 3 .( Yo u mu s t c o nt i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )

1 - 1L o c a l Co mmi t t e e s , e n t e r Da t e o f E l e c t i o n

Co u n t y t k L o c a l Co mmi t t e e s , e n t e r Co u n t y i nwh i c h E l e c t i o n i s h e l d

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e beg 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 . Th i s am o u n t MUST be t h es ame a s t he c a s h o n h a n d a t t h e en 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 be 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . ' , $ 336 2 : 1

ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : C a s h Co nt r i bu t i o ns t o t a l ( A t t a c h Sc h e d u l e A) . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . 7 , 5 -Sc h e d u l e F : L oa n s Re c ei v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Ca mp a i g n Pr o per t y At t a c h Sc h e d u l e H

( Sc h e du l e H a pp l i e s t o Ca n di d a t e s ' Co mmi t t e es On l y ) sSUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B : Ex p en d i t u r es t o t a l ( A t t a c h Sc h e d u l e B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , 49a. 2 " 8ySc h e d u l e F : L o a n Re p a y 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 en 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 mu s t / 'b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ / _ 3 6 3 ' 7 1UNPAI D BI L L S ( F r o m Sc h ed u l e D - At t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - At t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l e G At t a c he d? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h e d u l e H) $


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FOR I NSTRUCT I ONS, SEEBACK OF FORM

DISCLOSURESUMMARYPAGEC MMI TT E NAME ( M 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 no I k t r f f ~ u k P D, b f , c o K W4men5 ( 2 r c t f

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 l F r a n c h i s e C o mmi 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 ) S u p p o r t S l a t e o f C a n d i d a t e s

a543 - / C o ?gSI GNATUREOF TREASURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TELEPHONE

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

R o u t i n e P e n a l t i e s Du e F o r L a t e F i l e d R e p o r t s Ran g e f r o m $ 2 0 t o $ 8 0 pSEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :

I AM F I L I NG A 0C-4Oh" o " ' ~' 1a ? ODi v , REPORT FORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- E ECT I ON YEAR .I n d i c a t e o n e 1 0

L o c a l C o mmi 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 & L o c a l Comn~ 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

OCHECK I F AMENDMENT TOREPORT DATEDF 1 Chec 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 o r m OR- 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 . )

STATEMENT OF CASHON HANDCASH 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 amoun t MUST beds ame a s t h e c a s h o n h a n d a t t h e en 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 must be 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 J e d . ) . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . $

ADDTOTAL MONEY TAKEN I N THI S PERI ODSc h e d u 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H . T o t a l Sa l e s of Camp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e Ha pp l i es t o Ca n di d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d 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 h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Y . . . . . . . . .Sched t e F : L o a n Re p a yme 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 en 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 mustb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ,

UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . , . _ ; . . . . . . . . . . . _ . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l e G A t t a c h e d ? )VALUEOF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H)

FORMDR- 2( R e v Of / 8 ) DI SCLOSUREREPORT

F o r O f f i c e U e O n lComm . #I n d e x e dA u d i t e dC o mp u t e r


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F O I ? , . I NSTRUCTI ONS, SEE -BACK OF FORNfEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT . ,

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DE OR L EGI S L AT I VECANDI DATES, L I ST THE CANDI DATE I DE NT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEI ' / \ C CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD. . ,

T HI S BOXAPPLI ES TO CANDI DATES' COMMI TT EES ONLY :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 pe r t y c os t i n g $ 5 0 0 o r mor e mus t a l s o be i n v en t o r i e d o n Sc h ec i u J e, H ( Re f e r t ( a , Sc h ed ul e H- i n s t r u c f i b r i s . )Ex p en 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 ns 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 an i z i n g s er v i c es m u s t a l s o be d e t a i l i t e mi z e d o nSc h e d u l e G b y t h e a mo u n t , p u r p o s e , an d d a t e o f e a c h t y pe o f ex p en di t u r e made by t h e p er s o n l e nt i t y o n b eh a l f o f t h e c a nd i d a t e ' s c o mmi t t e e . ( Re f e rSc h e d u l e G i n s t r u c t i o n s and I o wa Code 5 6 . 6 ( 3 ) ( 1 ) . )

SCHEDULEB r v i 0NETd~y

( Re v 0 9 / 9 7 ) EXPENDI TURES

[ ~ CHECKTHI S BOX I FAMENDINGFORM

P a g e o f

( f o r Sc h ed u l e B)

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )?o I I ~ - ~o ~ ~~ ~ h c ~ Pr v r t I d r 7 r Yl e A

CANDI DATI L NAME ANDADDRESS TOWHOM 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 ) ( Di s b u r s e me nt ) WASMADE( i v 1 M/ DDI Y R) ANDPACCHECK

NUMBERI D# / 033 ~ah i sCK# A l - 1 0 7 s c ed l s ~~o s u z/ o o s ~ ~os~_ e . _ " , 97I D# `

- CK# i o 3~Z s ~D.o0I D# Ka r e n f h c l f l t s ' I - e r '3 7 1 , 7 / ,?&- 1 e,CK# / o f f . ' ,~d , l " s l ~ ` c ~ ' I I e o n 6 ~U~S1 D # s f o 3 l o ` r " - S- F , I o l e c ~ o Z P I -

J ~ a ~ l S 6 a 3 ~ F ~oS~-aO , ~ I l ~D~ CK# 1 0 3t y Do s r J 7 o ~ ~ ~ s - z i ~ } , o3a l ~~ r r l f I ~ r s - h l p ~! ? ~S ~/ . ~D

y e s r go, 4 P~ z. 4 4 6 -03 a I 'CK# 143 - 2 0 - ' - c ; r v / Y i o X ~ - : r NI D# ~SSSPl ea, 7 I r - r , i r

Z ) e s - n o , ` / t o S ~ } s o 3 ~ ! . XCK# / o 3 ~ ; _ ~al q r eP - 7 s . ~~ d e l o pP- 5 s"I D# . ' ESV- * , P/ I 7 I ~ , e ~n l a ~ l ~v~Des / I ?o; l i e s - X - A So 3s - t '

01 . 3 0 - 0 ~ -(CK# , 039 ~ s ~ - r t ~S j l o r - At I l e ~ I r r 4- / 3I D#

1~e s r ! ' I o T~ J e s ~,So3aD _a f ~ - o c f CK# / 0 e l , ~ > 04 e l m X Q G A , 0 , S k o c v 5 -

SUB- TOTAL.. " $. 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 ) $


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T HI S B O X A P P L I E S T O C AN DI D AT E S ' C O MMI T T E E S O N L Y :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 g i u s t a l s o b e i n v e n t o r i e d o n Sc h e du l e H . ( R e f e r t o Sc h e dp l H* i a s. t r u F Do n s . J --. t i . : . - . _ , , .E x p e n d i t u r e s t o p e r s b n s / e n t i t t 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 d o nSc h e du l e G b 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 p e 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 f e r t oSc h e du 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 ) ( 1 ) . )

P a g e _ _ 3 o f ' 1 5 , _

FOR I NSTRUCTI ONS, SEEBACK OF FORM SCHEDULE' EXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT .( Re v . 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE : F OR CONTRI BUTI ONSMADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES . UST 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 ST 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 be 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 )P 6tOomol t S CU- bi t .

CANDI DATE NAME AND ADDRESS TOWHOM 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 me n t ) WAS MADE( MMI DDI YR) AND PACCHECKNUMBER

I D# l k - ~0 t ! o - A , ' c - k e f S Sv ( c ~ ,~ 9 - c 2 3 CK# 1 1 0 4 9 / D a r _ S O ' 3 i - 1 ^ f o r t o ~~. $ i , o DI D # s ~ l ' r i a 7 f d ' w" e tv ~ b o - r r d s s ~ . ~ ' , 4 ~'v , r ~oCK# ~ ' e c J t ? r a yD 9 : ~ o - o i o s ' 0 o s e i c e Um . ~ s r e S k o c J aI D # z ~ a o SE i S . t , J _De s r l 7 e a t o ~ ZA S ' 4 3 . $ 4A 4o 9 - a 4 - a L CK# S O S / 4 - ~ - f ; Ce Mox " ~ c - : n }

d~y, SI w l 5 . Qs -1 0 #

CK# GS' S i J * _ i n V ) 0 o s t k e f ,9 - 0 2 0

CK#1 0 #CK#I D #CK#1 D #CK#

S U B - T O TA L -- - $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


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THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :P u r c h a s e s o f c e r t a i n c a m p 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 S c h e d u l e _ H ( R e f e r t o S c 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 mu s t a l s o b e d e t a i l i t e m i z e d o nS c h e d u l e G b 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 p e 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 f e r t oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 5 6 . 6 ' ( a ) ( i ) j

FOR I NSTRUCT I ONS, SEEBACK OF FORM : . SCHEDULE' EXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT

" . ( R e v . 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE: FORCONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE O CHECK T HI S BOX I FCANDI 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 CHECKNUMBER F OR EACH EXPENDI TURE . ' A UST 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 S t a t e m e n t o f O r g a n i z a t i o n )

l ~ 0 1 ~ ~ ~0 L ~ r t L ~ ~Q p c t b ~ ~ e a - n ~ r n e r t + 9G~8 'CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

r } ~ c : r l ~ e r - f z o rCK# / OSz C -O. d ~s

_ b r 4. t ( e + : n I I , A ~ c t 7 t~l a s k o w l e ' c t o , r ; a po , r $ ' 5 4Z . r9r l ; nn~a i ' ' l ~ n n s , f ~ l o ,i O l e i f l { I D# l 4 V I V I M ~ 0 0 s i _ Z ` t r - r - r ~ r i 4 eo r r " e , _ ~ a r . a ~ ; + - ~ o r L

CK#D , y r , ~a a k e~s T, ' a z tr - F r - 9 o e t e Q c s : - ~QuJ & & , T SoI D#CK# / , 453 U O t DI D# G/ en Oaks o a r l 7 " y C ( 3 ' { a k c c m&J i P g

e t f f A a 1 4 CK# G l e A 7 Os r k s ? J r "u J t ? s f . ' De s ma r u es 7 - R ( 'a r a n a . a / ( c a m 6 f l Sa " b ' f~ n 5 ~ 1 $ ' Od ~eG _ Si c / s e SI zOw' ~ " ~ c ( ~ eI D # W~~ / I 1 Q o ~ d l t > X ' s r e s l f ? 2 f e l ' ' ~ vI

G r l o n . a . ~ l o i 7 rt e wk 0 , 1

I D # / Zd ~ Gr &Ad a ne f f 8 5 a r S +a+e e Pl v 1 a f o ~ 4 , 3 1 ` ~ L o~S . ~ - r o e t , c l o r i a . ~ F %c a mCK# / o s 4 T h e - , a t . o I r n e s Z; . A S0 3 I a : " ! e e - 4 ; v n 300 . 00

I D# OMm; oe TE/ P t a ww tG: 70 13 Na) Sr ~ z . / l t e e : al ~ . v r ) - t c o rl a * CK# / 4F' J 0/ i v e ' / / , s ' d 3dS el e e X vn 0, 0I D# '. .CK#

SUB- TOTAL. $ ~Gl 0 0 i l lTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $


7/13

THI S BOX APPL I ES TO CANDI DATES' COMM1 T r EES ONLY :P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g &SWo r mo r e mu s t a i m t o I n v e n 6 o r t e d o n S c h e d u l e H. ( R e f e r t o S c 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 a l e n t i t i e s p r o v i d i r V a d v e r t > s i n g . f u n d - r 8 i p n g , p o l l i n g . m a r l a p i r p . o r g a n i z i r t g . s e r v w e s m u s t a l s o b e d e t a i l i t e m i z e d o nS d n e d u l e Gb y t h e a m o u n t . P u r p o s e . a n d =aopht y p e o f a z p e n d i l l u r e made b y f m p e r s a N e n t i t y a n b e h a l f o f t h e c a n d i d a t e ' s c o r m e t t e e . ( R e f e r t oS c h e d u l e Gi n s t r u c t i o n s a n d I o w a Code S t 3 . 6 ( 3 ) ( I ) . )

P a g e

- .FOR I NSTRUCTI OVS . SEE 8 + 4CKOF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEEACCOUNT ( Re v . O 9 1 9 7 ) EXPENDI TURES

STATE PAC COt t NTTT ' EES : NOTE. F OR CONTRI BUTI ONS MADE TOSTATEWI DE ORLEGI SLAT I VE 0 CHECK T HI S 13OX I FCANDI DATES . UST THE CANDI DATE MENTI RCATON NUMBER I N THE DESI GNATED COLUMNANDTHEPACCMECK NUMBERFOREACH 0CPENDI TURE . ' A L I ST OF t D h 1UMBERS 1 5 AVAI LABLE FROMTHE I OWA AMENDI NGFORMgTHI CS 8 CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE MANE ( Mu s t b e s a me a s o n St a t e me n t o f Q r g a n i z e f d n )~ ) dJ J LCOu , . { ~ " ' ~ ( ; e o , , 1 ( , c o r n a ~ 9~a8

CANDI DATE NAME AND ADDRESS TOWHOM 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( MMDD I YR) ANDPACCHECKNUMBER

10# 4 7 Pcmm%T r e e T Dr h . a~LZSb l - l y ~r i 0/ I- f o ~l o e, ~> VO: ~ l f Q" ~ ~ ^Gc O r t c t ' t i b n F v ( "1 0 1 1 -- a - 1 0 4 - CK# ~b n s : ~ f t So l 3 1*. e ( e G4 I o i l \ $

1 D# Po r n a t : e P - / o / e el6 1 a k - , s 2 ) r

IOGO SDa l e r , eke%ur n . ~ ' 30o. OC7I D# ~ c o mm4e e ` i v E( Qe4 S$ o 2 , , g t a h S4 , r a Qt

ho l e l o b CK# I , t ) 2 S f f p s , M . o : v ws wf t n a - ~, o wl 5 C Q( P F a t 3 Co . 00~ ~ ` l ' l ~ ~ mt Y f ~ p ` / e y e e ~ l 3 ma I3 3 o I ` T " " m6 r - ~ , r , a o n Road ~o ~~~ : o - r ~ ` ~u r/ CK# / 0 6 a { ~ - . k Q wy . S* s a n s l 300. 0~a l e G` '~ i 1 1 Y \I D# em 7 - f ~ - p e ~o E t p e } > LaPek

/ 4 Ax / C , CK# / 0 1 0 3I D# / ~~ Camwl i - e e ~ ( o E l e g y . ` i ! e u t r l Jr o f y / o ~ CK# / o G r f . De s / ~ 1 0 ~ i P5 zf } 5 ' o 3a 1 00 0 ?

I D# h o r r l ~s c r n - 4 , - Lw r e ss! v ~ 4 2 ~ p c ~ i o SS G"u. ~ C / Auk 0 / o ~ l ,Cr ~~CK# b l f s L - De s 1 ho i r \ OS n , Z. 3Q0 . DOl o l n 5 SO. z ( a GI D# G` r e 5 t Py ~r Se r k a 4 e, .I D I , a . . ( b ' ( - CK# r D / p ! o

Znd PI o d4 : : 4 a ~R (/ I f 1 i ( ~BS~k a~ /GCD i l a r ` ~ ; D~ ~e r v l p C ` ~ ; J r ~ 1 Sb .OD1~QS SO~

SUB- TOTAL $ , 2 / QO ODTOTAL ( i f l a s t pa w o f t h i s s c h e du l e ) $ , 5 / 9a d . F h b


8/13

FOR i NSTRUCTI ONS, SEEBACK OF FORM

DI SCLOSURE SUMMARYPAGE

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 :

C C 2 . 0 2 0 0 4C MMI TT E NAME ( M 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 hD wn 4 c Pn e ~u I t C : l t 0

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 mmi 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 ) S u p p o r t S l a t e o f C a n d i d a t e s

FORMDR- 2 DI SCLOSURE( R e v . 0 1 / 9 8 ) REPORTo r O f f i c e Us e On l yomm. #

h d e xu d i t e d

C o mp u t e r

a , Z3 - / t , 2 _2SI GNATURE OF TREASURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNEDRo u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Rep or t s R a n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :I AM F I L I NG A De c o b ' . " - l y , a o o - V

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

7 Che 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 o r m DR- 3 .( Y o u must 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 . )

/ o - i - ) - D " ' Z

REPORT FORAN/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR.

STATEMENT OF CASHON HAND

I n d i c a t e o n e

CASH 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 mon i e s h e l d b y t h e c o mmi t t ee . T h i s amoun 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 en 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 must be 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL MONEY TAKEN I N THI S PERI ODSc h e d u 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 e d 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 h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa 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 e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u 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 es On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d 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 h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n Rep a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L o c a l C o mmi 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 & L o c a l C o mmi 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

3s9o

CASH ON HAND a t t h e en 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 mustb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ S~ : / ~UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NOVALUEOF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H)


9/13

Fo r I n s t r u c t i o n s , See Back 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 St a t e me nt o f Or g a n i z a t i o n )Ao ( k , 6b-n-4 4pi t 6j . - C- 0 f ) WompNCab

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 EN T I F I C A T I ONNUMBER 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 : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co de , 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 ny c ommer c i a l p u r p o se 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 es .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e du l e )

SCHEDULEA I MONETARY( R e v . 0 6 / 9 7 ) RECE I PTS0 CHECK T HI S BOX I FAMENDI NG FORM

$18 , 13

' 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 yma r r i a g e ) ( S e e Pa ge 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 Pa g e o f _2-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 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)

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 4 I F FRECE 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 SENUMBER I NCOMI D#

0 0 - 1 9 , 0 CK# , ewe ( r * a l e SI D# ~P u~h . ~ : ddy

o 9 - l f o - o f f CK# c 4 r ` G dS c e- 2I D# h o e , G ! ) ~ l l g0 9 - ~ 7- o c ~ c K# i 5. o0

I D#CK# /g g ' y ~ ( e s l ? Uw s el l ! OOI D#

t ~ P ( P r ) C r c ~ c r t09 " 1~0~ CK# eQ sopY~? P~o ~ ~ o K, e S 3S' . O~I D#

~eposl ~ LI Ca ` t ge09 - 1 9 - 0 0 CK# used ~ 2 t ) 0 n dt o m , e - ~ J

I D# Axne - J " 7 ,

4 9 - l 9 - d f r CK# S e s i t o ~ J ? ~ i o~eSCg a ~G, o oI D# a c c d 4 " ~ wt e - 1~"SCK# I o wa / Y 4 004 . - 6 7 . 0 - 0 4 5 40" )I D# , De a~ o ~ r t d ~ i ' s v - mo t -

09 20- 0~ CK# e a o k : e f i a l e s , l e c d2 / r v ~Z a / e s ~ a 3C - o a o o


10/13

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI RVTI ONS - - MONEYTAKEN I N

' J r i 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 )CQMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e } h 7 e n t o f Or g a n i z a t i o n)

STATE CANDI DATES NOTE : I F A CONTR I 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 EN TI F I CA T I ONNUMBER 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 : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co de , 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 ny 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 es .

SUB- TOTAL' - TOTAL ( i f l a s t p a g e o f t h i s s c h e c l u J e f' 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 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 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 a m c 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 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 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

( J R e v . 0 6 / 9 7 ) MONETARYRECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

$ a 9 8 6 . 2 s

DATE PA C I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT V I F FORECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE" RECE I VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D# / ~ ' l u ~ . ` ~ l Kn ~ l l e r -

o ~ CK# as. ovI D# ~ ~CK#

f f l e s a r 7 h ~ ~ COd t s 24Ash") d , ~o . t x ~I D# f ~ 2 l l f ~ f j o r - - ~l hla~ cK#

1 D#CK# A - , y 1 a r md r Spv ~ '

~ c ~ c . o ~ . 277 . 00s SGLo SI f d o

g - ~ ~ - a t ~I D# / J ? or r ~ ` S

' ?a 7 - 0 CK# - ego l a m ' s ~ l o S - S l e S~~ 7 / a 5 "D# ~ r - "o e / _~e c_

9 a 7- v ~ cK#I D#C K#

'- CK#

I D# -CK#


11/13

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :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 a t i n g $ 5 0 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 mu s t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b 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 p e n d i t u r e ma d e 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 m m i t t e e . ( R e f e r t oSc h e d u l e G i n s t r u c t i o n s a nd I o wa Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

( f o r S c h e d u l e B )

FOR I NSTRUCT I ONS, S EE' B, 4 CK OF FORM SCHEDULEEXPENDI TURES B I UONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT . `- ( 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 El CHECK T HI 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 ame a s o n St a t e me n t o f Or g an i z a t i o n )

-?o l l , ~ _ 0 o k A l l . . b I ; . - , l d c q r n e A 5u , , ,CANDI DAT NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE 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 PACCHECKNUMBERI D # / 033 ~ah ( 5CK# dr s Q l osu~ o s ~ a ; ~~s ' ~ - 9 ~. - 97I D# ~ `CK# / o 3y ~ F- , C ' c J ~ ~~~, 6e r s ~ ; l 5 7 p , o 0zI D#CK# 1 0 , 3 5 - T: ~ d , ~ . ~ s 7 ~ ~ ` c ~ ' I r y I e h ' J 6~- c ~ u e , ~ 3 ' , SvD#

Dc , l S ~oS~a 9 ~ , ( ~ u I f o ` 7 ~ f 0CK# l e a p S .C' v ~ 7 hY 1 a - ~S

D~ - ' - o f f CK# 1 1 4 37 0~ " ; r e 41 OX 1 0 a r ( Q~~ ~ S a o . o~I D## 1039 1 ( ) 0 l , ? y - e P t g e l l d e / OPPs

I D #0 30dL CK# , 039 a SAMc a Ay - 6 e 40 ~ 1 r r i ~ - s < 3s

I D #

a~ ~ 7 - o f f CK# / t 7 e l oSUB- TOTAL.

, TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) $


12/13

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :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 / 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 d o nSc h e d u l e G b 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 p e n d i t u r e ma d e 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 f e r t oSc h e d u l e G i n s t r u c t i o n s a n d I o w a Co d e 5 6 . 6 ( 3 ) ( i ) . )

Pag e I Z I o f - , 3

( f o r Sc h e d u l e B )

FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULE" EXPENDI 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 DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0CHECK T HI 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 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 an i z a t i o n )~o l I L 0O" / ~ e p a l ~ , ' m- , , Z t ) d . 7 1 e , 4 s

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I 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

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SUB- TOTAL_ . $ 30~" ~'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 ) $ ,


13/13

T HI S BOX APPL I ES TO CANDI DATES' COMMI TT EES ONLY :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 i u 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 b l e Wi n s t r : c t i o n s . r ~ : A ", 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 , t 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 mu s t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b 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 p e n d i t u r e m a d e 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 f e r tSc 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 Code 5 6 6 ( 3 ) ( 1 ) )

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

STATE PAC COMMI TTEES : NOLTE : FOR CONTRI BUTI ONS MADE 1 0 STATEWI DE OR LEGI SLATI VE .CANDI DATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC . GHECK NUMBER FOR EACH EXPENDI TURE A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA At NI ENDI NG FORMETHI CS & GA NI PA I S ; N DI SCLOSURE BOARDCOMMI TTEE NAME ( l v f u 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 )

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 ) ( Di s b u r s e me n t ) WAS MADE( N I i N V D D YR) AND PACCHECKNUMBERD# Po / / CC 00 Cn c , ( ~ e S 8~l a Q.

p9-23- 0 ( / CK# W, t~ - ~ D r - ~O t . L SGQ' ~ ' l ~a . 00- I D# - i

CK# J ~ e c , - ; o ( m a y y - Jr C"0~XO50 f o S~ Z - ( , e wm ~~ S l e S k o u ] o z .I D#0 9 - a s l os / 4 4~ E 1 - C e / j 1 o x t7c - : n ~ - ; n

0 9 e ? 0 - , p t ~ - CK# I n ~o~ / r ` u 9~ err -a l - 04I D# ~"- , . ~ - . . - . . . .,CK#I D# -C K#D#C K#I D#

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SUB- TOTAL $TOTAL ( i f l a s t page o f t h i s s c h e d u l e )

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