Professional Documents
Culture Documents
Routine Penalties Due For Late Filed Reports Range from $20 to $800
heck if this is final (termination) report and attach Notice of Dissolution Form DR-3. County A Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed.)
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) .. .. .. . . . . .. . . . . . .. .. . . . .. .. .. . . . . . .. . . . .. . ... .. ... . . .. . . .. . .. . . . . .. .. .. ... . . .. . . . . .. . .. .. . . . .. ..... .. .. ..$
D
A v" I MONETARY
CONTRIBUTIONS - MONEY TAKEN IN
(Rev. 06417) RECEIPTS
(klckrdlrq canddete's PWWxtal lundt)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of OrganIzafion) AMENDING FORM
-]P r'.
SwW._&, L
h '/ / w Co )
STATE CANDIDATES NO IF A CONTR1" IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 688 .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (B applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# 'Sates.. D
`- g- 3ov CK# o1 M t -t X...r .. S4 ~--- $
A ~a~ 3 45`00
ID#
ID# , ~
A ~ qsr-TC~ ~ r R
CK# L}I~ f,t+L
T.5
~ &O
IDO
a P' 7
~ ^. -
ID#
oC o v~ y. F. c.,.~.i
-Da- S, ~ 52,3
ID#
ID#
o A wKa~. _ f-* r
1w CK# ) a 1 / S+,
S, DC7
_
ID#
CK#
SUB-TOTAL
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK ()f applicable) RAISER
NUMBER INCOME
ID#
ID#
...-l JoU,t
ICV36 /0 .00
iJAdty -
rf C A .S BDi3
ID#
PG l1 l eaaA.
2sz'1 8r" ~- Si- '~~ oZD .OD
-~ 3-kru CK#
-
ID#
CK#
t t. 1, 2 Prc s
~o .av
ID#
F Its _.,A %
.4s
. -
CK# a sz~ 5 _ y~Cas+
117-a, ' ,LI' , .,1- S> ~3
ID# to a
`© - ; 3
ID# M , d es.1 ,
ID# of
CK#
3 `1 LZ ~o.~ltd.r,Jtk.~,L
/- Sa . OO
SUB-TOTAL
.~ v ~
CANDIDATES NOTE : IF A d',ONTR1BUT "STAE CEtvED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS 1S AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 68B .32A(6). Iowa Code . prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory potical committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (g amicable) RAISER
NUMBER INCOME
ID# I+t9oOl ~~.s ..s
~
CK# 2 .rsha~ .,. ..5 t'
s' 1 ~3
IDs ~
lea" _P, a r .O"+l~
CK#
a.Y 0, %1
~--- I D, ~
Sa. g o~
IDtt C. $oark~l~'N.
CK# t F, 3 3 ~- C.4"
L`Oo .rw
IDII S a.,9c Lw
$,Ate
CK# 00
CK# 2 1 . 0V
IDII
CK#
~~ s3tFo3
asoo
IDII ~
T' A'Ft " o.l qr S 6~ ht
CK# a2 0 . 00
A S~ S ~ tr" 3
IDIt 2udw,*arr
SUB-TOTAL
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK Cd applicable) RAISER
NUMBER INCOME
ID#
CK#
ID#
~D.
ID# "'Do+ .OL S e..4*t" br.
l ~ 13 E I~ . Sk S+. 10 , a~
CK#
ID# (9 r 4Att l
t~ cue .,
j s'Lk 3 Si- ~._ IO . oa
CK# I
sh S }t~3
ID#
ID#
CK#
IN
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL
familial relationship, enter `not applicable' in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
~s C-0
CANDIDATE NAME AN -SS TO WHOM
!';1 PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID# 1w 0'J Ka,I u9o1- KS
b
10
;WUA [lot
ID#
CK# ~ y . ate`
lva
toil . A-
ID# M,lwr tfc,. .,k'.~ ~-
ID# x,1, .. ~-
~ t~ G) ~.1 3V " ~ ti. CI .I.-
CK# Its i ~ O© r 0c)
tt ~ trr
1D#
w"+E I~ a. ~ ~ ,,a mr lc s p Pa (, a ~ a+. cc.
$' t }0t9 JOIb a 1 3 G, ~.'
CK# ;2 3 . 76
/
ID#
CK#
SUB-TOTAL $
Y l. g
TOTAL (If last page of this schedule)
-0114~
.l
Purchases of certain campaign property costing 1500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions.)
Expenditures to persons/entitiee providing consulting, advertising, fund-raising . poitirp, managing, orgaNz(ng services must also be detall itemized on
"chedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee. (Refer to
hedule G instructions and Iowa Code 56 .6(3)(1).)
Page -/ _ of -.
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN KIND
COMMITTEE NAME (Must be same as on Stalenwnt of Oryrrlimdon) Rev. 06/97 CONTRIBUTIONS
30-7
00 / S q Sa~~
p 1
V
(7 ,G,
~~
,
_
~
~p " rrC,Da`4tT
~~orO
U4,1
0c)
SUB-TOTAL
TOTAL Of IM $
YSG . '*
page of this
- c7v .
schedule)
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives L-,
(for Sle )
by marriage) . (See Page 2 of forms packet.) if sumame of contributor is the same as candidate. but there is no
familial relationship, enter "not applicable' in the relationship column .
SCHEDULE
F
RECEIVED
L_ :)
(Rev. 08/96)
t a REPAID
;e ..
T- r` r.. (S -C, -t-
L [] CHECK THIS BOX IF
NOTE : This schedule reports money loaned to the c ittee which is deposited In the committee account.
AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIODS t ""I Dd . O0
PART I - MONETARY LOANS RECEIVED TM REPORTING PERIOD PART 11 - MONETARY LOAN REPAYMENTS MADEM REPORTING PERIOD
(Original source of ban, such as a bank, must be shorn it a third party is (Loans forgiven must be reported on Schedule E -- to-kind Contnbuhons l
involved Include loans from candidatospersonal funds .) - -
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (Include Endorser's Name, If Applicable) TO CANDIDATE OF LOAN (MM/DD/YR) (Include Endorser's Name, If Applicable) TO CANDIDATE' REPAID
MM/DD/YR It A IGWe' If likable
s s
'Disclosure law requires candidate committees to disclose the relationship of any relative
making a contribution to the committee. Relationship must be shown to the third degree of
consanguinity (blood relatives) and affinity (relatives by marriage). (See Page 2 of forms
packet.) If surname of contributor Is the same as candidate, but there Is no famikal
relationship, enter "not applicable" in the relationship column when It applies . Page- . .-- -~- of
(for Schedule F)