Professional Documents
Culture Documents
Late reports are subject to possible civil and criminal penalties. Pursuant to Iowa Code section 68B .32A(7) the candidate, for a candidate's committee,
and the chairperson, for any other yyye of committee, is the individual responsible for filing timely and accurate reports .
TELEPHONE
6C'3-3 ~ra 4so&
DATE SIGNED
o I ? s
I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR.
(report date) Indicate by #
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed .) which Election is held
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 LIST OF ID 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 (if applicable) RAISER
NUMBER INCOME
#4A&A*A0+CW1A1nlgr-_ /V~SO~J
ID#
1013/ OS CK#
0?47
0#/0 T, ~ ~L~DiP/s 5_d, 4P
44)e-4 elAR4
C~
ID#
)WIJLZWAI
~4/3ilas CK#
leer
ID#
r#ek :!WDld-l- VS6 ki~k~6i9 ~1
JD/~3l~05 CK# E g&
09 UPP 2 k1.~y Duo ff
,SQ, G9~
0
I D#
~D yo~h2
JI~~~DS CK# 508 Fi g D~oR~9f! a.~, o0
+IlMM SN!/Thl
CK#
ID#
C K#
SUB-TOTAL
* 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) . ofIf surname of contributor is the same as candidate, but there is no Page 1
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Fonn
SCHEDULE
ID#
e,W ~/TDlD Iy9, Oo
CK#
po,~xa~ D~C'o~9N -9 I 7"l.SAls
ID# Id
Po~TA~ s R~roE
CK# .STi~MP..S $37gO
ID#
meAoUH M6619PEe5
ll~//05 cK# ~D I PTI S/ ' ,x/37, o
40
~,
4),47M ST DE~B~P ~}
Mh8e!S )Q4STi9!V4fA17- r-L6 .°T70AI A>14~0ffT
1
11 ` 105
CK#
/v E, l0TL Y~ 51" )9r0RTy
so . Gb
/a/s/DS lJD~VATio~J
CK#
"10 AeflAmy 14),
D
SUB-TOTAL $
TOTAL (if last page of this schedule) l
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule 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
Schedule G instructions and Iowa Code 68A.402(3)(i) .)
(for Schedule B)