Professional Documents
Culture Documents
18 2006 11 :24AM P1
[a~ 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 fllo ruporto until a DR--3 13 flied .)
which Election is held
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TOTAL S . i5
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TOTAL (if last page of this schedule) _
Purchases of certain campaign property costing $500 or morn rnust also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to persona/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be dotall Itemized on
Sehedulu G by the arnount, purpoeo, and data of oach typt- of expenditure made by Ute pemonlnntity on behnlf of the candldatc's coironlttoe . (Ref~i to
l Schedule G Instructions and Iowa Code 68A .402(3)(i) .)
Page
(for Schedule B)
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FOR INSTRUCTIONS . SEE aACK OF FORM
Dale Purchased co
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(Schedule B) Purchase Current
Description of Property Price or Est . Value at Fair c
or Date Received Date Narne and AddreS : of Purchaser/Donee Descdption,cf Property SDIV Sale Value of
(Schedule E) Value When Market This (MWDDIYR) WN Price Donation n
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MMIDDYR) Acquired' Report co
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TOTAL VALUE CAMPAIGN PROPERTY THIS REPORT PROPERTY SALES & TRANSFERS TOTAL c t TOTALS $ 6OD $ 3
(TRANSFER TO SUMMARY PAGE) $ -G - (TRANSFER TC SUMMARY PF.GE) S
If estii nated . show est. beside figure. (Attach Additional Schedrles if Needed) Pace I _- Df I - -_ Pages W
(For Schedule H)
FROM :AGCON FINANCIAL SERVICES FAX NO . :+712-368-2855 Oct. 18 2006 11 :26RN P4
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71
SUB-TOTAL S
*Diarloaure low requires candidates to disclose the relationship of any relative making an in kind contribution to the Page I of )
commlttoe . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relativea (for Scheduie E)
by marriage), (See Page 2 of forms packet .) if surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" In the relatlonshlp column .
FOR WSTRUCT10NS, SEE BACK OF FORM
SCHEDULE
0 E _ - This schedule reports money loaned to the committee which is deposited in the ao»mittee account, EDCHECX THIS BOX IF
AMENDING FORM
1l .- '.T.., -LE ~r _ -~,~~~ L- J70J_-_ $
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LE f I U--- -~`.- - l-]_- 0 -0i --GC7-I-' __-7--ID-----0--- =--i:-
(Original source of ken, such as a bank, must be shown if a third party is (Loans forgivan must be reported on Scheduia E1= -- in-kind Contribvtions .)
involved_ ladude loans frorrr cana0date's personal funds.)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (Include Endorsers Name, If Applicable) TO CANDIDATE OF LOAN (MMIDDIYR), (Include Endorsers Name, If Applicabie) TO - CANDIDATE' REPAID
hALVDD[YR (It nabs* If Applicable)
$
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'Disclosure law requires candidate committees to disclose the relationship of any reladve
making a contribution to the cam mittee . Relationship m List be shown to the third degree of
consanguinity (blood relatives) and affinity (relatives by marriage)_ If surname of contributor is
the same as candidate, but there is no familial relationship, enter `not applicable" in the
relationship column when it applies, Page of
( r Schedule
4. A final report disclosing all transactions closing the committee .
For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed .
idate or Treasurer (if candidate's commltte /Signature of Chair or Treasurer (if PAC)
o ._t
Date Signed