Professional Documents
Culture Documents
Disclosur Summary Page Be Same As On Statement of Organization) JUN 1 0 $ OQ Repor?
Disclosur Summary Page Be Same As On Statement of Organization) JUN 1 0 $ OQ Repor?
SIGNAT
.
2i~~
k E OF TREASURER (or person fill his report)
a99 530
TELEPHONE DATE
0, IG ED
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A I REPORT FOR AN/*6T0LECTION /(2)NON-ELECTION YEAR.
Indicate
( rt date) l- one
ECK IF AMENDMENT TO REPORT DATED Local ittees enter Date of Election
~ Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Commute , enter Count
(You must continue to file reports until a Notice of Dissolution is filed.) which Election is held
**UNPAID BILLS (From Schedule D - Attach Schedule D) .. ....... ......... ....................... .. . .. ......... .. ... ....$
*IN KIND CONTRIBUTIONS (From Schedule E- Attach Schedule E) ......... .. .. .. . ............... ................$
**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) ........ .. ... . . .... . .... ...... .. ... .. . .............$
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES YNO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
For Instructions, See Back of r-irm SCHEDULE
I MONE-ARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 06/97) RECEj'P7S
(including candidate's personal funds)
Q CHECK THIS BOK IF
'Organization)
COMMITTEE NAME (Must be same as on Statement AMENDING FORK
t ~-k, ~
STATE CANDIDATES NOTE. IF A CONnIBUTIDN 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 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 .
r
CK#k
__ ~D lvl ;i v ,Y1Q
I
u
CK# 6D
41
(5I-9M $irrl
I b CK#
'N61
W YY/WK t, (,re V I
CK#
Lid
CK#
ID#
CK# . .
JEW
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL
$
TOTAL (if fast page of fhis
- schedule) $
' 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 sumame of contributor is the same as candidate, but there is no . Page of _
familial relationship, enter "not applicable , in the relationship column. (for Schedule A)
FOR INSTRUCTIONS, SEE SAc,K OF FORM
SCHEDULE
wt-
NUMBER
1A
. ID* tQ6U~l- ~bvytfiL~ b W~1 a~-t ~-
t (?~ ~ 1~r CK#
r 2[t ' ~o, (30X
ID# ~
~
r,V
/~ Phi
-
loo ~ ~1
eit
ID#
f I~
l9 CK#
.
D Ic~ 0, cal -;
ID#
L( Vt.II ~ o'~o~b ~-or ~' , sue, i
set
ID#
~ CK# ~ - I
w"lam
- -,W, - - 3UB-TOTAL $
TOTAL (ifiast page of this schedule) Ls G~rva
6~P
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 56.6(3)(1).)
(for Schedule 8)
L ACV
(a'
4-dx~
FOP 11,11STRUCTIONS. SEE BACK C - =ORM FORM
DISCLOSURE S~MMARY PACE DR-2 DISCLOSURE
(Rev . 0112001) REPORT
COMMITTEE NAME (Must became as on Statement of Org nizaiion
v For Office Use Only
Comm . # .1
IMPORTANT: Indicate type of com ee you are reporting for:
Indexed
tatewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party (4 )County/Local Candidate Audited 6-02--
)County PAC ( o )Ballot Issue/Franchise Committee (7 )CountyiCity Central Committee
( 8 )Support Slate of Candidates Computer
4'1
Office Sought District (if Senate or House) JAN 2 2 2002
1di -31
~7
D3
SIGNATURE OF TREASURER (or person lifting this report) TELEPHONE DATE iG ED
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A 1 I bZ LECTION /(2)NON-ELECTION YEAR .
i
(report date) dicate one
CASH ON HAND at the beginning of the reporting period . (This is the total of all monies held
by the committee . This amount MUST be the same as the cash on hand at the end
of the last reporting period, or must be zero if this is first report filed.) ... .............................$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) .........
Schedule F: Loans Received total (Attach Schedule F) ........ .................... ....... .......... .. .. ..... .
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ....... ..... .. . .. ..... ............
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL...... $
**UNPAID BILLS (From Schedule D - Attach Schedule D) . .......... ............. ..... ....... ....... .. ............ .... .. .$
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) ..... .. .. ... ...... ....... .. ... ....... .... .....$
**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) ......... .. .~J.. .1 . . . .: .....$
STATE CANDIDATES N IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC C I( NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE ICWA 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
far 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-
(MMIDDlYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
4~ r
f
3
b CK#
~M rv
ID#
ll~~ DI CK#
llV
AN J
_
CK#
ID#
ti CK#
l trot l
ID#
I' 16e, U U
CK# +~ u
ID#
It
q7
Z CK# v
ID#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
SUB-TOTAL
~~6 q 06 010
TOTAL (if last page of this
schedule)
' 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 sumame of contributor is the same as candidate, but there is no Page of
familial relationship, enter "not applicable* in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
EXPENDITURES s-
MONEY SPENT FROM COMMITTEE ACCOUNT a MONETARY
(Rev . 09197) EXPENDITURES
STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 7 CHECK THIS BOX IF
PAC CHECK NUMBER FOR E4CH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.
~l r -- S;XP
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# n 9
CK#
1D#
ftv,"
CK# U '
ID# IJ
ID#
- I
CK#
0i b CK# f
I
CK# P,
a.
CK#
ID# ~_
10
cK# I
LIM,
-
SUB-TOTAL
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 56 .6(3)(i).)
Page 1 of
(for Schedule B)
10 c1e Z '6Z tA-tj C
-6
oa" 4 ire s 5
i~b^-ovu 1~Q .
h I
~ , coo
P
(2j D
i
D5
5~1
~~I&
atkd-c~~
I
yviPU~a lt3w,
Co wt
- ~i k
OCA, c9 y ed 44 6 W ItOCQ-
NOTE : This schedule reports mono n to the committee which is deposited in the committee account. [] CHECK THIS BOX IF
AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $
PART I - MONETARY LOANS RECEIVED IRIS_ REPORTING PERIOD PART 11- MONETARY LOAN REPAYMENTS MADE THIS _ REPORTING PERIOD
(Original source of loan, such as a bank, must be shown If a third party Is (Loans forgiven must be reported on Schedule E -- In-kind Contributions .)
involved . Include loans from candidate's personal 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/DDIYR) (Include Endorser's Name, If Applicable) TO CANDIDATE* REPAID
MM/DDIYR If A Ilcable*) If A licable)
*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 familial
relationship, enter "not ap plicable" in the relationship column when It applies .
(for Schedule F)