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Disclosure Summary Page Dr-2: Nneaek S For Aerl'4
Disclosure Summary Page Dr-2: Nneaek S For Aerl'4
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S1 NATUROF TREASURER (or person filing this report) TELEPHONE DATE SIGNED
Late filed re ports are subject to possible civil and criminal penalties .
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report date)
Indicate one
Local Committees, enter Date of Election
FICHECK IF AMENDMENT TO REPORT DATED
&ue"e +- a , aoo ~
County & Local Committeeg, enter County in
which Election is held
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
(You must continue to file reports until a Notice of Dissolution is filed .) o P'L~ 0 L~'_U"
"*UNPAID BILLS (From Schedule D - Attach Schedule D) . . .. .. .. .. ...... . .... .. .. .. .. .. .. .. .. .. .. . ... . . ..... .. .. . . . .. .. .. $
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .. .. .. .... . . .. ... .. .. . . .. .. .. .. .. .. .. .. .. .. .. .. $
a
**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) .. .. .. .. .. .. .. . . .. .. . .. .. . . .. .. .. .. .. .... .. .. .. .. .. $
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) El YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
FGr Instructions, See Back of Form SCHEDULE
I
e S r ~~ - 102
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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
01M _1W
ID#
e
!~ v2 o CK# e
"r ID#
/U/D~/o l CK# p 0 3 ~'Eat f~ ~~-r et
GliVlkYb L9 1.L Wc,-, 50 J j
J
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) . Ifofsurname of contributor is the same as candidate, but there is no Page ___ I
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
Fo: Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
OM ITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
900je rs C~ r
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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
CK#
ID#
CK#
I D#
CK#
I D#
CK#
I D#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $~~~ 00
G r' lI WS s~I I
CANDIDATE
I
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
T .~.
~T ~1~.-tip IL 0-a
~Ket
I ~v o C K# a~ ~ root
c ~ )E l ~ V~l EST S .
1D# J , /cQ-Q. . .. ~ (~~~
LK~-e r I VYLES ootk
~9 D
lD CK# b 9, ~ - ~.c6,~ Au_e.
c1 A d-5 o "s e }WN"cc s
CK# oi mctk
SUB-TOTAL $~j
4 -I
TOTAL (if last page of this schedule) S
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, aganizing 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 .6(3)(i) .)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM "`~~ SCHEDULE
CK#
1D#
CK#
1D#
CK#
1D#
CK#
1D#
CK#
ID#
C K#
1D#
CK#
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, aganizing 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 .6(3)(i) .)
Page (/) of
(for Schedule B)