8/7/2019 Gaskill Mary__1376__scanned

1/4

F O R I N S T R U C T I O N S , SEE BACK OF FORMDI SCLOSURE SUMMARY PAGE

CO MI TTEE NAME ( Mu s t b e s ame a s a n St a t e me n t o f r g a ni z at i o n)L

f e J = MV

t 4 7r v < _

ruPORTANT : I n d c aOs p o f o 6mi t s . Yo u a r e

" g

t ) S t a t s w i d e l l e g 0Wi v e C an d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t s t e P a r t y ( a ) C o u n t y l t - o c a l C an d i d a t e( 5 ) C o un t y PAC ( 6 ) B a l l o t i s s u e / F r g n d i i s e Commi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co r t n n f e( 8 Ay y p o r t S l a t e o f c a nd i d a t e s

R o u t i n e P e n a l t i e s Du e F o r L a t e F i l e d R e p o r t s R a n g e f r t a n i s i Wj , OV

2 0 0 4S E E I NSTRUCTMS ON BACK AND C OMP L E T E T H E F O L L O WI N G S E N T E N C E : u r n I G - ~

I AMF I L I NG A

I , ~ S -AD~ ~-P/ D _ 2 1 0

REPORT FORANNA ( 1 ) ELECT/ 2 ON- ELECTI ON YEAR .

l

( r e p o r t d a t e )

-T

I n d i c a

CHECK I F AMENDMENT TO REPORT DATED

~C h e c k i f t h i s i s f i n a l { t e r m i n a t i o n } r e p o r t and a t t a c h N o t i c e o f D i s s o l u t i o n F or m DR- 3 .( Yo u must c o nt i nu e t o f i l e s po r t s u n f i t a No t i c e o f D i s s o l u t i o n i s f i l e d . )

STATEMENT OF CASH ON HANDCASHON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a lo f a l l mo v i e s h e l d b y t h e c ommi t t e e . T h i s amount MUST b e t h es ame as t h e c a s h o n h an d a t t h e end o f t h e t e s t r e p o r t i n g p e r i o d ,o r mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADO TOTAL MONEY TAKEN I N T HI S PERI ODSc h e d ul e A : Cas h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

I l

a S - . o G

Sc h e d ul e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . - - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FORMDR- 2~ DI SCLOSURE( Rev . 0 1 [ 9 8 ) REPORTL o r a l C o mm i t t e e s , e n t e r Da t e o f E l e c t i o n

C o u n t y 8 L o c a l C o mm i t t e e s , m e t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

8/7/2019 Gaskill Mary__1376__scanned

2/4

Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z e &o n )

L

1 ; ~Q=C> , ~~~4~-~. !e pa, , 42 r -

e

e

STATECANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC( POL I T I CAL ACT I ON COMMI TTEE) , L I ST THEPACI DENT I F I CATI ONNUMBERANDTHEPACCHECKNUMBER I N THEDESI GNATED COLUMN . AL I S T OF I D NUMBERS I S AVA I L A B LE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Sec t i o n 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e us e o f i n f o r mat i o n c o p i e d f r om r ep or t s and s t a t e me n t s f o r s o l

t g c of t t r i bu t a n s o r

f o r an y c omme r c i a l p u r p o s e b y an y p e r s o n ot h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SCHEDULEA MONETARY

( Re v . 0 6 1 9 7 ) RECEI PTSCHECKT HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT d I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DDI YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI D# l epc l < # 7 ! 7 7 3 ~: ~ 1 U l f ~ $ l , 1 ~ 0 ' DdI D# a o k ) a . 4 k Ao*e L 2 , - Y Z 6 j n P- 5 Z , - q - : : 7 - z 2 R. 0 9I D# 2 , 1 7 j . 17~ Add C : . r ` o Z . t r -CK# l ~( t r - e . en a o ' e 1 4 ) - , ; P - ' r r - a - ~ n o n ~ Sd~CJL92-I D# / t L 4 . J7 e r s , 4 - C

/ D~~ CK#va , z 3 ; F0 mod ~u~ / I i ' s Lut ,e . / .04 h am. SOD . ~ od e d L. . 6 z s :! 9 CK# , ~l ~8 FA5 P ., a l e -7 1 . 0 n. e . . l d D- 66o y . 8 9 2l D# j D . +t DWQ. ~nde~rt , t 3c t n

CK# 2a. l ~ I l eo3 - 2 - 2 n d 5 I t " 1Te . 2oz no n . E? / t ea-oaa zI D# ~/ L . ~ k . Z 10

8/7/2019 Gaskill Mary__1376__scanned

3/4

FOR I NSTRUCT I ONS , SEE a4CK OF FORM SCHEDULE

EXPENDI TURES B MONET ARY- MONEYSPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 9 1 9 7 ) EXPENDI TURESSTATE PAC COMUr I TEEB : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EGI S L AT I V ECANDI DATES, L I S T T HE CANDI DATE I DE NT I F I CA T I O N NUMBER I N THE DES I GNATEDCOLUMN AND T HE C7 CHECK T HI S SOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM T HE I OWA AMENDI NG FORME T HI C S b CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mus t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )

E l l v ` e - 5 e r t t 1CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE . AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACT I ON) EXPENDEDEXPENDED ( I f a p p l l c a b i s ) ( D i s b u r s e m e n t ) WAS MADE( MM I D I D V Y R ) ANDPACCHECKNUMBER

I D# d~Rl nu) ' s 1 ~ _ L ou~" t ~. w Zw f e dl D ' 4 5CK# a / , 3 . ~ . 7 a 1 7 , E~l l t 1 1 c e ) ~ z _ ~~~~ Sor um4 e - n Fu / I d

I D#CK#I D#CK#I D #CK#I D #CK#

8/7/2019 Gaskill Mary__1376__scanned

4/4

FOR I NSTRUCTI ONS, SEEBACK OF FORMCOMMI TTEE NAME( Mus t b e sa me a s o n S ta t eme n t o f O r g a n i z a t i o n )

e - e 5 ;NOTE : T h i s s c h ed u l e r e p o r t s mon ey l o a ne d t o t h e c o mmi t t e e wh i c h i s d e p os i t e d i n t h e c o mmi t t e e a c c o u n t .TOTAL UNPAI D LOANS FROM LAST REPORTI NGPERI OD $9PART i - MONETARY LOANS RECEI VED THI S REPORTI NG PERI OD( O r i g i n a l s o ur c e o f l o a n , s u c h a s a b a n k , mus t b e s h o w n i f a t h i r d p a r t y i si n v o l v e d . I n c l u d e l o an s f r o m c a n di d a t e s p e r s o n a l

TOTAL ( PART t )

$

' D i s c l o s u r e l aw r e q u i r e s c a nd i d at e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v ema k i n g a c o n t r i b u t i o n t o t h e c o mmi t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o fc o n s an g ui n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b y ma r r i a ge ) . ( S e e Page 2 o f f o r msp a c k e t . ) I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , bu t t h e r e i s n o f a m i l i a lr e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i on sh i p c o l u mn w h e n i t a pp l i e s

;e v e

TOTAL CASH REPAYMENTS ( PART / I )

$

F r o m Sc h e d u l e E - - TOTAL LOANSFORGI VEN

$

TOTAL OUTSTANDI NG LOANSEND OF REPORT PERI OD

PART 1 1 - MONETARY LOAN REPAYMENTS MADE THI S REPORTI NGPERI OD( L o a n s f o r g i v e n mus t b e r e p o r t e d o n Sc h e d u l eeEE - - I n - k i n d C o n t r i b u t i o n s . )

Page--- / - o f( f o r Sc h e d u l e F )

SCHEDULEF LOANS( Re v . 0 8 / 9 6 ) RECEI VED8 REPAI D( ] CHECK T HI S BOX I FAMENDI NG FORM

DATE PAI D( MMI DDI YR) NAME AND ADDRESS OF LENDER( i n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e ) RELAT I ONSH I PTO CANDI DATE"I f A p p l i c a b l e )

AMOUNTREPA I D$

DATERECEI VEDMM/ DD/ YR

NAME AND ADDRESS OF LENDER( I n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e )RELATI ONSHI PTOCANDI DATE

i f i c a b l e 'AMOUNTOF LOAN