Gronstal Michael142scanned

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FOR I NSTRUCTI ONS, SEE BACK OF

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FORM

D R- s2( Re v . 0 1 / 9 8 )

I Fo r O f f i c eUs e On i

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[ ] CHECK I FAMENDMENT T O REPORT DATED

SI GNATURE OF TREASURER ( o rp e r s o n f i l i n gt h i sr e p o r t )

~ I a - Sa e- a &~ ) RT EL EPHONE

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SEE I NSTRUCTI ONS ON BACK AND C OMPL ET E T HE FOL L OWI NGS ENTENCE :

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_ 1 q - - 0L - - - - REPORT FOR AN/ A( 1 )E L ECT I ON/ ( 2 ) NON- EL ECTI ONYEAR .

( r e p o r td a t e ) I n d i c a t eo n e

f 7 C h e c k i f t h i si sf i n a l( t e r m i n a t i o n )r e p o r ta n d a t t a c h N o t i c eo f Di s s o l u t i o nF or mDR- 3.

( Yo umust c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo f D i s s o l u t i o ni s f i l e d. )

STATEMENTOF CASHON HAND

L o c a lC o mmi t t e e s ,e n t e rDa t eo f E l e c t i o n

Co u n t y& L o c a lCo mmi t t e e s , e n t e rCo u n t y i nwh i c h E l e c t i o ni s h e l d

CASH ON HAND a t t h eb e g i n n i n go ft h e r e p o r t i n gp e r i o d. ( T h i si s t h e.t o t a lo f a l lmo n i e s h e l db y t h ec o mmi t t e e. T h i sa m o u n t MUST b e t h e

s a m e a s t h ec a s h o n h a n d a t t h ee n d o f t h el a s t r e po r t i n g p e r i o d ,o r must b e z e r oi ft h i si s f i r s tr e p o r tf i l e d. ) . . . . ... . . . . ... . .. .. .. . .... ... .. .. .. . . . .. ... . .. .. . . ... . . . . . ... . . ... .. . . ... .. .$ADD TOTAL MONEY TAKEN I NTHI SP ERI O D

S ch e du l eA: C a s h C o n t r i b u t i o n st o t a l( A t t a c hS ch e du l e A ). .. .. .. .. .. .. .. .. ... .. ... . . ... ... .. .. . .. . .. . .. .. . J4 t ( ~ . 6

i COMMI TTEE NAME ( M I I I

I >s t b e s ame a s o n o f Or g an i z e d

c o y '- ~Vb nt ar me n t ~Co mm .

I n d e x e d

I l Yi H ~ A u d i t e dI MPORTANT: I n d i c a t et y p eo fc o mmi t t e ey o ua r er e p o r t i n gf o r. C o mp u t e rk 1 1 2( 1 ) S t a t e w i d e / L e g i s i a t i v eCa n d i d a t e( 2 ) S t a t e w i d ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t y / L o c a lCa n d i d a t e( 5 ) Co u n t y PAC ( 6 ) b a l l o tI S S Ue l r r a n C n 1 S et; Q T r n l i t e e( 7 ) C ou n t y l Ci t yC e n t r a lC o mmi t t e e( 8 ) S u p p o f tS l u eo fCa n d i d a t e s



( ) t

F o r I n s t r u c t i o n s ,Se e B a c k o f F o r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TT EENAME ( Mu s tb e s ame a s o n St a t e m n t o f Or g an i z a t i o n )

SCHEDULEA MONET ARY

( R ev . 0 6 / 9 7 )I

RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI S RECEI VEDFROMA STATE PAC ( P OL I T I CA LACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENTI FI CATI ONNUMBER ANDT HE PAC CHECK NUMBER I NTHE DESI GNATEDCOL UMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se c t i o n 6 8 B. 3 2 A ( 6 ) ,I o w aCode , p r o h i b i t st h e u s e o f i n f o r ma t i o nc o pi e d f r o m r e p o r t san d s t a t e me n t s f o r s o l i c i t i n gc on t r i bu t i o nso rf o ran y c o mme r c i a l p u r p o s e by a n y p e r s o n o t h e r t h an s t a t u t o r yp o l i t i c a lc o mmi t t e es .

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i fa p p l i c a b l e ) T O CANDI DAT E' RECEI VED FUND-

( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SERNUMBER I NCOME

~ l ~ r OlI D#,~ y

a6 G

EL F ' a n o W~ O d

CK#~~~ ~ 5 a c 5 - ) Ob

L. , 1 A5

a sI D# ~~ R ; Z;o / 0 5

CK# f dZ~l Gj r 0 14/ &3 - e5

I S Ol d C SI n

l D# son

CK#° a t ea y ~ ~ l ' d 7

ID# ~ a 4 lt l

CK# 7 1 ~ ~ lf 8 r

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Fo r I n s t r u c t i on s , Se e B a c k o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a l f u n d s )

COMMI TT EENAME ( Mu s tb e s a m e a s o nS t a t e me n to f Or g a n i z a t i o n )

STATECANDI DATESNOTE: I FAC ON T R I B U T I O NI SR E CE I V E DFROMAS TAT EPAC( P O L I T I C A LA C T I O NC OMMI T T E E ) ,L I S TT HE PACI D EN TI F I CAT I O NNUMBERANDTHE PACCHECKNUMBERI NT HED E S I G NAT E DCOLUMN. AL I S TOFI DNUMBERSI SAVAI L A B L EFROMTHEI O WAE T HI C SANDC A MPA I G ND I S C L O S UR EBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h eu s eo fi n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o r s o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDULEA MONETARY

( R e v. 0 6 / 9 7 ) RECEI PTS

CHECKT H I SB OXI FAMENDI NGFORM

DATE PAC I DNUMBER NAMEA N DADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT q I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D/ Y R)A NDPACCHECK ( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOME

CK# . 39 , 30 > r ' .q

l

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I D# P e n n ! Y A( l AAd

CK# ~ b y a a lSf W,/ I e ~: " f i g I ~

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COMMI TT EENAME ( Mu s t b e s ame a s o n S t a t e me n to f Or g a n i z a t i o n )

" ~5 -f : ,x ( 3 ( - t tP~~ %

STATECANDI DATESNOTE: I FAC ON T R I B U T I O NI SR E CE I V E DFROMAS TAT EP A C( P O L I T I C A LA CT I O NC OM MI T T E E ) ,L I S TT HE PACI D EN T I F I C AT I O NNUMBERA ND T H E PA CCHECKNUMBERI NT HED E S I G N AT E DCOL UMN. AL I S TOFI DNUMBERSI SAVA I L A B L EFROMTHEI O WAE T H I C SANDC A M PAI G ND I S C L O S UR EBOARD.

CAUTI ON: Se c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h eu s eo fi n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a l p u r p o s eb ya n yp e r s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDUL E

A MONETARY( R e v. 0 6 / 9 7 ) RECEI PTS

CHECKT H I SBOX I FAMENDI NGFORM

DATE P ACI DNUMBER NA MEA NDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I FF ORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D/ Y R)A N DP A CCHECK ( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOME

/

~` %b l I D # GAD

CK#6 5 / 3s ~ w

I D # K ; f A ( ~ l J- &- J . 5 << ~

t i CK # i , A y e

I D # Al t R -C* C- r ~e

O

I D # 1 4 3 3

I D#J ,

~ , nd

1 CK# ' 7 i t ~ v I b 67v ~ ~ 3 0 9I D# j

" W5CK# Y ' v I

5 ~31 !S



F o r I n s t r u c t i o n s ,Se e B a c k o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

COMMI TT EENAME ( M u s tb e s a m e a s o nS t a l em n t o fO r g a n i z a t i o n )

' ~~ ~ e; t ~4 a d , 6~ 1 3 7

STATECANDI DATESNOTE: I FAC ON T RI B U T I O NI SR E CE I V E DFROMAS TAT EPAC( P O L I T I C A LA C T I O NC OMMI T T E E ) ,L I S TT HE PACI D E N T I F I C AT I O NNUMBERANDTHE PACCHECKNUMBERI NT HED E S I G NAT E DCOL UMN. AL I S TO FI DNUMBERSI SAVAI L A B L EFROMTHEI O WAE T HI C SANDC A MPA I G ND I S C L O S UR EBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h eu s eo fi n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o m m e r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mm i t t e e s.

SCHEDULE


CHECKT H I SB OXI FAMENDI NGFORM

DATE

RECEI VED

P A CI DNUMBER( i fa p p l i c a b l e )

NAMEA NDADDRESSOF CONTRI BUTOR RELATI ONSHI P

TO CANDI DATE*AMOUNTRECEI VED

I FF ORFUND-( MM/ D D / Y R )A N DP ACCHECK ( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOMEI D# OSI P N1 . O

CK# i 3 a , 3 1 1 7> J F %

$ C 6 1

wes i 91C , - Ax r t ~, 0 a 6 6

/ 1 1I D#

~4 6 Z S ~ P t ~ 5 ~ c ,

f ` f '

a .r o

CK# 3 ! * d?0 3

Co /o a

I D# A 1 f h e1 f

CK# o ~ 1 c 3 Gr Ry f ) ~0 1 1 ~ t ~d o f f .

i) CK# 13 j - /J . t n l 5 4 '

f II D # 10 A, _ j ,

hb o

CK# * 9 / s s .

%/ ~ a ~ ~ t c s ows , 431aI D #

i e v ' ~ 32 ~ 8A TE PA

CK# 3 &j ,. 6~6AJA1<5a ~s .



Fo r I n st r u c t i o ns , See Back o f F o r m


COMMI TTEE NAME ( Mu s t b e s ame a s o n St t o e n t o fOr g a n i z a t i o n )

C, 1 ' ~ 2 6 Q z a p 6 'x - 5

SCHEDULE

A I MONETARY( Re v. 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I F

AMENDI NG F ORM

STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI S R E CE I V E DFROMA STATE PAC ( P OL I T I CA LACTI ONCOMMI TTEE) ,L I S TTHEPAC I D EN TI F I CATI ONNUMBER AND THEPAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN. A L I S TOF I DNUMBERS I SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) ,I o wa C o d e , p r o h i b i t st h e u s e o f i nf o r ma t i o nc op i e d f r o m r e p o r t san d s t a t e me nt s f o rs o l i c i t i n gc on t r i b ut i o ns o rf o r a n y c o mme r c i a l p ur p o se b y an y p e r s o n ot h e r t h a n s t a t u t o r yp o l i t i c a lc ommi t t e e s.

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F F OR

RECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ D D/ Y R) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOME

I D# J T' f hQ& 0A, / i n

I D%: aID#

d )CK#

CK#

Al ai ~~ ~ ~

I D# / Q ~ ~ r r l ( > t '

CK#

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. 6y

CK#

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COMMI T T E NAME ( Muse s ame a s o n e~ o f Or g a n i z a t i o n)

C/ i z ~s av~

STATE CANDI DATES NOTE : I FA C ON T RI B UT I O NI S R EC E I V E DFROM A STATE PAC ( P OL I T I CA LACTI O NCOMMI TTEE) ,L I S TTHEPAC I DE NT I F I CATI ONNUMBERAND THEPAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN. A L I S TOF I DNUMBERS I SAVAI LABLEFROM T HE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se ct i o n 6 8 B . 3 2 A ( 6 ) ,I o wa Co d e, p r o h i b i t st h e u s e o f i nf o r ma t i o nc o pi e d f r o m r e p o r t san d s t a t e me nt s f o rs o l i c i t i n gc on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s eb y an y p e r s o n o t h er t h a n s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDULEA MONET ARY

( Re v . 0 6 / 9 7 ) RECEI PTS


AMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUN T 4 I F F ORRECEI VED ( i fa p p l i c a b l e ) T O CANDI DATE" ` RECEI VED FUND-

( MM/ D D/ Y R) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#

;/ No / CK# X3 y6 r~Sand I r ' A

FA ~i aI D #

o j g6 ~ ~ ~; ~ ~ A K cCK#

A V Z S 7

CK#

/ I D # A R , f i n. a s , a 0

ID# j ) c i 1 E ( i YA Q .

~ c o 0CK#`~ / %- I

ID# I A~k~l

/ a

CK#~

4




CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TT EENAME ( Mu s tb e s ame a s o n S t a t e m e f r to fO r g a n i z a t i o n )

S TATECANDI DATES NOTE: I FAC ON T RI B U T I O NI SR E CE I V E DFR O MAS TAT EPAC( P O L I T I C A LA CT I O NC OMMI T T E E ) ,L I S TT HEPACI D EN TI F I C AT I O NNUMBERANDT H EPACCHECKNUMBERI NT H E D ES I GN AT EDCOL UMN. AL I S TOFI DNUMBERSI SAVAI L A B L EFROMTHEI O WAE T H I C SA NDC A MPA I G ND I S C L O S U R EBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h eu s eo f i n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDUL EA MONETARY

( R e v. 0 6 / 9 7 ) RECEI PTS

CHECKT HI SBOXI FAMENDI NGFORM

DATE PA CI DNUMBER NA MEA NDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I FF ORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE* RECEI V ED FUND-( MM/ D D/ Y R)A ND PACCHECK ( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOME

CK #

I D# 6 o x A C C -07 " ? 06

t t CK #

I D# ~ 4 r , ~ RAC% V S, d L ) ' d dCK # d 8 & W ~5/ .

1ID#

60 5CK #L - A h '

n e - ~ a d aY O I.

I D# d y v 6 l v r e ,

CK #E f a n 5 ~ ~ ~1 D# ~ wr r t l h d o

1 3CK #





COMMI TT EENAME ( M u s tb e s ame a s o n St a t e met o f r g a n i z a t i o n )

Cy ' ~ - ~ ~ 2 sS TATECANDI DATESNOTE: I FAC ON T R I B U T I O NI SR E CE I V E DFR O MAS TAT EPAC( P O L I T I C A LA C T I O NC OM MI T T E E ) ,L I S TT HEPACI D EN TI F I C AT I ONNUMBERANDT HE PACCHECKNUMBERI NT HED E S I G NAT E DCOL UMN. AL I S TOFI DNUMBERSI SAVAI L A B L EFROMT HEI O WAE T H I C SA NDC A MPA I G ND I S C L O SU R EBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h eu s eo f i n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a n s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDUL E


Q CHECKT H I SBOX I F

AMENDI NGFORM

DATE PA CI DNUMBER NA MEA NDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I FF ORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ D D/ Y R)A ND PACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOME

CK #ZA, s = ~ a L A

I D# V h l y - - o O, ~

L1C O1n r ' f Yt Ckt G .

CK #0 2 z 5 A d ' ' S'

I D # dNA#CA

CK# 6 c ~0 VV t ~ h ~. / ~D s l

lD#1 - 1 7

' /6 Av - PA

p _~AC,

nd- d~

`~ s ~ -~a b Y y l, ~ y ~PA <

1Y CK # ~ V e - z %X oOt An A 1 ' 8 -

ID#

' 7 1CK #6 6 7

-




CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a nd i d a t e ' s p e r s o n a lf u n d s )

COMMI T TEE NAME ( Mu s t b e s ame a s o n St a t e e n t f Or g a ni z a t i o n)

STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI SRECEI VEDFROMA STATE PA C ( P OL I T I C A LACTI ONCOMMI TTEE) ,L I S TTHE PAC I DE NT I F I CATI ONNUMBER AND THEPAC CHECK NUMBERI NTH E DESI GNATEDCOL UMN . A L I S TOF I DNUMBERS I SAVA I L A B L EFROMTHE I OWAE T HI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se ct i o n 6 8 B . 3 2 A ( 6 ) ,I o wa Co d e, p r o h i b i t st h e u s e o f i nf o r ma t i o nc o pi e d f r o m r e p o r t san d s t a t e me nt s f o r s o l i c i t i n gc on t r i bu t i o nso rf o r a n y c o mme r c i a l p u r p o s e bya n y p e r s o n o t h er t h a n s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDULE

A MONET ARY( Re v . 0 6 / 9 7 ) RECEI PTS


AMENDI NG FORM

DATE PA C I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ I I F FORRECEI VED ( i fa p p l i c a b l e ) T O CANDI DATE* RECEI VED FUND-

( MM/ D D/ Y R) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SERNUMBER I NCOME

~~ t P

AVr x;/ L I P'

, . ..$ /

CK# i l l JFA / 1 ,-wr O

I D# nCK#

z n s . AcA45 7~ ~ o d . ( n f a~n Pk y Si. a00 0 6 ,

ID# K e yc K#a t Y~ ~S v r <13 d 3

I D# ~r A cr

v G VAACJ 4y a .CK#1 L J C. ~ R, 5 , - 1 W5 , Sd 3 a

I D# ~ . ' r v l e~2

W

C t , ~Al a 0

n . ~i ~, ~~) " / -- -vCK# J n

C~ , t 3 J U ~v ~ ~ i ~o 3

oa l c r

CK#4 ~ 60



Fo r I n s t r u c t i on s , Se e B a c k o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n al f u n d s )

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a e m n t o f Or g a ni z a t i o n)

C~ f " ~ZEr v o~ 6' v' a

STATE CANDI DATES NOTE : I FA C ON T RI B UTI ONI SR EC EI V E DFROMA STATE PA C ( P OL I T I C A LACTI ONCOMMI TTEE) ,L I S TTHE PAC I DE NT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I S AVA I L A B L EFROM THE I OWAE T HI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Sec t i o n 6 8 B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h e u s e o f i n f o r ma t i o nc o pi e d f r om r ep or t sa n d s t a t e me n t s f o r s o l i c i t i n gc on t r i bu t i on so rf o ra n y c o mme r c i a l p u r p os e bya n y p e r s o n o t h e r t h an s t a t u t o r yp o l i t i c a lc o mmi t t e es.

SCHEDUL E

A MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS


AMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-

( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SERNUMB ER I NCOME

~# VA ;f ~ n n- z e d-

s w, 3

CK#

o

PA~r J `I D#

-

/ yt ..t,

(. 3O3

, J ( x ' ' OG

A & c . ( l o a aI D#

W h 5 h 6 AMc ° 6 r'

CK# 6 a % n , ~ 1. Ar % 6 , s f E~- w _ 1 ~ ., ^ p z s ~

`

1 D# t c Gt ~ y , v~t oo

a - 1 0 e s

f N~ f I tCK#

l 0 e ( r u oI D#2 x ~ i N-. 1. 14 a d ; GZ Z

CK# L 5, ~~~d

CA~ r t r ± / 1 o t ~



F o r I n s t r u c t i o n s ,Se e Ba c k o f F o r m


COMMI TT EENAME ( Mu s t b e s ame a s o n St t e mj n t o fOr g a n i z a t i o n )

STATECANDI DATESNOTE: I FAC ON T R I B U T I O NI SR E CE I V E DFROMAS TAT EPAC( P O L I T I C A LA C T I O NC OM MI T T E E ) ,L I S TTHE PACI D E N T I F I C AT I O NNUMBERANDTHE PAC CHECKNUMBERI NT HED E S I G N AT E DCOLUMN. AL I S TOFI DNUMBERSI SAVA I L A B L EFROMTHEI O WAE T H I C SANDC A M PA I G ND I S C L O SU R EBOARD.

CAUTI ON: Se c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t s t h eu s eo fi n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o m m e r c i a l p u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDULEA MONETARY

( R e v. 0 6 / 9 7 ) RECEI PTS

CHECKT H I SBOX I F

AMENDI NGFORM

DATE P AC I DNUMBER NAMEA NDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT V I FF ORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM / D D / Y R)A N DP A CCHECK ( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOME

7 ~ YQ~ , rI D #

Pe 6 Pl 6 S NA4 i ' a n A1 6 A h k

CK# 4 r & ~ i ~ ~ R3

I D #US , BAn k

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#



FOR I N S T RUC T I ON S ,SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI T T EE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATEPACCOMMI TTEES: NOTE: F ORCONTRI BUTI ONSMADETOSTATEWI DEORL E GI S L AT I V EC A ND I D AT E S ,L I S TTHECANDI DATEI DE NT I F I C AT I O NNUMBERI NTHE DESI GNATEDCOL UMNANDTHE El CHECK T HI SBOX I FPAC CHECKNUMBERFOREACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI L A B L EFROMTHE I OWA A ME N D I N GFORME T H I C S&CAMPAI GN DI SCLOSUREBOARD.

COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n to f Or g a n i z a t i o n )

C t ' fso , ~ " ' a r v ~ , / - ~ /CANDI DATE N A ME A N D A D DRE S STO WHOM PURPOSE AMOUNT

DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE

( MM/ D D/ Y R )ANDPACCHECKNUMBER

' iAN J )

CK#30 ^ > 7 39 s - AS

$ `

_ 4cnx 43ID#

j ~ h6 Se e-

v l -

CK #

. ~ r t i ,. 3

I i 0 dw A ' r 1 S

/ r 9l e ,f 1 D # r 7

CK # 1 7 3 9 Gv 0 n ~ A~

I D #

CK #

/ I D #



FOR I N S T RUC T I ON S ,SEEBACK OF FORM SCHEDULE

EXPENDI TURESB MONETARY

- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURES

STATEP A CCOMMI TTEE S: NOTE: F ORC ON T RI B UT I ON SMADET O S TAT E WI D EOR L E GI S L AT I V EC A ND I D AT E S ,L I S TTHE C A ND I D AT EI DE NT I F I C AT I ONNUMBERI NTHE D E S I G NAT E DCOL UMNA NDTHE CHECK T HI SBOX I FPACCHECKNUMBER F OREACHEXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI L A B L EF ROMTHE I OWA A ME N DI N GFORME T H I C S& CAMPAI GN DI SCLOSUREBOARD.

COMMI TTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f r g a n i z a t i o n )

Pb As RCANDI DATE NAMEA NDADDRESSTOWHOM PURPOSE AMOUNT

DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE

( MM/ D D/ Y R )A NDP A CCHECKNUMBER

~ P lC

K#F e

` D Y Y \s ;Y 1 - ef ~ I ~ ,

l o l i g Ot - ,9 5 ~ r i ~ ,n 9 a i r w< -e

YVl f n k

I D#

CK#

I D# ' ~NA , QS l ;

CK#

~/ 1 vI D# -

~ CCJ u ~ ! a . I A T~z r CK# Q/ 4 1

I D# v S, BAl ~

D n - - k ~ ` V ' C 4 ' nl ` 7 Y , l r



' FOR I NSTRUCTI ONS, SEE BACK OF FOR&

COMMI TT EE NAME ( Mu s tb e same a s o n S t a t e me n to f Or g a n i z a t i o n )

SCHEDULE

E I I N K I ND( ( e v . 0 6 / 9 7 ) CONT RI BUTI ONS

0 CHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VE D

( MM/ D D/ Y R)NAME AND ADDRESS

OF CONTRI BUTOR

R EL AT I ONS HI PTO CANDI DATE

' ( i fa p p l i c a b l e )

D ES CRI P T I ONOF I NK I ND

CONT RI BUT I ON

ESTI MATEDFAI R MARKET

VALUE

v I F FORF UND - R AI S E R

CONT RI BUTI ON

V A) r-.4 1. ,5.. e , -

a .Q

J ; ; A d v ~ E~ 8 gr Oaf

OGj ~L r

4



FOR I N STHUGI I O N S,SE E BACKOF FORM

ICOMMI TTEE NAME( Mus tb e same a s o nS t a t e me n to f Or g a n i z a t i o n )A

NOTE : T h i ss c h e d u l er e p o r t smoney l o a n e dt o t h ec o mmi t t e e wh i c hi s d e p o s i t e di n t h ec o mmi t t e ea c c o u n t.

TOTAL UNPAI DL OANS FROM L A S T R EP ORT I NG PERI OD $

PART I - MONETARY L OANS RECEI VEDT_HI SREPORTI NG PERI OD( O n y r n a ls o u r c eo fl o a n ,s u c ha s a b a n k ,mu s t b es h o w ni ta t h i r dp a r t yi si n v o l v e dI n c l u d el o a n s f r o mc a nd i d a t e ' sp e r s o n a lf u n d s. L-

TOTAL ( PARTI ) $

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s e t h e r e l a t i o n sh i po f a n yr e l a t i v ema k i n g a c o n t r i b u t i o nt o t h ec o mmi t t e e. Re l a t i o n s h i pmust b e s h o w n t o t h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a nd a f f i n i t y( r e l a t i v e sb y ma r r i a g e ). ( S e eP a g e 2 o f f o r m sp a c k e t. ) I fs u r n a me o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h e r ei 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 ta p p l i c a b l e "i n t h er e l a t i o n s h i pc o l u mn w h e n i ta p p l i e s.

TOTA L C AS H REPAYMENTS ( PART[ l )

Fr o mSc h ed ul e E- -TOTAL L OANS FORGI VEN $

TOTAL OUTSTANDI NG L O A NS E ND OF REPORT PERI OD $

Page

PART I I- MONETARY LOAN REPAYMENTS MADE_THI SREPORTI NGPERI OD( L o a n sf o r g i v e nm u s tb e r e p o r t e do n S c h e d ul eE - -I n - k i n dC o n t r i b u t i o n s )

o f( f o rS c h e d ul eF )

SCHEDULE , I

F L OANS

( R e v. 0 8 / 9 6 ) RECEI VED& REPAI D

El CHECK T HI S BOX I FA ME ND I NG F O R M

DATE

RE C EI V E DMM/ DD/ YR

NA ME A ND AD DRES S OF LENDER

( I n c l u d eE nd o r s e r ' sName, I fA pp l i c a bl e )RELATI ONSHI PTO C AN DI D AT E

I fA p pl i c a b l e * )

AMOUNT

OF LOAN

DATE PAI D( MM/ DD/ YR)

NAME AND ADDRESS OF L ENDER

( I n c l u d eE n d o r s e r ' sName, I fA pp l i c a bl e )RELATI ONSHI P

TO CANDI DATE'I fA p pl i c a b l e )

AMOUNT

REPAI D

o ( d0 ~~ ~

X 1 3 1~~

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