0 10/18/2004 15 :47 FAX 3198333119 FOR INSTRUCTIONS, SEE BACK OF FORM DISCLOSURE SUMMARY PAGE COMMITTEE NAME (Must be same as on Statement of Organization) 1-42 7 1 IMPORTANT : Indicate by # type of committee you are reporting for . (1 )Statewids/l-cgislative/Judge Standing for Retention Candidate (2 )Stale PAC (3 )Stale Party (4 )County Central Committee ( 5 )County Candidate (6 )City Candidate (7 )School Board or Other Political Subdivision Candidate (e )County PAC (9 )City PAC ( 10 )School Board or Other Political Subdivision PAC 11 ) Local Ballot Issue CANDIDATE COMMITTEES ONLY: Candidate Name Political Party (if applicable) Office Sought District (if Senate or House) L"TURE OF PERSON FILING REPO 1 AM FILING A ® C ± / a2 (report date) []CHECK IF AMENDMENT TO REPORT DATED I SUBTRACT TOTAL MONEY SPENT THIS PERIOD _ . ..... -y~~ +I n aCNi Ns-- [] Check if this is fnal (termination) report and attach `Notice OT LASS01 (You must continue to file reports until a DR-3 is filed.) .~ /9-,23' ; --1ss(5' lo . 12 . d~ TELEPHONE DATE SIGNED er plw,, - cm l~ E Ind UCT 18 2004 STATEMENT OF CASH ON HAND CASH ON HAND at the beginning of the reporting period . (Total of all funds held bythe committee_ This amount MUST be the same as the cash on hand at the end of the last reporting period or must be aero if this is first report filed.) . .. . .. . . .. . . .. . . .. . .. .. . .. . . . . .. . . $ Schedule F : Loan Repayments total (Attach Schedule F) . . .. . . .. . .. .. . . .. . .. .. . . .. . . .. . . .. .. ... .. . . . .. . .. . .. '=UNPAID BILLS (From Schedule D - Attach Schedule D) .. .. . .. . .. ._ . . . . .. . .. . .. . . .. .. . ._ . .. . .. . . . .. . . ... .. . .. .. .. . . .. . .. $ *IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . .. . .. . . .. .. ... .. .. . . .. . .. . .. .. . . . . . .. . .. . . .. . $ "OUTSTANDING LOANS (From ScheduleF-Attach Schedule F) .. .... . .. . . .. . .. . .. . .. .... . .. . .. . .. . . .. .. . . .. .. . . . . $ CANDIDATE COMMITTEES ONLY : CONSULTANT BREAKDOWN (Schedule G Attached?) VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ CAMPAIGN FINANCE Z001/012 FORM DR-2 (Rev_ 0712004) DISCLOSURE REPORT For Office Use Oriltr Comm. # 1 7 (, 3 Logged In Scanned Computer Audited Late reports are subject to possible civil and criminal penalties. CTION 1(2)NON-ELECTION YEAR. by # V1 Local Committees, enter Date of FJection Nt~U, ~ 0200 County & Local Commhtees, enter County in which Election is held (Schedule H appll to Can4idates' Committees Only) suB-TOTAL . . .. .3 -3 5`7 1 ~ , Schedule 8 : Expenditures total (Attach Schedule B) (-also see debts and loans below) .... / 9,2 1 6 5- CASH ON HAND at the end of this reporting period (if final report balance must ' be zero) (Attach DR-3). . .. . . . . .. . . ._ . .. .. .. ... .. .. . . . .. . .. . .. .. . .. . . . . .__ . .. . .. . . . .. . . .__ . . .. ._ . . .. . .. . . .. . . . ._... . . . .. . . .. . . . . .$ 5 o . 01 /690 _ pD ADD TOTAL MONEY TAKEN IN THIS PERIOD Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) .. .. . .. . .. - ' .- - C D Schedule F: Loans Received total (Attach Schedule F) . . .. .. .. .. . .. . . .. . . .. . .. . . .. .... .. . .. .. . .. . .. . . . .. .. . .. Q . DO . 6 Schedule H: Total Sales of Campaign Properly (Attach Schedule H) .. . . .. .. . .. .. .. . . .. .... .. . . .. .. .. . "ts)-
Transcript
010/18/2004 15 :47 FAX 3198333119
FOR INSTRUCTIONS, SEEBACK OF FORM
DISCLOSURE SUMMARY PAGECOMMITTEE NAME (Must be same as on Statement ofOrganization)
1-4271IMPORTANT: Indicate by # type of committee you are reporting for.(1 )Statewids/l-cgislative/Judge Standing for Retention Candidate (2 )Stale PAC (3 )Stale Party(4 )County Central Committee ( 5 )County Candidate (6 )City Candidate (7 )School Board or OtherPolitical Subdivision Candidate (e )County PAC (9 )City PAC ( 10 )School Board or Other PoliticalSubdivision PAC
11 ) Local Ballot IssueCANDIDATE COMMITTEES ONLY:
Candidate Name
Political Party (ifapplicable)
Office Sought
District (if Senate or House)
L"TURE OF PERSON FILING REPO
1 AM FILING A
®C±
/
a2(report date)
[]CHECK IF AMENDMENTTO REPORT DATED I
SUBTRACT TOTALMONEYSPENTTHIS PERIOD
_. ..... -y~~+I n aCNi
Ns--
[] Check if this is fnal (termination) report and attach `Notice OT LASS01(You must continue to file reports until a DR-3 is filed.)
.~ /9-,23'; --1ss(5'
lo. 12 . d~TELEPHONE
DATE SIGNED
er plw,,-cm
l~ EInd
UCT 18 2004
STATEMENT OF CASH ON HAND
CASH ON HAND at the beginning ofthe reporting period . (Total of all funds held bythecommittee_ This amount MUST be the same as the cash on hand at the endof the last reporting period or must be aero if this is first report filed.) . .. . .. . . . . . . .. . . . . . . . .. . .. . . . . .. . .$
For Instructions, See Back of FonnCONTRIBUTIONS - MONEY TAKEN IN
(Including candidate's personal funda)COMMITTEE NAME (Must be same as on Statement of Organization)
CAMPAIGN FINANCE Ca 00 2/012
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LISTTHEPAC IDENTIFICATIONNUMBER AND THE PAC CHECK NUMBER IN THEDESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICSAND CAMPAIGNDISCLOSURE BOARD .CAUTION : Section 68B.32A(6), IDwa Code, prohibits the use of infondnation copied from reports and statements for soliciting contributions orforany commercial purpose by any person other than statutory political Committees .
Disclosure law requires candidate committees to disclose the relationship ofany relative making a confution to thecommittee. Relationship must be showntothe third degree of consanguinity (blood relatives) and affinity (relatives bymarriage), If surname of contributor is the same as candidate, but there is nofamilial relationship, enter "not applicable' in tha relationship Column .
SUBTOTALTOTAL (if lastpage ofthis schedule)
LS
Page
I -of1(for schedule A)
SCHEDULEA MONETARY
(Rev . 07/03) RECEIPTS
CHECK THIS BOX IfAMENDING FORM
DATE PAC ID NUMBER NAME ANDADDRESSOF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED(MM/DOIYR)
(d applicable)AND PACCHECK
TO CANDIDATE'(if applicable)
RECEIVED FUND-RAISER
NUMBER INCOMEIDO &?,*y\A-CK# 13 5 &r-aLe..!%'4fj $
~ 00 W-SOW (
ILltl U&cry r% o24-) e.y04 CK# aso wcsa-0 i ew e S
1 0 -6020
~I l 3'lJ~fiDtk
CK#
`r;rr~ Ar~~as ~rosp e,c~- tiu~. 6a 5a4-erl oo oho
~
V1 3'0y
]DO
Ctc# Seri!rytW r 9k~t o >,a s b w 0 ~
ID#°
ezv ao ~1 p o
p7 cK#Up~~ ~(~- So7~
~5
~Irf 3 IIlk rn i bC~- i'rt C' ,2o o a-*--s
LA-)rr',� c-'~- v-u FWNCK# / D 1 q A` a~ rJ
0I I~117 Cs<1lers I1i /rJOC,rrr _ _
o~ ~ CK# ,gw G q~~
C" d a --J-4 11 S AA S D(el
~1~.I0/
IDIICK#
deit, 9c, co4 0112 od
asuo a _ID#cK# ~G9q ,eos~tYO~O
-pov
_
FMo~i
9/,4/wID#
0 0
1CKO Ave,
O 1 T.-
10/18/200 4 15 :48 FAX 3198333119
For Instructions, See Back of Form
CONTRIBUTIONS - MONEY TAKEN IN(Indudlng candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM ASTATE PAC (POLITICAL ACTION COMMITTEE), LISTTHE PAC IDENTIFICATIONNUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGNDISCLOSURE BOARD,
CAUTION : Section 68B"32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by any person otherthan statutory political committees,
SUB-TOTAL
SCHEDULE
TOTAL (if lastpage ofthis schedule)
CAMPAIGN FINANCE fa 003/012
A MONETARY(Rev-07103) I RECEIPTS
Ej CHECK THIS BOX IFAMENDING FORM
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to thecommittee . Relationship must beshown to the third degree of consanguinity (blood relatlves) and affinity (relatives bymarriage) .
If surname of r ontribulor is the same as candidate, but there Is no
Page
_ offamirial relationship . enter "not applicable" in [he relationship column .
(for Schedule A)
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-(MMIDOIYR) AND PAC CHECK (if applicable) RAISER
INCOMENUMBER
m .~ " sCkh.,~(>f+~. 1 ~ l3~^oOk"5id` Dr"
"$
CK# ,2s'-00p Sob
0~CKti
a ~la~_o6
ID# P~ win6~ .Mor-2(l A
a-~- 6GK# AO , 0~e 1 '.1, 17 A 5'07 -7
$ IQ# ()on ahris4 ofei-/~'~ CK# 3J9 Rive- Fer'54
6 S0? a "7
gl ID# 12 ;ck C11 gCow..ber
l CK#g"vt2'- ~~~sf
o2D-VV L!_IJ . e Z SO?a
8l
' (~ n - i-i-e yr z.edQ
p~CK# C orl4-r;/ I
p cA,-~ ic)n ,5J LMSl ID# p e6 6 e r'r-~
3 E;~a+ei-l v u-t o
qIcy
IQ# 5~e- O
CK#~ 1 4 yCfo
R/ID#
CK#Pet ~ gvc~
f.oc~ Eq- a53
X
la# Cad inoore4 ~4 Iexas St
E~~41, CK# 3o-OdI~)C.fie' a0 , E49 ez
10/18/2004 15 :48 FAX 3198333119
4 CAMPAIGN FINANCE 2004/012
For Instructions, See Back of FormCONTRIBUTIONS - MONEYTAKEN IN
(Including candidate'spersonal tunas)
COMMITTEE NAME (Must be same as on Statement of Organization)
TOTAL (iflast page ofthis schedule)
STATECANDIDATES NOTE : IF A CONTRIBUTION 15 RECEIVED FROM ASTATE PAC (POLITICAL ACTIONCOMMITTEE) . LIST THE PAC IDENTIFICATIONNUMBER ANDTHEPACCHECKNUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS I$ AVAILABLE FROM THE IOWA ETHICS ANDCAMPAIGNDISCLOSURE BOARD.
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use ofInformation copied from reports and statements for soliciting contributions orfor any commercial purpose by any person otherthan statutory political committees.
SUB-TOTAL
Digdosure law requires candidate committees to disrJosc the relationship of any reladve making a contribution to thecommittee. Relationship must be shown to tho third degree of consanguinity (blood relatives) and affinity (relatives bymarriage).If surname ofcontributor is the same as Candidate, but there is no
page 3
Itqfamilial relationship, enter-not applicable" in the relationship column .
(for Schedule A)
SCHEDULEA MONETARY
(Rev. 07103) RECEIPTS
D CHECK THIS BOX IFAMENDING FORM
DATE PAC ID NUMBER NAMEANDADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-(MM/DDtYR) ANDPACCHECK (ifapplicable) RAISER
' SD, or'o r- c e;+ -r-,h Sn 4 /t ID# C_arr~ olj '
CK# 7s~ pi. oD ~ v D d d'IQ# W ~
6 C~ CK# 3913 Cct.T1 ~ r. ~D . d~' ti ps Ci 6 /
10/18/2004 15 :48 FAX 3198333119
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's pemonal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
SUB-TOTAL
TOTAL (iflastpage ofWs schedlfle)
CAMPAIGN FINANCE
2005/012
STATE CANDIDATES NOTE- IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATIONNUMBERAND THE PAC CHECK NUMBER INTHE DESIGNATED COLUMN. A LISTOF ID NUMBER$ ISAVAILABLE FROM THE IOWA ETHICS AND CAMPAIGNDISCLOSURE BOARD.
CAUTION= SeCtIon 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting Contributions orfor any commercial purpose by any person other than statutory political committees-
' Disclosure law requires candidate committees to disclose the relationship of any relative making a onnlnbution to thecommittee, Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives bymarriage) .
If sumame of contributor is the same as candidate, but there is no
Page
offamilial relationship, enter "not applicable" In the relationship column .
(for
chedule A)
SCHEDULEA MONETARY
(Rev. 07103) RECEIPTS
Q CHECK THIS BOX IFAMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MMIDDtYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEq ID# bor Shou.l ~Z
.
d.~ CK# d4 ~ /Ce.. l worF-h R~lOa e. - of T .s0 o l 30_ 60
y ID# -fh ornrs F-e,-,l 1,, svv,Co)k N.bas P .-
0~ Gaf'f'er-~o~
9 ID# -
uh- rfevniZe~O
CK#Con-'-ri iorvs ~3 90. t~
-f ID#CpC~r
YR~~I Nc~ Purel~s~~
CI<# a t o I ber-F Dlr.-ud;oh ;4-&,, a oo.~~ L-=--~h -Y-0 o
9/°t
ID#~h ' ~~e~t2.ecQ
-
,~l CK#
1oIDN ~zs0sa
CK# El--_
ID#
CK#
ID#
CK#
ID#
CK#
10* -
CK#
10/18/2004 15,:48 FAX 3198333119
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:
a CAMPAIGN FINANCE 000 6/012
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions.)
Expenditures to personsrentitles providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized onSchedule G by the amount, purpose. and date ofeach type of expenditure made by the person/entity on behalf ofthe candidate's committee, (Refer toSchedule G inSlructions and Iowa Code 68A.ao2(3)n .)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
EXPENDITURES B MONETARY- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES: NOTE. FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE D CHECKTHIS BOXIFCANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORMETHICS & CAMPAIGN DISCLOSURE BOARD.
COMMMEEE NAME (Must be same as on Statement of Organization)
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursarnent) WAS MADE(MNUDDNR) AND PAC
CHECKNUMBER
l̂ /ID#
~B.frtDcrxr3 /W OG("~Id~1o~
'CK#
GV~IGP-`DD . ~J4' SO. . ~h"~ ~ISr"IZ $ ~r"v
' ID# (/Qn51~4~QD 4- ,9 6eCK# "
~e 5010ID# Gpnd~°~ S R p 1 bllrs f~+~ry3'
L.'O~v i~ ~Sa7DID# Pr t ;- V+ Z.r>o 60
1.j ok-WI-9,e.
joq CK#
ghl CK#~dl `~ sorsi
ID#
CK#v o ~
~
ID#
a31°Y
CK#a J4 SoZa ->n0 Golla ~. ..Q ~�
~ba3
ID# a,�, GG LrfWIe
CK# oLU~ Ale, T4f-
sot GVD ~
SUB-TOTAL $
TOTAL (iflastpage ofthis schedule) $
10/18/2004 15 :48 FAX 3198333119
4 CAMPAIGN FINANCE 2007/012
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:
Purchases of certain campaign property costing 5500 or more must 0150 be inventoried on Schedule H. (Refer to Schedule H instructions .)Expenditure$ to peruonsrentities providing consulting, advertising, fund-raising, polling, managing, organizing ;miccs must also be detail ltamizad onSChadule G by the amount, purpose, and date ofeach type of expenditure made by the person/entity on behalf ofthe candidate's cornmlfee. (Refer toSchedule G Instructions and Iowa Code fi9A_402(3)(i) .)
Page of
(forSchedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
EXPENDITURES B MONETARY-- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE D CHECK THIS BOX IFCANDIDATES, LISTTHE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDITURE A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORMETHICS & CAMPAIGN DISCLOSURE BOARD.
COMMITTEE NAME (Must be same as on Statement of Organization)
Dyr IL 144le 42'o (_ v Pr- tliSor'-CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDEDEXPENDED Of applicable) (Diabursament) WASMADE(MMIDDIYR) AND PAC
CHECKNUMBER
ID# Re~~~ ~I4S'f~~S Al a+erlq,~5 fr 5»'"x.1/
/aI-3 CK# ~h~tg5~rik~ /~CtrIG SIyM'S + ~Qr,f r SJSi~s
$0 ltea- ~ so y r, . l «~,w~ID# ,~
~~oZS CK# Deb 6 w0,/ ,(c9~ Dtb t3errx QD~
5a-702t a, tI c t+ as ~~
,
ID# Jcl`rt i c e' L I -H I
~23 I K ;a- P6--'27>+ P i-ge ) ro% pa rSc^ e""-1 -Pcor
p-Lyv3,.e,,4 mo J c 4-0
`I~CK# 7~- "I(
',~ JahXdc (CL+t}I C E
O_
C a o
wa-fertoo ~XCha~~~ - ~PgI :tiS ~it(c>P ~~ct~
CK CI'jb
040-g-1 0a,ID#
Reic.I 0as4 ; '_s S I~h
.̀l CK# J atilp rh. i .a 4r I- s,1 Ioq,rk-' er1si (5JeU ., i. a u ~7
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H Instructions .)
Expenditures to persons/entifies providing consulting, advertising, fund-raising, poAlng, managing, organizing scrvicea must also be detail itemized onSchedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's commItlee . (Refer toSchedule G instructions and Iowa Code 6aA.402(3)0-)
(for Schedule S)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
EXPENDITURES B MONETARY-- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev_ 07/03) EXPENDITURES
STATEPACCOMMITTEES: NOTE : FORCONTRIBUTIONS MADE TO STATEWIDEOR LEGISLATIVECHECKTHIS BOX IFCANDIDATES, LIST THECANDIDATE IDENTIFICATION NUMBER IN THEDESIGNATED COLUMN ANDTHE
PAC CHECKNUMBER FOR EACH EXPENDITURE. ALIST OF ID NUMBERS IS AVAILABLE FROMTHEIOWA AMENDING FORMETHICS ACAMPAIGN DISCLOSURE BOARD.
COMMITTEENAME (Must be same as on Statement of Organization)
1- ~S IJ ~,-CANDIDATE NAME ANDADDRESSTO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBETRANSACTION) EXPENDEDEXPENDED (f applicable) (Disbursement) WAS MADE(MMIDDfYR) ANDPAC
CHECKNUMBER
ID# Pron4m " te+ for -p FD G .~y--
11.`.V
LiDrk~c^
rsCK# ,3NSx LQ .-Fr^Vc-f e 9® cahJg 5 $ 5707 . Oc'~S E da.r- a e o a
ID# /narf< IUB. eA
CK# 01v5_6 11601
Dt)~ V~er- oil D ra I_% er
g ID# D r
, ~
_ D7;-fc ~., sCK# ~3t~ W S~ Sf
0`1 er^ oa TA -d mr F~ h ra t.i
9ID# !rZCIZrk/ Car-d Odf1 e r T'1~'C rn SCK# 115-0 r
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H Instructions .)
Expenditures to persons/entlllcs providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized onSchedule G by the amount, purpose, and date ofeach type of expenditure made by the personlentdy on behalf of the candidate's committee. (Refer toSchedule Ginstructions and Iowa Code B8A.ao2(3)0.)
(for Schedule B)
FOR INSTROCTIONS, SEEBACK OF FORM IEtiT .,Y~-' SCHEDULE
EXPENDITURES B MONETARY-- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES: NOTE_ FORCONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVECHECKTHIS BOX IFCANDIDATES, LIST THECANDIDATE IDENTIFICATION NUMBER IN THEDESIGNATED COLUMN ANDTHE
PACCHECKNUMBER FOREACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORMETHICS &CAMPAIGN DISCLOSURE BOARD,
COMMITTEE NAME (Must be same as on Statement of Organization)
Dry, L*I-e -P>,- S~ ~V s .dr-CANDIDATE NAME ANDADERESSTO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Dfsbursement) WAS MADE(MM/DDIYR) AND PAC
CHECKNUMBER
lh ID# aenc-k (2ofanl/ 1'noL4eri r.U
CK# I°o fox Sf'~'~ 5)~''S $ )f8A3 K - ~obbs
fo/r log tuahsd~a,~e P~~~- ~as-f~.q,e
/) CK# 04-~~Ce-_ _ $L7E I/ dale o v
10
ID# Priit Z ,>b prin+%vfCK# Acs a°~ S ~s lL o . s~
Purchases of certain campaign property costing $500 or more mustalso be inventoried on Schedule H. (Refer to Schedule H Instructions-)
Expenditures to persons/entities providing consulting, advertising, fund-raising, potting, managing, organizing services must also be detail itemized onSchedule G by the amount, purpose, and date ofeach type of expenditure made by the person/entity on behalf ofthe candidate's committee . (Refer toSchedule G instructions and Iowe Code 68A.402(3)f) .)
(for Schedule B)
FORINSTRUCTIONS, SEEBACK OF FORM SCHEDULE
EXPENDITURES B MONETARY- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07/0) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVECANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECKTHIS BOX IFPAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORMETHICS & CAMPAIGN DISCLOSURE BOARD,
COMMITTEE NAME (Must be same as on Statement of Organization)
CANDIDATE NAME ANDADDIOESS TO WHOM PURPOSE AMOUNTDATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE(MM/DDYR) AND PAC
CHECKNUMBER
/ IDO h Ke rf-Q'~ Ne s fUews~~.P ~r)3 CK#
311 6 ry .s ; .~, G+ 1O lye d S-3,A ke'4 ,~ SDIID#
GO
ID#
CK#
ID#
CK#
CK#
ID#
CK#
ID#
GO
ID#
CK#
SUB-TOTAL $TOTAL (iflastpage ofthis schedule) $
10/18/2004 1549 FAX 3198333119
4 CAMPAIGN FINANCE Z011/012
FOR INSTRUCT70NS, SEE BACK OF FORM
COMMITTEE NAME (Must be same as on Stdternent ofOrUenizadon)
2
czPer c-2, LS6 'e
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to thecommittee_ Relationship must be shown to the third degree ofconsanguinity (blood relatives) and affinity (relativesby marriage).
(See Page 2 offorms packet.) If surname ofcontributor is the same as candidate, but there is nofamilial relationship, enter'not applicable" in the relationship column-
CHECK THIS BOX IFAMENDING FORM
Page I - of -(for Scheule
DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FORRECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISERMMIDD/YR OF CONTRIBUTOR ' if applicable) CONTRIBUTION VALUE CONTRIBUTION
~lz~ 9~sA~bti-I-~,y A~e. 111o/V~ W C:i/U ")50 .Oc~
4 ' S~lsa1,~ ;'eoo n7'-~
V Q E+e.-rou xA So a ~~ TiDr1O v,-t L i '-~ b-.
arf EVahs0(~.~e ~ Sb-2a~ ~' DO DO
FOR INSTRUCTIONS, SEEBA CK OF FORM
COMMITTEE NAME(Musfbe seine as on Statement cf Organization)
NOTE ; This schedule reports money loaned to the committee which is deposited In the committee account.
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $
~ SO - O O
PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD(Otlginel source afloen, such as a bank, must be shown 1f e Ihin1 partyisInuuved lndude loans from canm'dele's personal funds,)
TOTAL {PARTI}
$
9,00-00
'Disclosure law requires candidate committees to disclose the relatinnshlp of any relailvemaking a oontribuflon to the committee . Relationship must be shown to the third degree ofconsanguinity (blood relatives) and affirdty (relatives by marriage) . If surname of con0butor istha same ascandidate, but there Is no familial relationship, anler °not applicable" in therelellonshlp column when fit applies .
PART II - MONETARYLOAN REPAYMENTS MADE THIS REPORTING PERIOD(Loans forgiven must be reported on Schedule E-In-Mnd ConidbWons.)
TOTAL CASH REPAYMENTS (PART 11)
,$
'®
From Schedule E -- TOTAL LOANS FORGIVEN
8
TOTAL OUTSTANDING LOANS END OF REPORT PERIOD
$ /OSO - O O
Page,_of(for Schedule F)
SCHEDULE
F LOANS(Rav.07103) RECEIVED
8 REPAID
CHECK THIS BOX IFAMENDING FORM
DATE PAID(MMIDDIYR)
NAME AND ADDRESS OF LENDER(Include Endorsers Name, If Applicable)
RELATIONSHIPTO CANDIDATE'
If A .ble
AMOUNTREPAID
QATERECEIVEDMMIDDIYR
NAME AND ADDRESS OF LENDER(Include Endorser's Name, If Applicable)
