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- OR I NSTRUCTI ONS,SEE BACK OFF ' M
DI SCLOSURE SUMMARY PAGE
COMMI TTEENAME ( Mu s tb e s a me a s o n St a t emen t o fOr g a ni z
I MPORTANT: I n d i c a t et y p eo fc o mmi t t e ey o ua r e r e p o r t i n g f o r:
UWLD6 t 8OAM
J AN2 4 2 0 0 2
(1 ) S t a t e w i d e / L e g i s l a t i v eC a n d i d a t e( 2 ) S t a t e w i d ePAC(3 ) S t a t e P a r t y( 4 ) C o u n t y / L o c a lC a n d i d a t e( 5) C o u n t yPAC( 6 ) B a l l o tI s s u e / F r a n c h i s eCo mmi t t e e( 7 ) C o u n t y / C i t yC e n t r a lCommi t t e e(8 ) S u p p o r tS l a t eo fC a n d i d a t e s
SI GNATUREb F TREASURER( o rp e r s o nf i l i n gt h i sr e p o r t ) TELEPHONE DATESI GNED
Ro u t i n eP e n a l t i e sDu e F o rL a t eF i l e dR e p o r t sRange f r o m$ 2 0 t o $ 8 0 0
SEE I NSTRUCTI ONSON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :
IAM F I L I N GA REPORTFORAN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECTI ONYEAR.( r e p o r td a t e ) I n d i c a t eo n e
OCHECK I FAMENDMENT TO REPORTDATED
F-1Che c ki ft h i si sf i n a l( t e r mi n a t i o n ) r e p o r ta n da t t a c hN o t i c eo f D i s s o l u t i o nFo r mDR- 3.( Yo um u s tc o n t i n u et of 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 sf i l e d. )
STATEMENT OFCASH ON HANDCASHON HANDa t t h eb e g i n n i n go f t h er e p o r t i n gp e r i o d. ( T h i si st h et o t a l
o fa l lmo n i e sh e l db yt h ec o m m i t t e e. T h i samoun tMUSTb e t h e ~s ame a s t h ec a s ho n h a n da t t h ee n do f t h el a s tr e p o r t i n gp e r i o d ,S 1 ~ o fo rmu s tb e z e r oi ft h i si s f i r s tr e p o r tf i l e d. , $ADD TOTALMONEY TAKENI NTHI SPERI OD . r ,S c h e d u l eA: CashC o n t r i b u t i o n st o t a l( A t t a c hS c h e d u l eA) . . .. .. .. . . .. ... .. .
1. . . . . .. .. .. .. .. . . . .. .. . .. . 3
S c h e d u l eF: L o a n sRe c e i v e dt o t a l( A t t a c hS c h e d u l eF ) . . . . .. .. .. .. . . . .. .. .. .. .. . . . . . . . . . . .. .. . . . .. . . . . . . . .. ..S c h e d u l eH: To t a lSa l e so fCampa i gn P r o p e r t y( A t t a c hS c h e d u l eH) .. .. . . .. . . . . . . . . . . . . . .. . . . . .. . . . ..
( S c h e d u l eH a p p l i e st oCa n d i d a t e s 'Commi t t e e sOn l y )
SUB- TOTAL. .. . ..$
SUBTRACTTOTALMONEYSPENTTHI SPERI ODS c h e d u l eB : E x p e n d i t u r e st o t a l( A t t a c hS c h e d u l eB ) . . . . . .. . . . .5 1. e .S c h e d u l eF: L o a nRep a y men t st o t a l( A t t a c hS c h e d u l eF ) . .. . . .. . . . . . .. ... .. . . . . .. .. .. . .. .. ... .. .. .. .. .. ... .
CASHON HAND a tt h e
e n do ft h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a n c em u s t
b e z e r o )( A t t a c hD R - 3 ). .. .. . . . .. . . . . . . .. .. ... .. .. .. . . . . . . . . . . . . . . . . . . . .. . . .. .. .. . .. .. .. .. .. . . ... . . . . .. .. .. . .. . . . . . .. .. .. .. ... .. . $
UNPAI DBI L L S( F r o m S c h e d u l eD- A t t a c hSc h e d u l eD) . .. . . . .. .. . . .. .. ... .. . . .. . . . . . .. . . . . .. .. . .. .. .. . .. . . . . . .. . . .. .. ... . $
I NKI NDCONTRI BUTI ONS( F r o m Sc h e d u l eE - A t t a c hS c h e d u l eE ). .. .. . . . . . .. . . . . . . . . . . . .. . . . .. . . . . . .. .. .. .. .. ... . $
OUTSTANDI NG LOANS( F r o mS c h e d u l eF -A t t a c hS c h e d u l eF ) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . .. .. .. .. ... . $CANDI DATECOMMI TTEES ONLY:
CONSULTANTBREAKDOWN ( S c h e d u l eG A t t a c h e d ? )
VALUE OF CAMPAI GNPROPERTY( F r o m Sc h e d u l eH - A t t a c hSc h e d u l eH) $
FORMDR- 2 I DI SCLOSURE( R e v. 0 1 / 9 8 ) REPORT
F o rO f f i c eUs eOn l yComm. # II n d e x e d _A u d i t e d5 -- ( p_ 0. -Co mp u t e r( ( /
.` - -U1 1e , (
L o c a lCo mmi t t e e s ,e n t e rD a t eo fE l e c t i o n
C o u n t y&L o c a lCo mmi t t e e s ,e n t e rCo u n t yi nw hi c hE l e c t i o ni sh e l d
3 c ) ,L~ ' ' A
YES NO
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-, = or I n s t r u c t i o n s , See Back o f Fo r r .
CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc an d i d a t e ' sp e r s o n a lf u n d s )
COMMI TTEE NAME ( Mu s tb e s ame as o n S t a t eme n t o fOr g a n i z a t i o n )
Q' , A ' ,2sw, V _VA,STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI SRECEI VEDFROM A STATE PAC ( POL I T ICALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENTI FI CATI ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .
CAUTI ON : Se c t i o n 6 8B . 3 2 A( 6 ) , I o wa C o d e , p r oh i b i t st h e u s e o f i n f o r ma t i o nc op i e d f r o mr e p o r t s a n d s t a t e me n t s f o rs o l i c i t i n gc on t r i b ut i o nso rf o r a n y c omme r c i a l p u r p o s eb y 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 e s.
' Di s c l o s u r e l a wr e q u i r e sc an d i d at ec o mmi t t e e st o d i s c l o s et h e r e l a t i o n s h i po 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 nt o t h ec o mmi t t e e. R e l a t i o n s h i pmu s t b e s h o w n t o t h e t h i r dd e g r e e o f c on s an g ui n i t y( b l o odr e l a t i v e s )a n d a f f i n i t y( r e l a t i v e sb yma r r i a g e)( Se e P a g e 2 o f f o r ms p ac ke t. ). I f s u ma me o f c on t r i b u t o ri s t h e s a me as c an di d a t e , b utt h e r e i s n o P a g e I f -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 tap p l i c ab l e "i n t h e r e l a t i o n s h i pc o l u mn . ( f o rS ch e d u l eA)
SCHEDULE
MONETARY
( Re , 0 6 1 9 7 ) RECEI PTS
[ ] CHECK THI S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v IRECEI VED ( f ap p l i c ab l e ) TO CANDI DATE' RECEI VED FU( MM/ DDI YR) AND PAC CHECK ( i fa p p l i RAI
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THI S BOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :
Pu r c h a s e so f c er t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o r mo r emus t a l s ob e i n v e n t o r i e do n Sc h e d u l eH. ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )
Ex p e n d i t u r e st op e r s o n s / e n t i t i e sp r o v i d i n gc o ns u l t i n g , a dv e r t i s i n g ,f u n d - r a i s i n g ,p c l l i n g ,ma n a g i n g ,o r g a n i z i n g s e r v i c e smus t a l s ob e d e t a i li t e m i z e do nSc h e d u l eG b y t h eamo u n t ,p u r p o s e ,a nd d at eo f e a c h t y p eo f e x p e n d i t u r emad e b y t h e p e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc ommi t t e e. ( R e f etSc h e d u l eG i n s t r u c t i o n sa n d I o waCod e 5 6. 6 ( 3 ) ( i ). )
l f n r Cr h cr i , d o RS
FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE
EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TT EE ACCOUNT( Re v. 0 9 / 9 7 ) EXPENDI TURES
STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES,L I STTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHEDESI GNATEDCOLUMN ANDTHE CHECK THI SBOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n)
p Z- . -
CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED
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