Gifford Charles Chuck1316scanned

8/7/2019 Gifford Charles Chuck__1316__scanned

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

I MPORTANT: I n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p or t i n g f o r : 1 2 1( 1 ) S t a t e w i d e / L e g i s l a t i v e Ca n d i d a t e ( 2 ) S t a t e wi d e PAC ( 3 ) S t a t e P a r t y ( 4 ) Co u n t y / L o ca l Ca n d i d a t e( 5 ) Co u n t y PAC ( 6 ) B a l l o t I s s u e / F r a nc h i s e Commi t t e e ( 7 ) C ou n t y / Ci t y Ce n t r a l Commi t t e e( 8 ) A u pp or t S l a t e o f Ca n d i d a t e s

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :1 - f f `0. ) - -I AM F I L I NG A l

DISCLOSURESUMMARYPAGEu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i

C. s - ~ s Ja1&-. - - , 31-y% aooZEASURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE S I GNEDRou 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 Re p or t s R a n g e f r o m $ 2 0 t o $ 8 0 0

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

CHECK I F AMENDMENT TO REPORTDATED

E ] 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 a n d 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 .( Y o u mus t c o n t i n u e t o f i l e r e p o r t s u n t i l a N o t i c e o f D i s s o l u t i o n i s f i l e d . )

REPORT FORA N/ A ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .I n d i c a t e on e

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 l

o f a l l mon i e s h e l d b y t h e c o mmi t t e e . T h i s amoun t MUST b e t h es ame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . $

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e du l e B: E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e du l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

ADDTOTAL MONEY TAKEN I N THI S PERI ODSc h e du l e A: C a s 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 du l e A ) . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Sc h e du l 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 du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H: T o t a l Sa l e s o f Camp a i g n P r o p e r t y { A t t a c h Sc h e d u l e I - I ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASHON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b a l a n c e mus t $ 07 gg/ ~~b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . ~ . . . . _ . . . . . . ~ . . . 1 . . . . . -UNP A I D BI L L S ( F r o m Sc h e du l e D - A t t a c h Sc h e du l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I ND CONTRI BUT I ONS ( F r o m Sc h e du l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ , - 35: 07OUTSTANDI NGLOANS ( F r o m Sc h e du l e F - A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l e H - A t t a c h Sc h e du l e H) $ i 7


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F o r I n s t r u c t i o n s , S e e B a c k o f F o r mC O N T R I B U T I O N S - M O N E Y T A K E S . J

( 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 T NAME ( M s t be s ame a s o n S t a t e me n t o f Or g an i z a t i on )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E N T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c o mmer c i a l p u r p o s e by any p e r s o n o t h e r t h a n 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 .

SUB- TOTALTOTAL ( I f l as t page o f t h i s s c h ed u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i 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 any r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r m s p 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 , b u t t h e r e i s n o Page~-o ff a mi l i a l r 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 o n s h i p c o l u mn . ( f o r Sc h e d u l e )

SCHEDULEA MONETARY( R ev O 6 1 9 7 ) RECEI PTSQ CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT ~ / IRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECE I VED FU( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RANUMBER I NCI D# 7 7 , 77 77 7 ` 7 , 7 / 7l ` 4 ~oZ t ' Gt ~ r S

l ~ l ~ ~ l O 1I D# W, ` l l , ` c r s i t

S' 00o W- , A C )s f ' a G~dC ~ ~cv~~ ~ ppCK# t o 1 1 3I D#CK# 1 1 7 1 1 ~ ~ s / ~ o ~ r t ~ 5 1~So3a~I D#CK#S~~o 9 ~~~g ~ sf sow. G,I D# / ' 7cl ~ ~ l db . - - ~3 , 1

- m s s ~ . . - 1 s . Z~ . 5 22 3 1 7I D# &- , ~ , A/ r

/ L ' ~ CK# 1 4 0 7 1 0 , a , ~ 1_ r S "75v. 4 'I D # e ` ! I ' f s 1. 6~AYi aewl ad , -CK# ~ 9 a / 1I D#

1 1 3 ~, : ~~ s Sv3-I D # ~Ou ~?d~ul c~f. ~ l t ~m c ~'3 l a . ~~ t o OSoGI D # a c

l O~a l ~/ o f f CK# l osa~ ! 0 3 N. a~ vs oCK#D# H? ~ , s

60/ CK# 9eo C , c , l ~ ~ . a l s . s ~ t f o 3 ` DO. ~


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Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEY TAKE, J

( 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 )' M E NAME M/u s t b e s ameQS t a t e me n t O r g a n i z a t i o n ) SCHEDULEA I MONETARY( Re v . O 6 1 9 7 ) RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P O L I T I C AL ACTI ONCOMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p os e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL f i f l a s t page o f t h i s s c h e d u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec 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 f c o n s a n g u i n i t y ( b l o o d r 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 s b yma r r i a g e ) ( S e e Page 2 o f f o r m s p 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 s ame a s c a n d i d a t e , b u t t h e r e i s n o Page o f / >f a mi l i a l r 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 o n s h i p c o l u mn . ( f o r S c h ed u l e A)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT IRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MMDD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RANUMBER I N

G EL , l So 9 , ~- s z~o~ s vDa~ Dl CK# G6 ~ s ~ c ~ d y r . / e u . Vs sw , Sa ~o 3 / D. o vI D# 1 1 4 a m - . c 1 GKe weF , S/ r F Wv cC K # X33 9 ' ! 0 8 ' o I l l z c vr S 3CK# l l s o r t s ~ '~~SG o , , i r q s aI D# S a ` t ~ I ~


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Fo r I n s t r u c t i o ns , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE . A

( 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 T EE 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 a t i o n)

r 1 1 - / - 4, l OGs12

SCHEDULEA I MONETARY( Re v . O6 / 9 7 ) RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMTTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mmer c i a l p u r p os e by a n y p er s o n o t h e r t h a n 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 .

SUB- TOTALTOTAL ( f f l a s t page o f t h i s s c h e d ul e )

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h own t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 s b yma r r i a g e ) ( S e e Pa ge 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e `3 o ff a mi l i a l r 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 o n s h i p c o l u mn . ( f o r Sc h e d u l e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT d IRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECE I VED FU( MM/ DDNR ) AND PACCHECK ( i f a p p l i c a b l e ) RANUMBER I Nl D# &,44 ~ ) Zca/ a 70CK# t o o Qox

s 4d , 1I D#l l l Gl ~ l CK# 9 0 7 ~

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I D# ~QSx kW. l s~-l ` l o ~ CK# ~~r / J ?m, ~ c , t s . . t o m So a l ~I D#CK#~~ s~ 7 y ~ ~ v

1 1 1 _ 2 / / CK# 00 ` 1 o mI D# * 4 e o 0 V d j 1-

l 1 /. ; 2 l o l CK#: , ? o 9V 3` 3~S"~~ ~ wz ~~ ~oo-wI D# T f . 3 o~ 1 a 7 4 l CK# ~~ ZW i - 7 . s z : > # W- e t . . , Peek 4v - Avvc s s l s t ~r ~ ood~ ~~~bI D# d ht ~!. 0 > - ~pK~l arCK# , ( oa 4t oa7 sy~. ' i f l e e cI D# l ~ f i t d t _ ( - " e SSCK# 4 , 1 l d ~~ `1

7 ~1B o s. ~ So l o. a~I D#CK# 1 7 ~-D o / O. ODc J


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Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE . A

( 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 TT E NAME ( Mu s t be s ame a s o n S t a t e me n t o f Or g an i z a t i o n)

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER ANDTHE PACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mmer c i a l p u r p o se by an y p e r s o n o t h e r 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 .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h ed u l e )

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu s t b e s how n t o t h e t h i r d d e g r e e o f c o n s a n g u i 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 yma r r i a g e ) ( Se e Page 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b u t t h e r e i s n o Page o f 17f a mi l i a l r 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 o n s h i p c o l u mn . ( f o r Sc h e du l e A )

SCHEDULEA MONETARY( Re v . O t i l 9 7 ) RECEI PTSQ CHECKT HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT ~ ( IRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FU( MM/ DDI YR ) AND PACCHECK ( i f a p p l i c a b l e ) RANUMBER I NI D# f , - ,C o . - Ca r - , ,

` ; 7 / Z I D I CK# 30~ S ~1~u1 C v ~ s $ vs -9 7 l , V . e 4 J ~ . ~ s f ;0~0 3DI D# we e , ?CK#

k 3s"I D#CK# ~4( 6 < t . F . ~r st7 3 7 ~o nsI D# Eu 1 , ! s p r ~T, c o nr ~ ~r ' : dt r s . r a !

l - ) L - 1 4 / 0 1 CK# ~0 l 6 6~ 5 4s 74-4 o o l ~ . e CJ vA1 4 4 2 0s'! p - o vI D# 5 1 r 1 i ' l e a ~r n c w. ~ f mr r e 0- -! 3 0 I ~ a l y ~ t t m t ~ " ~ r ./ 0 1 CK# ~ ' y6S' o?D- a t ea~ ~I D#

l 02 1 l GY cK#37o l , . ` 1 ~ . . f o 3~ ~. oaI D# of o r r o , +1 r ~, ~ I l ~. l l ~o . =

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S' o 4 ~ , fYas s / " _OIc K# 7 - 09 2 4 - 4 1 Spao


16/24

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS -MONEYTAKE6 J

( 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 St a t eme n t o f Or g a n i z a t i on )

STATE CANDI DATES NOTE : I F A CONTR I BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 68 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o mmer c i a l p u r p os e b y an y p e r s o n o t h e r t h a n 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 .

SUB - TOTALTOTAL ( i f l a s t page o f t h i s s c h e du l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p mu s t b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 s b yma r r i a g e ) ( S e e Page 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa g e 4 : L- : o f 17f a m i l i a l r 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 o n s h i p c o l u mn . ( f o r Sc h ed u l e A)

SCHEDULEA MONETARY( R e v . O 6 / 9 7 ) RECE I PTSQ CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FU( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# ~06e~~~Ad ~l hG! ` s ~

~~l ~~~< < f o 7 S 9 'CK# o eyI D# b _ e wo v i s3 0 6 Sv ~ 7 r Sam"c K# 137 , 7 2 a r s ~ l ~Kr oI D#CK# S! 8

~DCK# as $T a0SI D#

I 1 0 CK# ! ~ ~ l $ 60~WoeL r 7 01I D# ~J p / l Wr ' a ~ i GCK# 71zlI D# , S f ~ o t g r i Q. T ` ~ -

/ , / p l CK#I D# t oI D#

i G . i w. e s 7~CK# 77 7, Y'' / * l ~ o . - ~ S3S63


17/24

Fo r I n s t r u c t i o ns , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEI r

( 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 St a t e me n t o f Or g a n i z a t i o n)C1z 1 1, 91 ' /4" _Z;WGc 7 0 ~ e _STATE CANDI DATES NOTE : I F A CONTR I BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D EN T I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i ed f r o m r e p o r t s a nd s t a t emen t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c omme r c i a l p ur p o s e b 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 y p o l i t i c a l c o mmi t t e es .

SUB- TOTALTOTAL f i f l a s t page o f t h i s s c h ed u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm$ 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec 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 f c o n s a n g u i n i t y ( b l o o d r 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 s b yma r r i a g e ) ( Se e Pa g e 2 o f f o r m s p a c k e t . ) . I f s umame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e 1 46 o ff a m i l i a l r 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 o n s h i p c o l u mn . ( f o r Sc h e d u l e A)

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT ~ / I FRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECE I VED FU( MM/ DDYR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# ~a * sa , VW S' ksPeel z 1 1 l o l c K# Z' 0 s f NJ


18/24

Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEYTAKE J

( 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 be s ame a s o n S t a t e me n t o f Or g a n i z a t i on )

u- , 7o~e / -Z, l - T , F, cow. 5~- AI a/ e

S TATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) , L I S T T HE P AC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r om r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y an y p er s o n o t h e r t h a n 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 .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e du l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o m mi t t e e . R e l a t i o n s h i p mu s t b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 s b yma r r i a g e ) ( S e e Page 2 o f f o r m s p a c k e t . ) . I f s umame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page o ff a m i l i a l r 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 o n s h i p c o l u mn . ( f o r c h e d u l e A)7

SCHEDULEA MONETARY( Re v 0 6 1 9 7 ) RECE I PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J IRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECE I VED FU( MM/ DDI YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R ANUMBER I NI D# , G u . ~ c rhd . s ' ~ " r s SL . a " ~ . e . ^CK#~~~s ~ . 9 0 1 ' t ' 3 Al ,N, ~ ~ o Da1 D# Al

/ ~A I O CK#6& s MA 2 0 20 02 86lI D#4 7 o

I D#Y t ' VVa o / o l CK# 3Zf s t ! . So I r k. rw _ ~ S" ~~OS- .

I D#a%~ l CK# c ~y gc f / t . 3 f - 4 2 S' 1 1 4 . S. ` p c o 0s r '7 D1 D# So c t s 1 e~ S s o - - i c e

I a l o ~ - ~ ~ ~~CK 77I D# D~c u , d oa " e d , . s 4 r " ` , - l eoy wCK# 3 S, 09, P~3a l ~ ~ - ~ T~ Soo~~.sI D# a, %1 . l ~ L ? c a m I Qs ~ l t e ,CK#a ` a 5'

S" s/ ~ 1 . ? ~ c r ~ Zr ~ , G 00m: x 7 o s 1w o /I D# 1 E

6, 9 - 7 ~mooI D# _~Vi dd ~. e ~ l ~e ~e

/ l 0 / CK# 7 / S sC a~. ~'


19/24

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 mCONTRI BUTI ONS - MONEY TAKE n l

( I n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )COMMI TTEE NAME ( Mus t be s ame a s on St at ement o f Or g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CAT I ONNUMBER ANDTHE PACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA ETHI CS AND CAMPA I GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

Di s c l o s u r e l a w r e q u i r e s c a n di 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 a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e h 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 gr e e o f c o ns a n gu i n i t y ( b l o o d r 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 s b y /ma r r i a g e) ( Se e P a g e 2 o f f o r ms p a c k e t . ) . I f su r name o f c o n t r i b u t o r i s t h e s ame a s c a n di d at e , b u t t h e r e i s n o P a g e ` 7 o f


20/24

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o 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 s mu s t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e m a d e b y t h e p e r s o n l e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e rS c he d u l e G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

l f n r R c h o r f d o Rl

f UK. 1 NS l KUC I 1UNS, SEE BACK Of RM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( R e v . 0 9 ) 9 7 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T H I S BOX FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .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 ni z a t i o n )

1~ Sown~en Qc . ~CAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( D ESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

I D# l oad! 73 9 G~7 / n /0 CK#! Onl $~Sl G. ~2

I D# G! 5 Aost o y 1 : K" c . 1 _ 97L, e , . ,3D ! So3 i s -

I D#~ SF~~r o ~ - ~ -7 / 7 4 / w CK#APO3 j r

6 / 7 h 4 V CK# ~6, 1r 8'Ag o e/CK#I D#

X 9 , 0 / '8 t h ~ C, t : G~ r sMh ~ CK#~007

I D # A l e . ' d , ' Al z d d l r ; f _ ' 6 f t o - e l o ~ . 5,1 "~3~y yCK#`m7 J a s l A~ . r r s , S. ~ S~3 SUB- TOTAL $TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) $


21/24

T HI S BOX APPL I ES TOCANDI DATES' COMMI TTEES ONLY:Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $SOD o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s t e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o 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 s mus t a l s o b e d e t a i l i t e mi z e d o nSc h e d u l e G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e m a d e b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e rSc h e d u l e G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

( f n r Rn h a r f d a R l

1- UK4NJI KUG11UN5, 5t t 1J AGK Of ; RM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROM COMMI TT EE ACCOUNT MONETARY( Re v . 0 9 / 9 7 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FPAC CHECKNUMBER F OR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TT E 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)

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( D ESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MMi D DI YR) AND PACCHECKNUMBER

I D# 40 . ~e5 / i L B i KCS L l S , r " r ~ SS AJ// e 9 / _ D ~- ~~

CK#A - 1 v 9I D# I vy Ge wSf r u i I , o & i ' e AoY14 i P , r r 5 ~ a c /

~ o

5 1 - P ; 11 101 CK# 1 ' 7 31 5 ; ' r a ~ o - ww, /l a ~l `


22/24

FOR- I NSTRUCT I ONS, SEEBACK OF RMEXPENDI TURES - - MONEY SPENT FROMCOMMI TT EE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EGI S L AT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEB MONETARY( R e v . 0 9 1 9 7 ) I EXPENDI TURECHECK T HI S BOX I FAMENDI NG FORM

COMMI TT E NAM~ ; 1 7 1 0 4 1 ? . 0 _ 4 (

E u s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )

CK#1/ 7

I D#CK#/ . o ay

, s o so sE l 5 / $ &

1ges~ 4u

s ~O. r r G3 ~ f l , s o3~Sf l Cc v B4 I a r c sg303 i ~a i ' Gv ~d' ~ lc t r v n F~3S" s T -

k: . ~ I t " o sSl Eb ~pG~s s ~ SJ ~

~7, ~s . g i g ~p 3/ dSw 6 ' . /~~~ a f i s t s

N~r j t G Z a 6 V l s 40 -- , e , -

TOTAL ( i f l a s t page o f t h i s s c h e du l e ) $

AMOUNTEXPENDED

$ l V 11 , . ss/

hooa p p , ov

G 3 0; 7

3 Sala ' e V

~~3 ySUB- TOTAL $

T HI S BOX AP PL I E S TO CANDI DATES' COMMI TTEES ONLY :Pu r c h a s e s o f c e r t a i n campa i g n p r o p e r t y c o s t i n g $SOD o r mo r e must a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s t e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , manag i n g , o r g a n i z i n g s e r v i c e s must a l s o b e d e t a i l i t e m i z e d o nSch e d u l e Gby t h e amoun t , p u r p o s e , an d d a t e o f each t y p e o f e x p e n d i t u r e made b y t h e p e r s o n f e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c ommi t t e e . ( R e f e rSch e d u l e G i n s t r u c t i o n s an d I o wa Code 5 6 . 6 ( 3 ) ( i ) . ) /

l f n r Rn h ar i i d a R)

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSEDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON)EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER


23/24

T H I S BOX A PP L I E S TO CAND I DATES ' COMMI TTEES ONLYP ur c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d ul e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o 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 s mu s t a l s o b e d e t a i l i t e m i z e d oSc h e d u l e G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e m a d e b y t h e p e r s o n l e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e rSc h e d u l e G i n s t r u c t i o n s a n d I o wa C o d e 5 6 . 6 ( 3 ) ( i ) . )

l f n r R n h a r i i o l a R 1

FOR- I NSTRUCTI ONS, SEE BACK Of RM SCHEDULEEXPENDI TURES B MONETARY- - MONEY S P ENT FROM COMMI TTE E ACCOUNT ( R e v . 0 9 1 9 7 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR L E GI S L A TI V ECAND I D A TE S , L I ST THE C A ND I D A T E I D ENT I FI C AT I ON NUMBER I N THE D E S I GN A T E D COLUMN AND THE CHECK T HI S BOX I FP A C CHECKNUMBER FOR E A CH EX PE N DI T URE . A L I S T OF I D NUMBERS I S A V AI L A BL E FROM THE I OWA AMENDI NG FORMETHI CS & CAMPA I GN D I SC LOSURE BOARD.COMMI TT EE 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 a t i o n)

B 4 ) 4 a - 1< 5 ~ - KA- l +CC A ND I D A T E NAME ANDADDRESS TO WHOM PURPOSE AMOUNTDAT E I D NUMBER EX P EN D I T URE ( D E SC RI BE TRANSACT I ON ) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MMI D D/ YR) AND P A CCHECKNUMBERI D# h ~ , Scow e.

CK#l 0?S 00 l geX ~D~ .

i t /I D#CK# I vy6

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SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ / ~ ` - 3


24/24

FORI NSTRUCTI ONS, SEE BACK OFFORM

COMMI TTEE NAME ( Mu s t b e s ame 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 )_7 1". 1 _01/ ~ 40 4 2 -

SCHEDULEE I I N K I ND( Re v . 0 6 ) 9 7 ) CONTRI BUTI ONSCHECK T HI S BOX I FAMENDI NG FORM

SUB- TOTAL

TOTAL ( i f l a s tp a g e o f t h i s

s c h e d ul e )

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t 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 a n y r e l a t i v e ma k i n g a n i n k i n d c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 f c o n s a n g u i n i t y ( b l o o d r 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 y m a r r i a g e ) . ( S ee Page 2 o f f o r ms p a c k e t . ) I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of a mi l i a l r 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 o n s h i p c o l u mn .

DATERECEI VED( MM/ DD/ YR)

NAME AND ADDRESSOf CONTRI BUTORRELAT I ONSHI PTO CANDI DATE

' ( i f a p p l i c a b l e )DESCRI PT I ONOF I N K I NDCONTRI BUTI ON

EST I MATEDF AI R MARKETVALUE

J I F FORFUND- RA I SERCONTRI BUTI O

y J r y / ~ . 5 - , w - o , -. 4 Fea9 6 1 -

Fv r d. ~ a %s e r ' ~S' a 7 ,/

Gifford Charles Chuck1316scanned

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Transcript of Gifford Charles Chuck1316scanned

Gifford Charles Chuck__1316__scanned

Documents

Transcript of Gifford Charles Chuck__1316__scanned

Gifford Charles Chuck1316scanned

Transcript of Gifford Charles Chuck1316scanned