8/7/2019 Great River Uniserve Unit PAC__6145__scanned

1/3

FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCL OSURE SUMMARY PAGE

COMMI TT EE NAME ( Mu s t b e same 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

k I l mr Al / n ' ) , &V[ LA- ~o t ~ l uJ ~4p : - h I D / 1 C ~ G m ~ m ~ t {PORTANT : ' I n d i c a t e b y # t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PAC ( 9 ) C i t y PAC ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC L 1 1 ). L o c a l B a l l o t I s s u e

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

D i s t r i c t ( i f S en a t e o r H o u s e )

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l a n d c r i m i n a l p e n a l t i e s . P u r s u a n t t o I o wa Cod e s e c t i o n 6 8 B . 3 2 A ( 7 )t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mm i t t e e , a n d t h e c h a i r p e r s o n , f o r a n y o t h e r t y p e o f c o m m i t t e e , i s t h ei n d i v i d u a l r e s p o n s i b l e f o r o i l i n g gMe l y a n d a c c u r a t e r e p o r t s .1 1 G ~ - ~ ~ t > ~ '

F PERSON N RE TELEPHONEFWIS I GNA

I AM F I L I N G A( r e p o r t d a t e )

[ ] CHECK I F AMENDMENT TO REPORT DATEDC 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 o r m DR- 3 .( Y o u must 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 DR- 3 i s f i l e d . )

\ - ' ) & 3 ~ s l - _ - ) _ ~ I

REPORT F OR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HANDCASH ON 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 o t a l o f a l l f u n d s h e l d b y t h e

c o mm i t t e e . T h i s amoun t MUST b e t h e same a s t h e c a s h o n h a n d a t t h e e n do 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 must 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N T HI S PERI ODSc h e d u l e A Cash 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 ) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u 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 S c he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l S a l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

- ( Sc h ed u l e Ha pe l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $

Sc h e d u 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 d u l e B ) ( * * a l s o s e e d e b t s a n d l o a n s b e l o w ) . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n Re pa y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON 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 mustb e z e r o ) ( A t t a c h D R- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

" * UNPAI D BI L LS ( F r o m Sc h e du l e D - A t t a c h Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" 1 N K I ND CONTRI BUTI ONS ( F r o m S c h e d u l e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTANDI NG LOANS ( F r o m S c h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )CANDI DATE COMMI TT EES ONLY:VALUE OF CAMPAI GN PROPERTY ( F r o m S c h e d u l e H - A t t a c h Sc h e d u l e H)STATE COMMI TTEES : S u b mi t a r e c o n c i l e d c amp a i g n a c c o u n t b a n k s t a t e m e n t i n J a n u a r y o f e a c h y e a r .

FORMDR- 2 I DI SCLOSURE

( R e v . 1 2 / 2 0 0 5 ) REPORTF o r Of f i c e Us e On l yComm . #L o g g e d ISca n n e dCompu t e rA u d i t e d

F i l e w i t h :I o wa E t h i c s a n d Campa i g nD i s c l o s u r e B o a r d5 1 0 E . 1 2 ' " ' , S t e . 1 ADes Mo i n e s , I o w a 5 0 3 1 9F a x : 5 1 5 - 2 8 1 - 3 7 0 1

- q _ 0 - 7DATE SI GNED

L o c a l C o mm i t t e e s , e n t e r D a 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 m m 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

X0 , - L

YES - NO

8/7/2019 Great River Uniserve Unit PAC__6145__scanned

2/3

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN 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 a t i o n ) Cv l -~jGI CD4T~ ~ ) u ~ C _ i 0 _ C i t i ) l 5 t E X , ' t / Z i i u ) T -pv i - / -r l Z-4L i k 4 / 0 j - ) 6 " mnSTATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A S TA TE PAC ( P O L I T I C A L ACT I ON COMMI T T E E ) , L I S T THE PAC I D EN T I F I C AT I O NNUMBER AND T HE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM TH E I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHERT HA N A N I N D I V I D U A L , THAT CONTR I BUTES MORE THAN $ 7 5 0 TO YOUR CAMPA I GN MAY HAVE F I L I NGR ESPONS I B I L I T I E S AND SHOULD I MMEDI ATELY CONTACT THE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 m e 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 r f o r an yc 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 ommi t t e e s .

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 m a k i n g a c o n t r i b u t i o n t o t h ec o mm i 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 ) . 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 Pa g e o f -f 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 )

SCHEDUL EA MONETARY( Re v . 0 7 / 0 3 ) RECE I PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT J I F FORRECE I V ED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECE I VED FUND-( MM/ DD/ YR) A ND P AC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMEI D#

/ f i CK# ~L~ I t ! i nnI D#c K# ~ c d

" I D#/ c K#

4 ~ 1L p t J L- - ~ ~' : ` ' aI D#

i . 3 o t CK# C~ L i t 1 " i ~Q- I D# `

CK#1 1

.~C? z '

I II D#CK#I D#c K#

. I

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

8/7/2019 Great River Uniserve Unit PAC__6145__scanned

3/3

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONL Y :P 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 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 S c 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 , m a 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 mi z e d o nS c h e d u l e G b y t h e a m o 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 made 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 mm i t t e e . ( R e f e r t oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Page o f

( f o r S c h e d u l e B )

FOR I NSTRUCT I ONS , SE E BACK OF FORM R e s ~ c , F SCHEDUL EEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T T HE CANDI DATE I D E N T I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND T HE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE 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 O r g a n i z a t i o n )

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

I D#CK # u l t . - e - _ Fe eI D#CK #I D#CK #I D#CK #I D#CK #I D#CK #1D#CK #

SUB- TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) r s