Local No 1142 UFCW Political Fund__9673__scanned

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  • 8/7/2019 Local No 1142 UFCW Political Fund__9673__scanned

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    MI TTE= NAME ( Mu s r n s Same a s o n S ; a f e me r r t O f O r g a n i z a t i o noCAj t i 1 6 . / l ~2- h ! FC i c ; l = ' v l i c i q / ~u i v

    I MPORTANT : I n d i c a t e 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 .UI t ) S m t s w 1 O e / L e g i s l a t i v e C a n a l a a t e ( Z ) S t a t e w l a e PAC ( J ) S r a t e P a r t y ( a ) C o u n t y / L o c a l C a n a l a a t e( 5 ) C o u n t y PAC ( e ) B a l l o t I s s u a / F r s n c h i s e C o mm i t t e e ( 7 ) C o u n t y l C l t y C e n t r a l Cx n mi d a e( 3 ) S u p p o r t S l a t s o f C a n d i d a t e sSI GNATURE OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNED

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    Check i f t h i s i s f l n a l ( t a f 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 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 i o n i s f l i e d . )

    CASH 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 h i s i s t h e t o t a lo f a l l man i a 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 am e 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 l i e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . gADD TOTAL MONEYTAKEN I N THI S PERI ODSc h e d u l e A; Ca 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 d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 Sc h e d u l e F ) . . . . . . . . . . . . . . . . _ . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u 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 S Ch C d u l p H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    ( . $ g h e d u l e H a p p l i e s t o Ca nd i d a t e s ' Co mmi t t e o g On l y )/ Z I C )

    C + - iSc 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .SUBTRACT TOTAL MONEY SPENT THI S PERI OD

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    F o r O f f i c eCo mm . #l n d e x e d k ~A u d i t e dCo mp u t e r

    L o c a l C o mm i t t e x 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 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

    CASHON HAND a t t h e e nd 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 tdb e z e r o A t t a c h DR- 3

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    UNPA I D BI L L S ( F r o m Sc h e du l e D - A t t a c h SC : I e d u l e 0 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -I N KI ND CONTRI BUT I ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A=eh Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE CcQMM( T j , . E S _ 4~YCONSULTANT BREAKDOWN ( Sc h e du l e G At t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H ) 3

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    1 0 / 1 2 : ` 2 0 0 4 1 1 : 0 2 0 0 0 0 0 0 0 0 0 0 U F C I A FAGS 0

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  • 8/7/2019 Local No 1142 UFCW Political Fund__9673__scanned

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    F u r c h e s e s o f c e r t a i n c a mp a i g n p r o p er t y c o s t i n g S E 0 0 o r mo r e m u s t a l s o t o i n v e Me r l e d o n S c 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 M . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d 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 A c a ms mu s t a l s o h e d e t a i l i t e mi z e d o nSc h e d u l e 3 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 mede n y t h e p e mo n l e n dt y o n b e h a l f o f t h e o a n d i d a t e - e c c mmi t t o o . ( R u l e r t oSc h e d u l e G i n s t r u c t i o n s a nd l a ws Code E 6 ~ ( 3 ) ( I ) . )

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    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO 9TATEVHI DE OR L EGI S L AT I V E; : ANDI CATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND T HE L CHECK T HI S SOX I F? AC CHECK NUMBER FOR EACH EXPENDI TURE, A UST OF I O NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TT EE 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)

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