Montgomery County Republican Women_9559_scanned

8/7/2019 Montgomery County Republican Women_9559_scanned

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FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( M u 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 )Mo n t g ome r y Co u n t y Re p ub l i c a n WomenI MPORTANT : I n d i c a t e b y # t y p e o f c o mmi 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 PA C ( 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 ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TT EES ONLY:C a n d i d a t e Name

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 e " n -mi n a l p e n a l t i e s . P u r s u a n t t o I o w a Code 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 mmi 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 mmi t t e e , i s t h e

i d u a l r e s p o n s i b l e f o r f i l i a l t i me l y a nd a c c u r a t e r e p o r t s .D- , , L y ~ , oNATURE OF PERSON F I L I N G REPORT

I AM F I L I N G A 5 - 1 9 - 0 6( r e p o r t d a t e )

CHECK I F AMENDMENT TO REPORT DATED

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 )

0 C h e c k i f t h i s i s f i n a l ( t e r mi 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 mDR- 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 . )

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

STATEMENT OF CASH ON HAND

Res e t Fo r m

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 o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amount MUST b e t h e same a s t h e c a s h o n h an 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL MONEY TAKEN 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 S c 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 ed u l e F : L o a n s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c 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 S c h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e du l e H a p pl i e s t o Ca n di d a t e s ' Commi t t e e s On l y )SUB - TOTAL . . . . . . . . . . . . . . . . . . . . . . . $ 1 , 8 6 6 . 4 4

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h ed 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 S c he 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 ) . . . . . . . . . . . . . . . . . 4 0 0 . 6 0S c h e d u l e F : L o a n Re p a ymen t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

FORMDR- 2 DI SCLOSURE( R e v . 1 2 / 2 0 0 5 ) REPORTFo r O f f i c e Use On l y G5 , 5 , 6 1Comm. #L o g g e d I nScannedC o mp u t e rA u d i t e d

F i l e w i t h :I o w a E t h i c s a n d Ca mp a i g nD i s c l o s u r e B o a r d5 1 0 E . 1 2 ` h , 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

TELEPHONE DATE SI GNED

L o c a l C o mmi 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 mmi 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

* * UNPAI D B I L L S ( F r o m S c h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $' I N KI ND CONTRI BUT I 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 ? ) - YES NOCANDI DATE COMMI TT EES ONLY:VALUEOF CAMPAI GN PROPERTY ( F r o m S c h e d u l e H - A t t a c h S c h e d u l e H)STATE COMMI TT EES : Su bmi t a r e c o n c i l e d c a mp a i g n a c c o u n t b a n k s t a t e me n t i n J a n u a r y o f e a c h y e a r .

1 , 1 0 8 . 1 3

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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 TAKEN 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 St a t e men t o f O r g a n i z a t i o n )

STATECAN ( DATES NOTE : I F A CONTRI BUTI ON I S R EC E I V E D FROM A STATE PAC ( P O L I T I C A L A C T I ON C OMMI T T E E ) , L I S T THE P AC I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N T HE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHERTHAN AN I N D I V I D U A L , THAT CONTR I BUTES MORE THAN $ 7 5 0 TOYOUR CAMPA I GNMAY HAVE F I L I N GRESPONS I B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT TH E 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 a n 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 a n yc o mme r c i a l p u r p o s e b y a n 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 - TOTAL $ 3c oo .TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) $ v 5 C S 0 0 ' . _ i 3D 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 mm i t t e e . R e l a t i o n s h i p m u 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 ym a r r i a g e ) . 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 1 ~ ? o f 1 21f 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 S c h e d u l e A )

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECE I PTS0 CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTR I BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D# D o ) , n c t n 1 a c - t h 5 . ~ a~~ ~.. 7 7 OgL r o l 015a v i $ DoCK# Rc S CL I I P _ 140. 1 n s e X' J c o

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Fo r I n s t r u c t i on 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 as on S t a t e me n t o f O r g a n i z a t i o n )n?e - ? a7wer

R e s e t Fo r m

STATE CANDI DATES NOTE : I F A C ON TRI B UT I ON I S RECE I V ED FROM A ST AT E PA C ( P OL I T I C A L AC T I ON C OMMI T T E E ) , L I S T THE PA C I D EN T I F I C A T I O NNUMBER AND THE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER T HA N A N I N D I V I D U A L , THAT CONTRI BUTES MORE THAN $ 7 5 0 T O YOUR CAMPA I GN MAY HAVE F I L I N GRESPONS I B I L I T I E S AND SHOULD I MMEDI A TE L Y 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 a n yc omme r c i a l p u r p o s e b y a ny 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 ( i f l a s t p a g e 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 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 m u 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 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 Sc h e du l e A )

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECE I P T S0 CHECK T HI S BOX I FAMENDI NG FORM

DAT E PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RE L A T I ONSHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND( MM/ DD / YR) A ND P AC CHECK ( i f a p p l i c a b l e ) RA I S ERNUMBER I NCOMEI D# r o am r et ~ ~ -

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T o t a l Me mb e r s h i p To D a t e _ / ~ , c l Amoun t E n c l o s e d C h e c k No D a t e 9 - / 8 - C c p sDO NOT I NCLUDE ASSOCI ATE MEMBERS ON T HI S FORM. 2 / 9 7 g e

# L a s t Name F i r s t Name M1 f i f N ewI - C - ( fA d d r e s s Chg . A d d r e s s C i t y S t Z i p Home P h o n e Wo r k P h o n eBl u e Ka r e n R 6 0 6 S u n s e t Z e d Oak 5 1 5 6 6 7 1 2- 6 2 3 - 4 0 8 1Ca r d e r Ca t h e r i n e 1 4 0 0 E Ch e r r y Re d Oa k I A 5 1 5 6 6 7 1 2 - 6 2 3 - 4 3 3 5Eb e r t Ka t h l e e n 1 0 0 3 Oa k Kn o l l Rd Re d Oa k A 5 1 5 6 6 7 1 2 - 6 2 3 - 4 2 6 6Ge l l e r ma n D o n n a 1 2 1 4 I r e n e Cr t Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3 - 3 1 5 3H a n s e n Ro s a l i e R 1 4 0 9 E Co o l b a u g h Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3 - 2 8 0 4Ol s e n Ca r o l L 1 2 0 0 Hi g h l a n d Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3 - 4 1 8 8Pe t e r s o n J e a n e t t e 1 7 0 1 Fo r e s t A v e Re d Oa k I A 5 1 5 6 6 7 1 2- 6 2 3 - 4 7 2 1Se d e r b u r g Ma r j o r i e E 1 0 0 6 Di v i s i o n St Re d Oa k I A 5 1 5 6 6 7 1 2 - 6 2 3 -Smi t h D o n n a Ma e 1 2 0 9 Mi l l e r Re d Oa k I A 5 1 5 6 6 7 1 2- 6 2 3 - 4 1 2 9St o l d or f Ma r g a r e t 1 4 0 3 E Ch e r r y St Re d Oa k I A 5 1 5 6 6 4 0 2 - 3 9 7 - 9 9 2 1Vo n Di e l i n g n St a c e y L 9 1 1 E Wa s h i n g t o n Re d Oa k I A 5 1 5 6 6 7 1 2- 6 2 3 - 2 1 7 6

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OF REPUBLI CANWOMENREPORTMe mb e r s h i p C h a i r T r e a s u r e r

D i s t r i c t 5 Name J o A n n Bu t l e r Name Name J on e t t e Ot t eCo u n t y Mo n t g o me r y A d d r e s s 1 1 1 1 Di v i s i o n St A d d r e s s A d d r e s s 1 1 5 0 C A v e n u eCl u b Name Mo n t g o me r y Co C i t y / Z i p Re d Oak 5 1 5 6 6 C i t y / Z i p C i t y / Z i p He n d e r s o n 5 1 5 4 1

Re p u b l i c a n Wo men 7 1 2 - 6 2 3 - 9 2 0 4P h o n e P h o n e P h o n e 7 1 2- 8 2 5 - 3 9 0 2


5/6

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# L a s t Name F i r s t Name Al t f N" wr c , i fA d d r e s s Ch g . A d d r e s s Ci h S t Z i p Home Phone Wor k P h o n eBr u n i n g Ca r l e e n 2 6 89 - 1 8 0t h St a n t o n A 5 1 5 7 3 7 1 2- 8 2 9- 2 7 88 7 1 a - c ~ z 3 - , I 3 C: 3Bu t l e r J o A n n 1 1 1 1 Di v i s i o n S t Re d Oa k A 5 1 5 6 6 7 1 2 - 6 2 3 - 9 2 04 ' 7 12 - 6 2 3- 9 3 : 3u l v e r a r i l n 1 2 Hi h l a nd Av Re d Oa k A 5 1 9 6 6 7 1 2- 6 2 3- 6 8 92 1 / 2 - E2 3 . 3 s ` z

De Vr i e s J a c k i e 3 Shau n Ci r c l e Re d Oa k A 5 1 5 6 6 7 1 2 - 6 2 3 - 4 6 46Er n s t J o n i 9 1 0 N 6 t h St Re d Oa k A 5 1 5 6 6 7 1 2 - 6 2 3 - 4 9 3 1 7 ~ ~ - 6 2 3 7Gu f f e y El i z a b e t h 8 1 1 N 4 t h S t Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3 - 2 7 8 7Gu f f e Ma r 8 1 1 N 4 t h S t Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3- 2 7 87He c k e r t Ma r t h a 1 2 1 1 E Va l l e y S t Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3- 2 8 54Mc Qu o wn Gr e t c h e n 1 9 9 6 - 2 00 t h S t Re d Oa k I A 5 1 5 6 6 7 1 2 - 6 2 3 - 3 2 1 2Mi l l e r St e h an i e 3 0 9 - So 6 t h Re d Oa k A 5 1 5 6 6 7 1 2- 6 2 3- 5 3 5 3Ne l s o n N a n c y 1 0 6 2 n d , POB 9 2 Re d Oa k I A 5 1 5 3 2 7 1 2 - 7 6 7 - 2 7 1 2Ot t e J o n e t t e 1 1 5 0 C Av He n d e r s o n A 5 1 5 4 1 7 1 2 - 8 2 5 - 3 9 0 2 7 1 2 - 8 2 5 - 3 9 0 2Ra s mu s s e n Vi v i a n 2 4 63 - 1 4 0 t h S t El l i o t t I A 5 1 5 3 2 1 2 - 7 6 7 - 2 3 0 3Th o r n b u r J a ni c e 8 0 8 1 / 2 Mi l l e r A Red Oa k I A 5 1 5 6 6 1 2 - 6 2 3 - 9 0 8 9Ve n n e r b u r g Ma r j o r i e 2 5 8 3 L Av St a n t o n I A 5 1 5 7 3 1 2 - 8 2 9 - 2 6 0 3

3 - 5 . 2 1 2We l s c h - Ro s a e s Da n i k a 5 0 6 N 6 t h S t Re d Oa k I A 5 1 5 6 6 7 1 2- 6 2 3- 5 1 27 7 i ~ - < 3 - 5 1 . ? 7

A d d r e s s 1 1 1 1 Di v i s i o n St A d d r e s s A d d r e s s 1 1 5 0 C AvC i t y / Z i p Re d Oak , I A 5 1 5 6 6 C i t y / Z i p C i t } ~ / Z i p He n d e r s o n , I A 51 5 4 1P h o n e 7 1 2 - 6 2 3 - 9 2 04 P h o n e P h o n e 7 1 2- 8 2 5- 3 9 02


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FOR I NSTRUCT I ONS, SEE BACK OF FORM R e s e t Fo r mEXPENDI TURES - - MONEYSPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I O N 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 7 / 0 3 ) I EXPENDI TURES

CHECK T HI S BOX I FAMENDI NG FORM

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :P u 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 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 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 nS c 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 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 mmi 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 Cod e 6 8 A. 4 0 2 ( 3 ) ( i ) . )

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