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FOP J N~TRUCTI ONS SEE BACK OF FORM
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I MPORTANT: I n d i c a t e 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 :
( r ) S t a t e w i d e / l . e g i s Wt i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ; 3 ) S t a t e P a r t y ( a ) C o u n t y / L o c a l C a n d i d a t e1 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e Co mmi t t e e ; 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e( 8 ) S u p p o r t S t a t e o f C a n d i d a t e s
a ' , - - . f l y ' ( s s )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 )
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SI GNATURE
DI SCLOSURE SUMMARY PAGE
TEL EPHONE
Ro ut i n e P e n a l t i e s Du e Fo r L a t e F i l e d Re po r t s R a n g e f r o m $ 2 0 t o $ 8 0 0
SEE I NSTRUCTI ONS ONBACKANDCOMPL ETE THE FOL LOWI NG SENTENCE
AM F I L I N G A
( r e p o r t d a t e )
OCHECK I F AMENDMENT TO REPORT DATED
9 s - 9 ? . ? 3
0 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 o r t h DR - 3 .( Y o u mu s 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 . )
/ ` 2 1 - 200
DATE S I GNED
REPORT FOR AWA ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR
STATEMENT OF CASH ON HAND
I n d i c a t e o n e
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 b 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
SUBTRACT TOTAL MONEY SPENT T H I S PERI OD
q -2 2 - . - 79S c 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 S c h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
S c h e d u 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 S c 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 o d ( i f f i n a l r e p o r t , b a l a n c e mu s t ~
0b e z e r o ) ( A t t a c h . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . - . . - . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . - . . . . . . . . . . . . .
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 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 ( Fr o mS c h e d u l e F - A t t a c h S c h e d u l e F j . . . . . . S
CANDI DATE COMMI TT EES ONLY
CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d )
VALUE OF 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) $
YE S NO
CASH ONHAND 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 mo v i e s h e l d b y t h e c o mmi t t e e . T h i s a m o u n t MUST b e t h ec a r n 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 f 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 t i l e d . ) . . . . . . . . - . - . - . - - . . . . . . . . . . . . . . . . . . . . . . $
ADD TOTAL MONEY TAKEN I N T H I S PERI OD
I D- L 4S c h e d u l e A C a s h 0 - - 7/ 0,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 )
S c h e d 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 Ca mp a 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . .
( S c h e d u l e H a o u l i e s t o C a n d i d a t e s ' Co mmi t t e e s O n l Y l
(S~~SUB- TOTAL . . . . 5 -
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r v r I n su uc uv r l s , ac e D0 e . R o f n or m
CONTRI BUTI ONS - - MONEYTAKEN I t '
( 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 nd )
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SCHEDULE
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( Re v . 0 & 9 7 ) RECEI PTS
STATE CANDI DATES NOTE : I F A CONTRI 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 E NT I F I C A T I O N
NUMBER AND THE PACCHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 6 6 8 . 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 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 r
f o r an y c omme r c i a l p ur 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 .
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 e
. R e l a t i o n s h i p m u s 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 y
( 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 a s c a n d i d a t e , b u t t h e r e i s n o
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 umn ( f o r Sc h e d ul e A )
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ Y R) AND PACCHECK Of a p p l i c a b l e ) RAI SER
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r o r i n s t r u c t i o n s , bee OBCK OT r o r m
CONTRI BUTI ONS - MONEY TAKEN I N
( I n c l u d k l p c a n d i d a t e ' s p e r s o n a l h i n d s )
COMMI TTEE NAME ( Mu s t b e same a s o n S f a f e r n e n f o f O r g a n i z a t i o n )
t ~ f J u ~ u l i ^ ~ ~ ' cc -. e l e c f 6 - r N t i o 4 6e' q i ' '
SCHEDULE
TOTAL ( i t l a s t p a g e o f t h i s
s c h ed u l e )
CHECK T HI S BOX I FAMENDI NG FORM
A MONETARY( R e v . 0 6 1 9 7 ) I RECEI PTS
STATE CANDI DATES NOTE : I F A C ON T RI B UT I O N I S R E CE I V E D FROM A S T A T E PAC ( P O L I T I C A L A C T I O N C OMMI T T EE ) , L I S T THE PAC I D ENT I F I C A T I O NNUMBER AND T HE P AC CHECKNUMBER I N THE D E S I G NA T E D COLUMN A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T H E I OWA E T H I C S AND CAMPAI GND I S C L O S UR E BOARD .
CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , 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 y c o mm e 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 m m i t t e e s .
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 e
c o m m 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 y dm a r n a g e ) ( S e e P a g e 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 same 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 - _ 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 m n ( f o r S c h e d u l e A )
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v 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 PACCHECK ( i f a p p l i c a b l e ) RAI SER
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CONTRI BUTI ONS - MONEY TAKEN I N
( I n c l u d f r q c a n d i d a t e ' s p e r s o n a l h x l d s )
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Cew. w . ; ~ 4 e 4 - o e l ee+ ( r u~, of be r ,j - t o + ue .
S T A T E C AN D I D AT E S NOTE I F A C ON T R I B U T I O N I S R E CE I V E D F R O M A S T A T E P A C ( P O L I T I C A L A CT I O N C OM MI T T E E) , L I S T T HE P AC I DE NT I F I CA TI O NNUMBER A N D T HE P AC C H E C K N U M B E R I N T H E D ES I G N A T ED C O L U M N A L I S T O F I D N U M B E R S I S A VA I L A B L E FROM T H E I O WA E T HI C S A N D C A MP A I G ND I S C L O S UR E B O A R D
CAUTI ON : Se c t i o n 668 . 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 ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r
f o r an y c o mme 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- TOTAL
TOTAL ( i f l a s t page o f t h i s
s c h ed ul e )
SCHEDULE
CHECK T H I S BOX I FAMENDI NG FORM
A MONETARY( R e v 0 6 / 9 7 ) I RECEI P T S
D i s c l o s u r e l a w r e q u i r e s c a nd 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 e
- 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 ns a ng 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 y 2Z9ma r n a g e ) ( Se e P a g e 2 o f f o r ms p ac 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 a m e a s c a nd i d a t e , b u t t h er e i s n o P a g e ~ 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 pp l i c a bl 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 AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
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i - o r i n s t r u c t i o ns , bee c aCK OT I - o r m
CONTRI BUTI ONS - MONEYTAKEN I N
( i n c l u d i n g c a n d i d s t s ' s p e r s o n a l f u n d s )
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CAUTI ON : S e 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 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 r
f o r a n y c omme 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 .
TOTAL ( i f l a s t page o f t h i s
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AMENDI NG FORM
A I MONETARY
( Re v . O 6 / 9 7 ) RECE I P TS
. D i s c l o s u r e l a w r e q u i r e s c a nd 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 e
~ o mml t l e e R e l a t i o n s h i p mus l 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 ns a ng 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 y 2p
ma r r i a g e) ( Se e P a g e 2 o f l o r ms p ac 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 di d a t e , b u t t h er e i s n o P a g e - , 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 pp l i c a bl 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)
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT v I F FOR
RECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE ' RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
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CONTRI BUTI ONS - MONEYTAKENI K
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QCHECK T HI S BOX I FAMENDI NQ FORM
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STATE CANDI DATES NOTE : I F A C ON T R I B UT I O N I S R E CE I V E D FROM A S T A T E PAC ( P OL I T I C A L A CT I ON C OMMI T T E E ) , L I S T T HE PAC I D ENT I F I CA T I ONNUMBER AND THE PACCHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T H I C S AND CAMPAI GND I S C L O S UR E BOARD
CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , 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 y c o m m e 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 mm i t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s
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 e- o m m 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 n a g e ) ( S e e P a g e 2 o f l o r m s p a c k e t ) I f s u r n a m e o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 m n ,
s c h e du l e ) ( $
P a g e -~_o f( f o r S c h e d u l e A )
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
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CONTRI BUTI ONS - MONEYTAKEN I .
( I n c l u d n p c a n d d a l 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 l z a Uo n )
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CAUTI ON - S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e, 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 r
f o r a n y c o mme r c i a l p u r p o s e b y a ny 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 e s .
$13,00
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s c h e d u l e )
D i s c l o s u r e l o 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 e
z o mm l 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 n 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 of 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 )
SUB- TOTAL 5
Pa g e o f _2- _C
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I F FOR
RECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
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CONTRI BUTI ONS - MONEY TAKEN I ) .
( I n c l u d k q c a n d i d a t e ' s p e r s o n a l f w ~ d s )
COMMf TTEE NAME ( M u s t b e aama a s o n S t a t e r n o n i f o f O r g a n i z a t i o n )
COV^ w . ; 4 4 - e e - b e ( e r uv j L I e r ` I 6 4ousp-
CHECK T H I S BOX I FAMENDI NG FORM
SCHEDUL E
A MONETARY( R e v 0 6 1 9 7 ) R EC EI P T S
S T A T E C A ND I D A T E S NOTE I F A C ON T R I B U T I O N I S R E CE I V E D FROM A S T A T E P A C ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T T H E P A C I DENT I F I CA T I O NNUMBER A N D T H E P AC C H E C K N U M B E R I N T H E D E S I G NA T E D C O L U M N A L I S T O F I D N U M B E R S I S A VA I L A B L E F R O M T H E I O WA E T H I CS A N D C A MP A I G ND I S C L OS U R E B O A R D
CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e 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 y c 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
$,
TOTAL ( i f l a s t p a g e o f t h i s
s c h e d u l e ): ) 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 e
c o m m i t t e e R e l a t i o n s h i p m u l l 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 yr n a r n a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t ) I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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
SUB- TOTAL~DDa
P a g e - ° "_( t o t S c h e d u l e A )
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMODNR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
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n o r i n s t r u c t i o n s , b e e o aC K O f r - o r m
CONTRI BUTI ONS - MONEY TAKEN I I -
( 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 d u l d s )
COMMI TTEE 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 l z e t l o n )
C o v - v Z ' f e e + - e eG v .
CHECK T H I S BOX I FAMENDI NG FORM
SCHEDULE
A MONETARY( R e v 0 6 1 9 7 ) R EC EI P T S
S T A T E C A ND I D A T E S NOTE : I F A C ON T R I B U T I ON I S R E CE I V E D FRO M A S T A T E P A C ( P O L I T I C A L A CT I O N C OM MI T T E E ) , L I S T T H E P A C I DE NT I F I CA T I ONN U M B E R A ND T HE P AC C H E C K N U M B E R I N T H E D ES I G NA T E D C O L U M N A L I S T OF I D N U M B E R S I S A V AI L A B L E FRO M T H E I O WA E T HI C S A N D C A MP A I G ND I S C L OS U R E B O A R D
CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) I o w a C o d e , 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 y c 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
TOTAL ( i f l a s t p a g e 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 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 e
: o m m l t l e e R e l a t i o n s h i p m u s t b e s h o wn 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 n a g e ) ( S e e P a g e 2 o f l o r m s p a c k e t ) I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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
P a g e --- o f . _- _ , _( f o r S c h e d u l e A )
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CONTRI BUTI ONS - MONEYTAKENh
( I n c l u d f c a n d i d a t e ' s p e r s o n a l h u l k )
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D i ' " I A- f 1°a eG Y_ t AN t 6 f A ' _ 4 I Use
CHECK T HI S BOX I FAMENDI NG FORM
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NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF 1 0 NUMBERS I S A V AI L A B L E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD
CAUTI ON : S e 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 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 ny c omme r c i a l p u r p os e b y a ny 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 e s .
SUB- TOTAL
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s c h e du l e )
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- o m m 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 wn 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 Pa g ef 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 ul e A )
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) T O CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER
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CONTRI BUTI ONS - MONEY TAKEN I I( h w k l d n p e a n d d a t e ' s p e r s o n a l h i n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o ! O r g a n i z a t i o n )
f o r an y c 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 mm i t t e e s .
COMI M ' I ' 4 4ec - f ! 7 2c . Y s n o t z °Y - 4 D oU, Se
STATE CANDI DATES NOTE : I F A C ON T RI B UT I ON I S R E CE I V E D FROM A S T A T E PA C ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T THEPAC I D EN T I F I C AT I O NNUMBER AND T HE P AC CHECK NUMBER I N THE D E S I G NA T E D COLUMN . A US T OF I D NUMBERS I S A VA I L A B L E FROM THE I O WA E T H I C S AND CAMPAI GN
D I S C L O SU RE BOARD .
CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C o d 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 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
: 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 e- m mi 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 ya ma g e ) ( S e e P a g e 2 o f f o r m s p a c k e t ) . t 1 s u r n a me o 1 c o n t r i b u t o r i s t h e s a m e 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 o f
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 )
SCHEDULE
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( R e v . 0 6 1 9 7 ) R EC EI P T S
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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 m
CONTRI BUT I ONS - - MONEY TAKEN I t( I n c l u d k V c a r b f d e l e ' s p e r s o n a l k x l d s )
COMMI TT EE NAME ( M u s t b e s a m e 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 )
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SCHEDULE
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CHECK T H I S BOX I FA M E ND I N G FORM
S T A T E C AND I D A T E S N O T E : I F A C ON T RI B U T I ON I S R E C E I V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T I O N C OM MI T T E E ) L I S T T H E P AC I D E N T I F I C A T I O NN U M B E R A ND T H E P AC C H E C K N U M B E R I N T H E D E S I GN AT E D C O L U M N A L I S T O F I D N U M B E R S I S A V A I L A B L E F R O M T H E I O WA E T H I C S A ND C A MP A I GND I S C L O S U RE B O A R D
CAU T I ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , 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 y c 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 mm i t t e e s
J > 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 eR 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 y
( S e e P a g e 2 o f f o r m s p a c k e t . ) I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e 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 o f _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 m n ( f o r S c h e d u l e A )
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELA T I ONSH I 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 SER
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CONTRI BUTI ONS - MONEYTAKENI N
( k i c l u d l 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 l e r r i e n t o f Or g a n i z a t i on )
ec - c , e I , - - c I r U vI d - 4 o . i , - - I l ows2
STATE CANDI DATES NOTE : I F A CONTRI BUT I 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 E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A UST OF I D NUMBERS I S A V AI L A B L E 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 r
f o r a n y c o mme r c i a l p u r p o s e by 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 es .
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 e
^ , m 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 yi ma g e ) ( Se e P a g e 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 am e a s c a n d i d a t e , b u t t h e r e i s n o
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 )
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NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S A V AI L A B L E FROMTHE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON : S e 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 r
f o r an y c o mme 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 e t i c a l c o mmi t t e es .
, 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 e
mmi 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 y
a r n 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 a s c a n d i d a t e , b u t t h e r e i s n o
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)
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S T A T E C AN D I D AT E S NOTE I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E P A C ( P O L I T I C A L A CT I O N C OM MI T T E E) , L I S T T H E P A C I DE NT I F I CA T I O NNUMBER AND T HE P AC C H E C K NUMBER 1 1 4 T H E D E SI G N A T ED C O L U M N A L I S T O F I D N U M B E R S I S A V AI L A B L E FROM T H E I O WA E T HI CS A N D C A MP A I G ND I S C L O S UR E B O A R D
CAUTI ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , t 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 rf o r a n y c 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
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CONTRI BUTI ONS - MONEY TAKEN I t .( I n d u c i n g c e n r i l d a t a ' s p e r s o n a l f u n d s )
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STATE CAND I DA TES NOTE: I F A C ON T R I B U T I O N I S R E CE I V E D FROM A S T A T E P A C ( P O L I T I C A L A C T I O N C OMMI T T E E ) , L I S T T H E P A C I D EN T I F I C A T I O NNUMBER A N D T H E P A C C H E C K NUMBER I N T H E D E S I GN A T E D C O L U M N A L I S T OF I D N U M B E R S I S A V A I L A B L E FROMT H E I O WA E T H I C S A N D C A M PA I GND I S C L O S UR E BOARD
CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) I o w a 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 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 rf o r a n y c 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
TOTAL ( i f l a s t p a g e o f t h i s
s c h e d u l e )D 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 e
~ o m m r 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 ym a r r i a g e ) ( S e e P a g e 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 a m e a s c a n d i d a t e b u t t h e r e i s n of 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
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Fo r I n s t r - i c t ) r n s , Se e Back ( _ Fu i . . )
CONTRI BUTI ONS - MONEYTAKENI r e
( I n du dn 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 on St a t e me n t o 1 Or g a n i z a t i o n )
e l e 6V ' L l w. S2
STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM. A STATE PAC ( P OL I T I C A L ACTI ONCOMMI 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 GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON : S e 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 fi 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 men 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 ommer c i a l p ur p os e by 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 b t i c a l c o mmi t t e es .
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- o mmd 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 u 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 y
, n a r r r 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 am e 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 _ _ L _ ~ _ . 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 umn ( f o r Sc h e d u l e A )
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECE I VED FUND-( MM/ DD/ Y R) AND PACCHECK ( i f a p p l i c a b l e ) RAI SE
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Fo r I n s t r u c t i o n s , See Back o f f or m
CONTRI BUTI ONS - MONEYTAKENi . .
( I n c t u d l n g c a n d l d e t e ' s p e r s o r n l t u r f s )
COMMI TTEE NAME ( Mu s t be s ame a s on S t a t e me n t o f Or g a n i z a t i on )
COt NMM f 4 4eGTp eGf61 ^ Nwl +t " US~
STATE CANDI DATES NOTE: I F ACONTRI BUT I ON I S RECEI VED FROMASTATEPAC ( POUT I C AL ACTI ON COMMI TTEE) . L I S T THE PACI DENT I F I CATI ON
NUMBERANDTHE PACCHECKNUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBI RS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON:Se c t i o n 68B. 3 2 A( 6 )
.
I o waCod e, p r oh i b i t s
t h e u s e o fi n f o r ma t i o n c op i e d f r om r e p or t s and s t a t e me nt s f o r s o l i c i t i n g
c on t r i bu t i on s o rf o r any c omme r c i a l p u r p o s e b y 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 e s
D, s c l o s ur e l a w r e q u i r e s c a nd i d at e c o mmi t t e es 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 e
' o mmi l 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 ns a ng u i n i t y ( b l o od 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
- n a r r r a g e ) ( S ee P a g e 2 o f f o r ms p a c ke 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 am e a s c a nd i d a t e . b u t t h e r e i s n of a m i l i a l r e l a t i o n s h i p , e nt e r ' n ot a p p l i c a bl e i n t h e r e l a t i o n s h i p c o l u mn
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F o r I n s t r u c , o n - , S e e B a c k o f F o r t h
C ON T R I B U T I ON S - MONEY TAKEN 1 1 .( I n c l u d i n g c a . d d a N ' 8 p e r s o n a l h i n d s )
C OMM I T T E E NAME ( M u s t b e s a m e a s o n S t a t e m e n t o f O r g a n i z a t i o n )
Co mr , , ' - f e e - - b e ~ e c f Gr r u t ^ e t L. ) s + ' ~ 4 - o
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T O T A L ( i f l a s t p a g e o f t h i s
Q C H E C K T H I S B OX I FA ME ND I N G F O R M
S C H E D U L EA
( R e v 0 6 / 9 7 )MON E T A R Y
R E C E I P T S
S T A T E C A N D I D A T E S N O T E I F A C O N T R I B U T I O N I S R E C E I V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T I O N C O M M I T T E E ) L I S T T H E P A C I D E N T I F I C A T I O NN U M B E R A N D T H E P A C C I 4 E C K N U M B E R I N T H E D E S I G N A T E D C O L U M N A L I S T O F I D N U M B E R S I S A V A I L A B L E F R O M T H E I O W A E T H I C S A N D C A M P A I G ND I S C L O S U R E BOARD
C A UT I ON S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , 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 rf o r a n y c o m m e 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 m m i t t e e s
s c h e d u l e ) 3 a , ® 1 7 .D 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 e
c o m m 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 I c t h e t h u 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 ) ( S e e P a g e 2 o f f o r m s p a c k e t I f s u r n a m e o f c o n t r i b u t o r I s t h e s a m e 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 o f d
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 m n ( f o r S c h e d u l e A )
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RE L A T I ONSHI P AMOUNT J I F FORECE I VED ( i f a p p l i c a b l e ) TO CANDI DAT E ' RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SE
NUMBER I NCOM
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I S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :
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 m u s t a l s o b e i n v e n t o r i e d o n S c h ed 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 . )
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 nc 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 ma 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 r t o
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 wa Co d e 5 6 . 6 ( 3 ) ( i ) . )
P a g e . _ _j _ _ _ _ _ o f _ _ _ _
( f o r S c he d u l e B )
FOR I NSTRUCT I ONS, SEE BACKOF FOl SCHEDULE
EXPENDI TURESB MONETARY
- MONEY SPENT FROM COMMI TT EE ACCOUNT( Re v . 0 9 1 9 7 ) EXPENDI TURES
STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLATI VE
CANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE O CHECKTHI S BOX I FPAC CHECK NUMBER FOR EACHEXPENDI 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 n i z a t i o n )
i 4 , & e - 1 a c ? ( e c 4 - <~~ u " d I e, - ,D 4 . f ' I - , Q - 1 - o uS . p -CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT
DATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( o 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 DD / YR) AND PAC
CHECK
NUMBER
I N~Y' , S~Z t r ~Q~~ Fees
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FOR I NSTRUCTI ONS, SEE BACKOF FOf
EXPENDI TURES - MONEY SPENT FROM COMMI TT EE ACCOUNT
STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUT I ONS MADE TO STATEWI DE OR L EGI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DES I GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPEND I TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWAETHI CS 3 CAMPA I GN DI SCLOSURE BOARD.
COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g a n i z a t i o n )
V 1 4 e ,
1 2514 1 1
I N
CK#
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