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Documentos de Profesional
Documentos de Cultura
,~1a3--~ ~3.-1193
OF PERSON FILING REPORT TELEPHONE DATE SIGNED
D Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed.) which Election is held
**UNPAID BILLS (From Schedule D - Attach Schedule D) .. ...... .. .. .. .. .... .. .. .. . . . .. .. .... .. ....., .., . .. .. . .. .. .. .. .. $
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . .. .. .. .. .. ........... .. .. .. .. .., . .. ... . . .. .. ..$
**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . .. .. .. . . .. .. .. .... .. .. ... .. .. .. ...... .., ., . . . . .. ..$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN
(Including candidate's personal funds)
(Rev . 07103) I RECEIPTS
STATE CANDIDATES NOT F A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHE NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
/o .
~~d $ Or
CK# ` ~ `l0
.-~,. S.z73y
ID#
JD~
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o~ I D#
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I D# '
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-
J o5 CK# /0
:S 3
2 73
ID# l
ID#
CK#
CX.4C. 3, o0
I D# ~,
I D#
CK#
SUB-TOTAL
* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
STATE CANDIDATES NOTE! IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER ` INCOME
I D#
,7 O $
3 .2I 7d
e
a7
C K#
- ~
ID# ~
c~
. cK# 9rs_
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ID# _
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a 45-
gal
CK#
y
I D#
,~ZoCh.~.<-rv
CK#
J,113-ss~.
I D#
I D#
CK#
Oy
ov. .~ ov, Z7 y 'Z SUB-TOTAL
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page ' of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back or Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07103) RECEIPTS
(Including candidate's personal funds)
771 CHECK THIS BOX IF
I COMMITTEE NAME (Must be same as 9,p Statement of Organization) AMENDING FORM
STATE CANDIDATES NOTE: iF A CCDlGTRIBUTICN IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT d 1F FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
l;
/ ID#
v
L
/S.
1D# '
CK#
W
i2 -73-2-
10#
r l
sz
ID# ,-L,~
CK#
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CK#
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ID#
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CK# /~ YG
_ ?2-73 z
ID#
CK#
SUB-TOTAL
$ n
TOTAL (if lastpage of this schedule)
1$
* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page -,~ of _
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
ac.HtUULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 06/97) i RECEIPTS
(Including candidate's personal !Lx)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statemen' of Organization) AMENDING FORM
STATE CANDIDATES NOTE: IF A 15'ONTRIBIJT*N IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 68B.32A(6), Iowa Code . prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
/ 0C
CK# p
ID# 01
ZO U
. CK#
ID#
CK# "'
~w SL 3 Z
ID#
2 - 1/2-0/o33
CK# ~ 3o 7Z"S,Cle-
' sL 3z
ID#
oa
CK# ~30 -,f-e
z 3z
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CK#
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CKN
S 2, 732, '
ID# - -
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37
SA
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ID# '
cK# 33d`j
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SUB-TOTAL $ 0©
6
TOTAL (if last page of this
schedule) !j
disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
-:mmittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
-)arnage) (See Page 2 of forms packet .) . If surname of contributor is the same as candidate. but there is no Page of
'amilial relationship, enter -not applicable - in the relationship column ( r Schedule A)
For Instructions, See Bac .k of Form SCHEDULE
MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
I~ CHECK THIS BOX IF
AMENDING FORM
STATE CANDIDATES NOTE: IF A &dNTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST CF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED I FUND-
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# L-
~. ..
.2-C o
CK# -r- S . _p ~C o- ar,
. ~D P
7/
Sz v
S2- - 732,
1D#
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* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If sumame of contributor is the same as candidate, but there is no Page --5- of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07!03) RECEIPTS
(Including candidate's personal funds)
I~ CHECK THIS BOX IF
,~~ ,
I MMITTEE NAME (Must befsame on Statement of Organiz tion) AMENDING FORM
Z
C ,~
_ J c-f
STATE CANDIDATES NOTE : IP'A CONTRUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED I FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
hEf~~ ~-'
3 03 ~j, 1-z ~~~- -
CK#
~.~Z73 i
CK#
I D# "
CK#
lD#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
SUB-TOTAL
* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .
Page _6 of
(for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY
(Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE El CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .
CK#/2,5 0 $ ~~ .
-.
ID#
l% , f . 'i~J i . ~~ 00
.7
l~ CK#, z s
ID#
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7l
ID# - 7 ~ . CIO
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CK#
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la
ID# w ..
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CK#
1700J
SUB-TOTAL
TOTAL (if lastpage of this schedule) $
Purchases of certain campaign property costing $500 or more must also be inventoried oa Schedule H . (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)
(fnr Rrharliila Rl
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
[D#
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ID#
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ID#
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ID#
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ID#
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ID#
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SUB-TOTAL
Purchases of certain campaign property costing $500 or more must also be inventoried oa Schedule H . (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i).)
of Page .2- ;_
(fnrgrhs-riAilc> R1