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LOW T 33 - AC,: Disclosure Summary Page DR-2
LOW T 33 - AC,: Disclosure Summary Page DR-2
0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a DR-3 is filed.)
39 tai :25
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . .. . .. .. .. .. . . ... .. ... .. .. . .. .. ... .. .. .. ... .. . .. .. ... .. ... .. ... .. ... ... .. ... .. ... .. ... .. .. . .. .. ... .. ... ... $
**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 F-] NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
SCHEDULE
A MONETARY
NS -- MONEY TAKEN IN (Rev . 0710 RECEIPTS
ding candidate's personal funds)
KJ CHECK THIS BOX IF
EE NAME (Must be same as on Statement of Organization) AMENDING FORM
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 0 CONTR , UTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) Orlb` ;i'1,t~YY~Ct'C, ~ TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK O(CL~ ,~ ~~ (if applicable) RAISER
NUMBER Wk; C INCOME
ID#
r $
I `U~'I CK# l.
,tn
El
ID#
CK#
ID#
CK#
ID#
2 4t,1 CK#
Its#
~~ CK#
ID#
~~ CK#
ID#
CK# \\_ r
ID#
CK#
Yli
1D#
)1,4 j CK#
E:1
ID#
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 Page of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
Fi-r Insttuctions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03 RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
$ /Too
ID#
CK#
E]
ID#
CK#
ID#
El-
CK#
I D#
-.
E:1
CK#
ID#
CK#
-
I D#
CK#
I D#
CK#
I D#
E:1
CK#
I D#
E:1
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 Page 0!~o of "--
familial relationship, enter "not applicable" in the relationship column .
(for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM I trorn~ SCHEDULE
ID#
Jaua oem-tx,tzjhc r
CCoo,
0c~~offag U t~~~
-C ( l t
.
c:~.-Q.
ID#
CK#~~ ~ ~~ ;
-
ID# '
Ck~~(
CK# (S R)
S
3/AA v)l - d3
IN
frZf _ CIS' Cr VR(ko a _
ID# -
CK#
I D#
CK#
SUB-TOTAL $
Purchases of certain campaign property costing $500 or more must also be Inventoried on 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 a nd Iowa Code 68A .402(3)(1) .)
(for Schedule B)