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Disclosure Summary Page sg5-S) LO DR-2,.:21,513 7 G
Disclosure Summary Page sg5-S) LO DR-2,.:21,513 7 G
611-~~2 - 3i V I
TELEPHONE DATE SIGNED
F1 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 .)
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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDOIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
&,qn'SS
ID#
I D# O
yZA4 Ar ~13r~ l ~ C Lh n
CK#
V &Won n_1)
ID#
C41'n
CK# o~ 3 oet
ID#
E:1
j S~gnE mcl'f'll9klprl
CK# ~2 T mbFx.l4xF
242P
TY
, JIFQ) ~~
171 E::1
ID#
PM e_01)4)3Vn
CK# ~ FIB 43-S ' 11 p4 i.IIVV 1'1
sA>7 ~r~ ~~falr~)Fw,~
-
k 2PP
ID#
~~ha Pr Ivh ~Dn
6 `Z -'QS CK# ~) Lnvae .l Pot
1 b -:1fl
P ly T
ID#
J 3 - 9~ CK# &
Z
ID#
ID#
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 of Form SCHEDULE
A I MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
Q CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
SOS_ S)LP
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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
S~TE~h~ ??,~vs~ CC
ID#
~,Qi~g
b 1Z _VS cK# s. yam,
Sr $ Z~
L sLS~
ID#
Y71CC /)1r4 0vn
E:1
-34
- t- y-
ID#
CK# 22-Z'3
'Z'-
il -0-N- t'
ID# T) r*7 44crs
Z2-2'3 i gs .~ St --
CK# ~5
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 of Form
I
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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
)3vb k Fut~
Z- 0 CK# 8)Ti S.
-1-*,9-
ID# ZLm. ~`7r n )d Ex4non
$-- ~~GS CK# bVZ A)P_<id E7 Pig ZDi~~'
.SZ.S
ID#
E s-
WA4.j J-01 E:& XF
CK# V9 CDPk`r r
El
ID#
CK# El
ID#
CK# E]
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
E]
ID#
CK#
SUB-TOTAL
$ 2-4-5-
TOTAL (if last page of this schedule) r?'
' 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 3 of _3
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE
D
STATE PAC COMMITTEES : N0TE : FOR CONTRIBUTION6 MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 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.
SPS- SIL :,
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# . E -59n Gv11r1T'7 ~OLJIe b d q~-~ ~Fm~~
CK# f,-4) it 3©-11 $
Sa V ~/
~l- ld ~ Fcr~~
ID# !"oj t~2 II~F S 'V~~ C9q 1ES ~t~Q
CK# ,SU 4 E. WASH )FIST p n
i T.--)L s
ID# ~s)~ ~~rr1nF bFS~,~>-, l ~'a 1 ~xwchvrz~ dFS,~h
CK# (00) aEFts*rjT yV
ID#
JiZVIr7TUnE PR-)nT"q5 CV 1CVU4VAES
SUB-TOTAL $
TOTAL (if last page of this schedule) $
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).)
Page -~ of - 2--
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM ,Keset Form SCHEDULE
SC)_'--sj/_v
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# 1~~I__ __
fi~'
p, ._p cK# E. 8A01IJ>~7 $ ZY' y U
Ap-ion7ch ~L .
ID# 7,_V t-7 -TA pmpSP)l
3~
1!ti
r 4-)72 ` )LF ~y2. yIJ~47 'iC
CK# ~q
8~1Q4~ 32-Sf
ID#
CK#
ID#
CK#
ID#
CK#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $2
'
1 $329)-14
TOTAL (if last page of this schedule)
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to personstentities 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) .)
(for Schedule B)