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2005-09-21 DR2 Summary
2005-09-21 DR2 Summary
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SIGNATURE OF ERSON FILING REPORT TELEPHONE xa.
**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?) a YES F-1 NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
For Instructions, 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 ASTATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE 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 otherthan statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (11' applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
wI G~Y1 h Y I
C ,I NCI / U V~ f ( Vf~L~ N
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
farnilial relationship, enter `rat applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
- CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECKTHIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organizadon) AMENDING FORM
k t .~ S fiG YS
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/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# ~ ~~
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1K#
ID#
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l
ID# '
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t
CK# U . Bill" GSd
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1D#
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ID#
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e
11 ID#
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11 c3~1 ' y - /d
CK# Iev yaG'/ 1( ,
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ID#
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CK#
ID#
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ID# - - -
CK#
SUB-TOTAL
s
L F i9,a
TOTAL- (if last page of this schedule)
I s Iq 3?" 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_ LA of
familial relationship, enter "not applicable' in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM
I
SCHEDULE
SUBTOTAL
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 personlentity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)().)
Page
(for Schedule B)