Professional Documents
Culture Documents
Ay wn'-0: Disclosure Summary Page DR-2
Ay wn'-0: Disclosure Summary Page DR-2
I AM FILING A Nov. 30, 2005 REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by # 0
Oct. 31, 2005 Local Committees, enter Date of Election
;/CHECK IF AMENDMENT TO REPORT DATED
Nov. 8, 2005
County & Local Committees, enter County in
[A Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . which Election is held
(You must continue to file reports until a DR-3 is filed.)
Washington
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
CK#
;, .Z 141 aSa yl-A S_'f
CGlc . 4r r^ .. e ~, .-L *v ` 3 53 5 3
ID# -'
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
' 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 Ro-wt
Form SCHEDULE
MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B
(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 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 .
lwe
COMMITTEE NAME (Must be same as on Statement of Organization)
CK#
ID#
CK#
1D#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
SUB-TOTAL $
t$1~ y~
TOTAL (iflast page of this schedule) $ ~ ,
y
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 and Iowa Code 68A .402(3)(i) .)
(for Schedule B)