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Disclosure Summary Page J-055: Instructions. See Back of Disclosure For Only
Disclosure Summary Page J-055: Instructions. See Back of Disclosure For Only
a Comm. # J- 055
(
IMPORTANT : Indicate type of committee you are reporting for:
1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate -°ul Z--
Audited
( 5 )County PAC (o )Ballot Issue/Franchise Committee (7 )CountyiCity Central Committee .r
( 8 )Support Slate of Candidates Computer L
Routine Penalties Due For Late Filer! Reports Range from $20 to $800
SEE INSTRUCTIO NS ON SACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A ZIA_V. . .c ;w A ZZ "2LnZ REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one
El 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 Notice of Dissolution is filed.) which Election is held
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-
(MfWDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
10161 lot
CK# (o 67 1 14 L6
o - v i l~
/ ID# kl ;.~ c~
Z S/c~ i ~ o
U
~dl CK# i~cS~l 6 - v1 $f~.
Ce ~ a.~ ~i31 s -L,r4 ~`Z`+k~2
o ~ rcfLS _ ~i, ;3 13
ID# ~a,r01~ ~ ~ leSS
I ( l03/01 CK# -rsov+
rSl rEC?..i `- So 3 t ~ f ~ aZ_
ID# ~, ~ Sc-k vt.~1 l
la
CK#
na .a, r;r - 5 3rD
ID# /4ocXr s .c1
Hr 1Ce -
1425fof CK# 314
:G4 .5664q Z15' -
ID#
Disclosure law requires candidate committees to disclose the relationship of any relative malting a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by `
marriage) (Seed Page 2 of forms packet .). If surname of contributor is the same as candidate, but there is no Page
familial relationship, enter "not applicable° in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 06/97) RECEIPTS
(Including candidate's personal funds)
Q CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
- ~ lCL 4
C 6, wk e (o-ell '
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/DDfYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# SVl"wI CG., ~ur' ~s5
1111 5Z z
10lb~~~I CK#
rs 1'Ylo t n-e5 -L{1 5c>313
ID#
3q 3 Ps
E ID o I CK#
hPS rutitrQs ~ ~a3t3
I D# GLtit ~% l H G~
G h~
~T4
CIC# 117 3 /4o M4 j
Ctlr^ S ~ (il t ~UJ It '~ \ ~O
ID#
CK# ._
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ID# t, ii) jtiat'e.
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f JS
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ID# pc, o-f( 1~rYSsS
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ID#
" Disclosure law requires candidate committees to disclose the relationship of my relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives bar
of Page 2- ,
marriage) (See Page 2 of forms packet .). 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
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 06197) 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-
(MIUUDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# ~or1 C . lychee,
II /ZOIU~ CK# 36 ~i v~S io v~ 6r~v-~
o ,,i VJ S35 F>3
ID# ~l 8e-y
(0Z-7 cll,46A ~~ -
CK#
es !Ylo1#1es Q? 0313
ID#
vua-Ve~
rn o vk e-S si,313
ID# ~~ (c C~IG ao
l LloZ/o+ CK# 41-7 vk&w,
i&cs -<u315
I D# R. L,h C --r J+L lrvl:4e-rs ,1
Zl0 Z~/p I CK# (,CJDe I u;H tl ~,, cJt~l`S
G ~G 5ZZ" u lt~ °-~
ID# Ph ; +( ;,,
V - sA
ID#
Z/62,/off
CK# 51 u - 3T~` S-fK-e
bgs M o gs -:C- A So3(z l
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) (See Page 2 of forms packet .). If sumame of cordriturtor is the same as candidate, but there is no Page 3 of
familial relationship, enter "not applicable" in the relationship column. (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 06197) 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-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# a.v~~-f - ~e bvY-
'
Zw3wl CK# d1! F~-f 3~ s Cp -t
cs /ti( o ~ .~. So3
ID# J i a.. (c'f Z
a zlo4/D! CK# 11 S E av'x- 2:
Dz,z lo Z~
P~~ C~
ID#
ID#
cv`
°°
r o/zeb u CK#
a ass ~f~rl~ ~ t~Y ._
ID#
FOX
1'~bzlo f CK#
ID#
CK#
ID#
CK#
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) (See Page 2 of forms packet .). If surname of contributor is the same as candidate, but there is no Page
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
P
.~hhs -~-r4 S~I3(
ID# '
ID# -,-
~e.wv~4.rt D eCor~l ~ ~ 3
v~ C K# ZOO 1 LZ~ E-S- .. 8(0 ::71
o `n4S =Ls4 So!
I D#
IZlzq/or CK# ZC~~ ~I73q 1;. ..k6- 8n
4uZ
,tJeS OLh~" yr7S~ (b ~~~~ t'S
ID#
~.-m~,(~ 6",-,;d
tzlz-t1o, CK#~ups P ~ /.2.3,5
Mn .~ ?' Sb3d
ID# '
CK#
SUB-TOTAL $
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
3chedule 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 larva Code 56.6(3)(i).)
Page
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
Avol I
~7 r Alw Y~
- I cx;~ 7°3 -74z _" 65 t 5rl
S~ lr>Jv r li 5~3 ~ 3
SUB-TOTAL $
*If actual figure is unknown, show "estimated" beside the figure . Page I of ~_
(for Schedule D)
1A VI P.t/
TOTAL VALUE CAMPAIGN PROPERTY THIS RE R ** PROPERTY SALES & TRANSFERS TOTAL TOTALS $ $
(TRANSFER TO SUMMARY PAGE) $ (TRANSFER TO SUMMARY PAGE) $
* If estimated, show est. beside figure . (Attach Additional Schedules if Needed) Page of Pag
(For Schedule H)
I' (,4/t (,1rv