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Miller Tom - 5064 - Scanned
Miller Tom - 5064 - Scanned
M FORM
DR-2 I DISCLOSURE
DISCLOSURE SUMMARY PAGE (Rev. 01/98) REPORT
/,/;z a z-
SIGNATURE OF THE URER (or person filing this report) TELEPHONE DA1 SIGNED
Routine Penalties Due For Late Filed Reports Range from $20 to $800
IAMFILING A s 4err 22- . ° ~Z-- REPORT FOR ANNA (1) ELECTION /(2)NON-ELECTION YEAR.
(report date) Indicate one 0
El Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. County b Local Committees, enter County in
(You must continue to file reports until a Notice of Dissolution is filed .) which Election is held
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . .. .. .. . .. .. .. ... .. .. .... .. .. ..... .. ..... .. .... ......... . . . . .. .. .. .. ... . . ... .. .. ......... .... .. .. .. .. .... .$ fZ.~ a~S~ `~'Y
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?) - e eA Ch
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
,For, Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 06/97) 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
!D#
c71 .,(/ l .2 ~V L (G
Z/~/o 1
CK# y.s /Vi,,/ 46 -~~ ;~&,P
Z~ s'aa v~
v~'nG
1D#
CK# boo, o
ID#
/A
IZ i //~.1 Lf .
/ Al CK# Z-5a
/'4o , nw,f ,~~ Jo3/c/
ID#
-r
r~ c - Gar
CK#
121 ID#
G
CK# 00
, 5,
C, 3 `f
SUB-TOTAL
$ Jaooo,jo
TOTAL (if last page of this
schedule) $
' 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 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 . 06/97) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
, DL4/-1 i'1 ,)
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 ,f IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
jl~
NUMBER INCOME
1D#
17 o
lZ~ia/ol
CK# a Y ~.~ ~ "~ . .-~
I D#
1211o/
CK#
iD#
'~,.r l. ~,~ 7`f o r fl--
2
7//
ID#
Z fl b~~l CK#
I D#
d
X0 I:> bo. 60
i
vel
ID#
4,~e
q2
0
1
ID#
9- Pi- J4d-17 -*-- .
11 y/~~ CK# ZC c -Sp°o.~ Cam--epk
y S ~02
ID#
CK#
1D# ~
fZlz~lDl CK#
co
SUB-TOTAL
$28b,C o
TOTAL (if last page of this
schedule) $
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 of
familial relationship, enter "not applicable" in the relationship column. (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 06/97)
MONETARY
RECEIPTS
(Including candidate's personal funds)
Q 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 688 .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#
y~ZS"A.~ra c~ .~ .
cK#
1D# '
~./~e ~ cl ~ ~ Qr7
Z 4/DI "..+b ` u~-mar
CK#
3y r s
ID#
_-
ID#
z/
CK# 6 3y A-1- Gt/
n A CJ/
o Q S j 66.5 /
SUB-TOTAL
CAUTION : Section 688 .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#
12 - CK#
1D#
ID#
1D#
I CK#
ID#
ID#
CK#
G
ID# ""
CK#
SUB-TOTAL
G.eaJ rs
NUMBER
ID# ,& 7 Priir~ l~c-0 rye
l~ plb l 6 &S"
CK#
ID# ,'
CK#
/rsl~
A.70/
Wti l4 .
Sb3i =~
JD#
u. S AJ--,~,,
woo
r
! 4,~a
i~ CK# /IST _ A
ID# D _ 13 c-xl?.Ph
Ce4P' - fL-D t c.'tj,e.e-
c5/ CK#
Z/ 3! 6o
1-7
&Y" ~~r D.S~ ~rC' I? fl~ iz 6. a
l r~s
CK# a / .3
~3~Z ~s
CK#
ID# r/ kv `~
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 persoNentity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 09/97) 1 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 .
CK#~~b /
;0 1-r
~l~b/OI 7i '0
ID#
CK#
~SQ.P ~,~ ~
~QJ
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 56 .6(3)(i) .)
(for Schedule B)
FOR . INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN KIND
COMMITTEE NAME (Mustbe same as on Statement of Organization) (Rev . 06197) CONTRIBUTIONS
i
'n 7j. 4P 0
i
r"1
y,-j va
~ZTo f
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives
Page `L_ of
(for Schedule E)
by 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 INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
G BREAKDOWN
THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY (Rev . 02/96)
OF MONETARY
EXPENDITURES
BY CONSULTANT
L1 41-11 EXPENDED
MM/DDIYR
NAME AND ADDRESS TO WHOM EXPENDITURE
Disbursemen WAS MADE PURPOSE
AMOUNT
EXPENDEI
Mailing Address
$
I 14
V
TOTAL ANTICIPATED
COMPENSATION FOR
CONTRACT PERIOD (MM/DD/YR) PERFORMANCE
From 3
To 1
Y102- . C' I $ /,,f150.b0
ESTIMATES OF PERFORMANCE
SUB-TOTAL $
Page of
(for Schedule G)