Transcript
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.,DISCLOSURESUMMA - YPAGEMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f O r g a n i z a t i o n )
h e Co mmi t t e e t o El e c t Da v i d Co l b er t
PORTANT : I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :
) S t a t e w i d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mm i t t e e) S u p p o r t S l a t e o f C a n d i d a t e s
NATURE OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE
Ro u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Re po r t s R a n g e f r o m $ 2 0 t o $ 8 0 0
I NSTRUCT I ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :
F I L I NG AJ a nu a r y 2 2 , 2 0 0 2
( r e p o r t d a t e )
HECK I F AMENDMENT TO REPORT DATED
Kr i s t i ne A . Br e n n e r 7 1 2- 8 8 3- 2 9 06
i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .
( Y o u mus t c o n t i n u e t o f i l e r e p o r t s u n t i l a N o t i c e o f D i s s o l u t i o n i s f i l e d . )
REPORT FORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- ELEC
STATEMENT OF CASH ON HAND
I n d i c a t e o n e
ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a l
o f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s amoun t MUST b e t h e
s ame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a s t r e p o r t i n g p e r i o d ,
o r mus t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
DR-2 DI SCLOSURE
( Re v . 0 1 / 9 8 )
IREPORT
F o r O f f i c e Us e On l y
Comm . #
I n d e x e d -
A u d i t e d
Co mp u t e r
L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n
J u n e 2 , 1 9 9 8
C o u n t y & L o c a l C o mm i t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d
ADD TOTAL MONEY TAKEN I N THI S PER I OD - 0 -
Sc h ed u l e A : Ca s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h ed u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h ed u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0
Sc h ed u l e H : T o t a l Sa l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h ed u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 -
( Sc h ed u l e H a pp l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )
SUB- TOTAL . . . . . $SUBTRACT TOTAL MONEY SPENT THI S PER I OD
Sc h ed u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e du l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sc h ed u l e F : L oa n Re p a y me n t s t o t a l ( A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b a l a n c e mus t
b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
DATE
1 - 1 8 - 0 2
6 9- 3 5
69 . 3 5
- 0 -
0 . 0 0
I ~ 2 - L
6 9 . 3 5
AI D BI L LS ( F r o m Sc he du l e D - A t t a c h Sc h ed u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
KI ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h ed u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . $ 1 , 4 00 . 0 0
I NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
NDI DATE COMMI TTEES ONLY :NSULTANT BREAKDOWN ( Sc he du l e G A t t a c h e d ? ) YES X NO
OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h ed u l e H) $ 0 . 0 0
JAN2 4 200
1 7 \
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BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :
o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g 5 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )
t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o n
G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )
( f o r Sc h e d u l e B )
I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE
' EXPENDI TURESB MONETARY
- - MONEY SPEN i r ROMCOMMI TTEE ACCOUNT( Re v . 0 9 / 9 7 ) EXPENDI TURES
PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VEDATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I F
NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMS & CAMPAI GN DI SCLOSURE BOARD.
MI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
Th e Commi t t e e t o El e c t Da v i d Co l b er t
CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT
I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED
DED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE
DD/ YR) AND PAC
CHECK
NUMBER
I N Do na t i o n
- 1 5 - 0 2 Ci t y o f Dan bu r y ( Ba l a n c e l e f t i n a c c tCK# 1 0 3 5Gene r a l F u n d Di s so l u t i o n o f Co mmi t t e e )
$
6 9 . 3 5
I N
CK#
I D #
CK#
I D #
CK#
I D #
CK#
I D #
CK#
I D #
CK#
I D #
CK#
S U B - T O T A L $ 6 9 . 3 5
TOTAL ( I f l a s t p a g e o f t h i s s c h ed u l e ) $ 6 9 . 3 5
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I NSTRUCTI ONS, SEE BACK OF FORM
MMI TTEE NAME ( Mu s t b e s ame as o n S t a t e me O r g a n i z a t i o n )
Th e Co mmi t t e e t o El e c t Da v i d Co l b er t
r e l a w r e q u i r e s c a n d i d a t e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a n i n k i n d c o n t r i b u t i o n t o t h e
mi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s
ma r r i a g e ) . ( Se e Pa g e 2 o f f o r ms p a c k e t . ) i f s u mame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
r e l a t i o n s h i p , e n t e r ' n o t a p p l i c a b l e ' i n t h e r e l a t i o n s h i p c o l u mn .
FSCHEEE
( Re v . 0 8 1 9 7 )
I N
CONTRI Bk
p CHECK T HI S BOX I IAMENDI NG FORM
Pa g e 1 o f I
( f o r Sc h e d u l e E )
DATE
CEI VED
I DD/ YR)
NAME AND ADDRESS
OF CONTRI BUTOR
RELATI ONSHI P
TO CANDI DATE
' ( i f a p p l i c a b l e )
DESCRI PT I ON
OF I N K I NDCONTRI BUTI ON
ESTI MATED
FAI R MARK ET
VALUE
J I F FOR
FUND- RAI SER
CONTRI BUTI ON
1 - 1 5 - 0 1 Da v i d Co l b e r t s e l fL o a n Fo r g i v e
Di s s o f Comm)
S
1 4 0 0 . 0 0
JSUB- TOTAL S
1 40 0 . 0 0
TOTAL ( i f l a s t
p a g e o f t h i s
s c h e d u l e )
S
1 4 0 0 . 0 0
/
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FOR I NSTRUCTI ONS, SEE BACK OF FORM
T h i s f o r m i s n o t a p p l i c a b l e t o s t a t u t o r y p o l i t i c a l c o mmi t t e e s
Not i ce of Di s sol ut i on
E v e r y N o t i c e o f D i s s o l u t i o n s h a l l b e a c c o mp a n i e d b y a
c o mp l e t e d D i s c l o s u r e R e p o r t Fo r m c u r r e n t t o t h e d a t e o f
d i s s o l u t i o n
COMMI TTEE NAME
E f f e c t i v e d a t e o f d i s s o l u t i o n
J anua r y 1 8
S i g n a t u r e f T r e a s u r e r
J anua r y 1 8 , 2 0 0 2
Da t e S i g n e d
FORM ( R e v 0 2 1 9 6 )
F o r O f f i c e Us e O n l y
DR-3
NOT I CE OFDI S SOLU T I ON
Comm. # f 2 :I n d e x e d
A u d i t e dComp u t e r S
C e r t i f i e d Da t e o f D i s s o l u t i o n
x ' 9 - 20 . Q 2
OWWWWBOA
J AN 2 4 200
T HI S BOX APPL I E S TO CANDI DATES ' COMMI T T EES ONLY :
1 , t h e c a n d i d a t e , c e r t i f y t h a t my c a n d i d a t e c o mm i t t e e ' s c a s h b a l a n c e i s z e r o , a l l d e b t s , o b l i g a t i o n s a n d l o a n s h a v e b e e n p a i d o r s a t i s f i e d i n a c c o r d a n c e
w i t h l a w a s s h o w n o n my c o mm i t t e e ' s f i n a l r e p o r t a n d a l l c a m p a i g n p r o p e r t y a n d l e f t o v e r f u n d s h a v e b e e n d i s t r i b u t e di n a c c o r d a n c e w i t h my
c o mm i t t e e ' s l a s t f i l e d S t a t e me n t o f O r g a n i z a t i o n .
WHEN TO FI L E :T h e N o t i c e o f D i s s o l u t i o n mus t b e f i l e d w i t h i n t h i r t y ( 3 0 ) d a y s o f t h e c o mm i t t e e ' s d i s s o l u t i o n , w i t h a c o p y o f t h e
f i n a l b a n k s t a t e m e n t a t t a c h e d
O f f i c i a l Name o f Commi t t e e
The Commi t t ee t o El ect Dav i d Col ber t
S t r e e t
4 6 1 4 320 t h
C i t y , S t a t e , Z i p Co d e
Danbur y I Owa 51019
Ar e a T e l e p h on e
C o d e
7 1 2 ) 883 - 2023
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