Berry Deborah1393scanned

8/7/2019 Berry Deborah__1393__scanned

1/9

FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECO MI TTEE NAME ( Mu t h e same a s n St a t e me n t o f O r g a n i z a t i o n )

. _ I _ m a u - a t e , o2- . e , ,I MPORTA T : n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :

( 1 ) 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( 5 ) 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 m m 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( 8 ) S u p p o r t S l a t e o f C a n d i d a t e sCANDI DATE COMMI TTEES ONLY :Ca n d i d a t e Name

O f f i c e S o u g h t D i s t r i c t ( i f Se n a t e o r H o u s e p

SI GNi TUR F T REASURER ( o r p e r s o n f i l i n g t h i s r e p o r t )

I n d i c a t e o n e

P o l i t i c a l P a r t y

L at e f i l e d r e p o r t s a r e s u b j e c t t o p o ss i b l e c i v i l a nd c r i mi n a l p e n a l t i e s .SEE I NSTRUCTI ONS ON BACK AND COMPL ET E THE FOLLOWI NG SENTENCE :I AM F I L I NG A 1 J L ' ( a / / ~ , ; ) e 5) 04 REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- E L ECT I ON YEAR .( r e p o r t d a t e )

[ ] CHECK I F AMENDMENT TO REPORT DAT ED

Ch e c k 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 an d a t t a c h No t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Y ou must c o n t i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )

ST AT EMENT OF CASH ON HANDCASH ON HAND a t t h e be 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 db y t h e c o mmi t t e e . T h i s amou n 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 do 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 must 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD T OT AL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Cash 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 e d u l e A) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . .Sc h e d u l e F : L o an s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Campa i g n Pr o p er t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e d ul e H app l i e s t o Ca nd i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B) ( ' * a l s o s e e d e bt s an d l o an s b e l o w) . . . .Sc h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH 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 al a n c e mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ad s

* " UNPA I D BI L L S ( F r o m Sc h e d u l e D- At t ac h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N K I ND CONTRI BUTI ONS ( F r o m Sc he d ul e E - A t t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ . 3 6 ( 6 VZ' " ' " OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULT ANT BREAKDOWN ( Sc h e d ul e G At t a ch e d ? )VALUE OF CAMPAI GN PROPERT Y ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H)

1 _. ~ L GL o g g e d I nSSca nne dCompu t e r

L o c a l C o m m i t t e e s , e n t e r Da t e o f E l e c t i o nCo u n t y & L o c a l C o m m i t t e e s , e n t e r Co u n t y i nwh i c h E l e c t i o n i s h e l d

a a s a - 1 5 -

s a s

YES LJNO


2/9

Fo r I n s t r u c t i o n s , See Bac k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )

STATE C A A I D I I I V I T E S NOTE : I F A CONTRI BUTI ON I S RECEI VE6FROM A STATE PAC ( P O L I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co de, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c omme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h ed u l e )

SCHEDULEA I MONETARY( Re v . 0 6 / 9 7 ) RECE I PT SCHECKT HI S BOX I FAMENDI NG FORM

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e 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 c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mu s 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 ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Pa ge 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n o Pa g e-~o f A-f a m i l i a l 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 . ( f o r Sc h e d u l e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOME

Ja m .~7 -

I 1 7 ~4 JL,~ L~,Y~

CPOCK#I D# Yr a P04 `CK# P~~~ZGs o S A- -I D#CK# aA and s~-c # a lC 3 7 371tl ~I D# . 4

70-I D# ~ r r 7 i 7 , L C~CK# 'I D# i l t i rw:VI A


3/9

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g an i z a t i o n)

SCHEDULEA MG; NETARY( R ev . 0 7 / 0 3 ) RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

STATE VANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( POUTI CAL ACTI ON CCMMI TTE_ ) , UST THEPAC I DENl 1 F I CATI CNNUMBER ANDTHE PAC CHECKNUMBER I N THEDESI GNATED COLUMN . A UST- OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCL OSURE BOARD.CAUTI ON: Se ct i o n 688 . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u se o f i nf o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c ont r i b ut i o ns o rf o r a n y c omme r c i a l p u r p o s e b y an y p e r s o n o t h er t h an 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 .

SUB- TOTAL

TOTAL ( f l a s t page o f t h i s s c h e du l e )D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e 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 mak i ng a c o n t r i b u t i o n t o t h e

c ommi t t e e . R e l a t i o n s h i p mu s t b e s h o w 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 ) and a f f i n i t y ( r e l a t i v e s b ymamage) . I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b u t t h er e i s no P a g e_a.f a m i l i a l 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 ( f o r Sc h e d u l e A)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ OD / YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI 0 #

$ E l ~ lY [ . V / 0 L 1 CK# 'I D#CK# E;D~S D I o #CK#

p.'o N,- 1 6 1 ? o ' L 0y A ? 1 / , 0 V ~D . 1 ~ 0

i D#

D I o #_ _ _~ ~R - . SDI y~a U

C K#- I C# An ' ~ '

CK# 6 . Kl o #CK#

~Rh ~i 1 ' 1d C.

I D# e I - ~ TI D# GCAM~IRCK# 3 7 A 30 , 4 )

4 1 i ; ,I D#CK#

~: ~'y"oY I


4/9

Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n)

STATE VANDI DATES NOTE : I F ACONTRI BUT I CN I S RECEI VED FROMA STATE PAC( POUT I CAL ACTCNCCMMI TTEE) , UST THEPAC I CENT I F I CATI CNNUMBERAND THEPACCHECKNUMBER I N THE DESI GNATED COLUMN . A UST- OF 1 0 NUMBERS I S AVA I LABLE FRCMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 688 . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r mat i o n c o pi e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i on s o rf o r an y c omme r c i a l p u r p o s e b y an y p e r s o n ot h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

STOTAL ( f l a s t page o f t h i s s c h ed ul e )

SD i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s r l g s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h e

c o mmi 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 a # > o g 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 b ymamag e) . I f s u r n a me 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 er e i s n of a m i l i a l 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 .

SUB- TOTAL

SCHEDULEA I MONETARY

( Re v . 0 7 / 0 3 ) RECEI PTS0CHECKT HI S BOX I FAMENDI NG FORM

Page . 5 ,_ o f( f o r Sc h e du l e A)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM, ODI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#CK# 1510 ~ c a ! ,

I D#CK# ~4a $/ 4 I / I wa ' J5. 4 vI D#

6 V60 0/f z 4 CK# AgX ! 70AI D# "i rXa ( 1, ~ . . 8 lWA~F, ~

.

v ~ a 6 - xX4 ( 0 3

C K# ~. D . ~ UCK# EQ

0 1 pCK#I C# A . - B - 1 MCK# ~S~J ~I r ~ ~ , . . ' Ci Al .

I D# LOat t t &"i n 1Q~_ " _y Y11 -CK# J70 l AYd&- .,I _. J , - 9 ~SdU


5/9

Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )

STATE CANUI DAI ES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE ) , L I S T THEPAC I DENT I F I CATI ONNUMBER AND THE PAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LAB LE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c omme r c i a l p u r p o s e by an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i s s c h ed u l e )' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e 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 c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu s t b e s h own 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 ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Pa ge 2 o f f o r m s p a c k e t . ) . I f s u r n ame 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 P a g e - o f ,~f a m i l i a l 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 . ( n o r c h e d u l e A )

SCHEDULEA MONETARY( Re v 0 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE P AC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D#

/ , /11CK#

_-

So ) . 1 - 7 0I D# Z, 0

I . k 0 A CK# d o ~ - -CK#

- 7 - 7

CK#r i l lI D#

q/ i 4 / 1 0 q CK# aN- - v Otvf~- ; s . t~ - . a r ~ b , 1 a 0I D# ,CK#

I D#

6 0 / 0 CK#9I D#CK# (

- ' I D# . " ~ . y"f a CK# I r SU - ~ I ~ j - 'w


6/9

Fo r I n s t r u c t i o ns , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g a n i z a t i o n )

STATE C A N( J I D F f r E S NOTE : I F A CONTRI BUT I ON I S FWCEI VED FROM A STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T T HE P AC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n 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 .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h ed u l e )

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e 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 c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mu s t b e s h o w 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 ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a me 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 P a g e _ _ 5 o f 6f a m i l i a l 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 . ( f d r S c h e d u l e A )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI P TSQ CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT - 4 I F FORECE I VED ( i f a p p l i c a b l e ) TOCAND I DATE ' RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMI D# 8CK# l r c v ~ S ~ d Z ` ~d73 A000d ~ - - -I D# 4393c K# rF1S~S ~ r r c~~d4

I D# Ad zCK# 9 5 D I PO~~%, , 4 - ~~60 I L . ~ ~ OdI D# d 7 3cK# 79 / 0 , 9 /w _ , y Y l m . ~ r 4 ~ a ~ 6 1 , 5 0 , I U DI D# &c K# 4307 "7 ~ - -

" ' ' I D#CK#

c K# 1 ~ D 7 8 ~ l s l t o l D~ . Do ~ . . . ~ . 1 -I D#CK#

C K#I D#CK#


7/9

T HI S BOX APP L I E S TO CANDI DATES ' COMMI TT EES ONLY :Pu r c h a s e s o f c er t a i n c a mp a i g n pr o per t y c os t i ng $ 5 0 0 o r mo r e mu s t a l s o b e i n v en t o r i e d o n Sc he d ul e H ( Re f e r t o S c he d u l e H i n s t r u c t i o n s . )Ex p e nd i t u r e s t o p er s o ns / e nt i t i e s p r o v i d i n g c o ns 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 , man a g i n g , o r g a ni z i n g s er v i c es mus t a l s o b e d e t a i l i t e mi z e d o nS c he d ul e Gb y t h e amo u n t , p u r p o s e , a nd d at e o f e a c h t y p e o f e x pe nd i t u r e mad e b y t h e p e r s o n / e n ' , i t y o n b e ha l f o f t h e c an di d at e ' s c o mmi t t e e . ( R e f e rS c he d ul e G i n s t r u c t i o n s an d I o wa Code 5 6 . 6 ( 3 ) ( i ) . )

Page _ t . o f

( f o r S c he d ul e B)

FOR I NS TRUCT I ONS , SEEBACK OF FORM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROM COMMI T T EE ACCOUNT MONETARY( Re v . 0 9 / 9 7 ) EXPENDI TURE

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE T O STATEWI DE OR L E GI S L A T I V ECANDI DATES, L I S T THE CANDI DATE I DE NT I F I CA T I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE. A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORME T HI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEENAME ( Mus t be s ame a s o n St a t emen t o f Or g an i z a t i o n )i

"WJ 1 V9 1 a r MJ i . . _ - 'CANDI DATE NAME AND ADDRE TOWHO PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i f a pp l i c ab l e ) ( Di s b u r s e me n t ) WASMADE( MM/ DD/ YR) ANDPACCHECKNUMBER

D# ~~. & ' a l l -a ~ , d Z " r - &r~CK# $WCK#I D #CK# PCB , Sam`J A a " FA R If- )CK# a 6 4 -~(~t ' a c vI D # e u 4 , u aq~, V ~I ~~CK# ~~ i YY1b~V_ I D # 1 1 " wS , O o

y h 3 e h , v c K# a s 5 ' ' ' i f u 0 : 5 ,D CK# Gv~j&- s < 1 7 ge1 D #

CK# ~ J GASUB- T OT AL $

TOTAL ( i f l a s t pa g e o f t h i s s c h e du l e ) $


8/9

FOR I NSTRUCTI ONS, SEE BACK OF FORMEXPENDI TURES - - MONEY SPENT FROM COMMI T TEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTR I BUT I ONS MADE T O STATEWI DE OR L E GI S L AT I V ECANDI DATES . L I S T T HE CANDI DATE I DE NT I F I CAT I ON NUMBER I N THE DES I GNATED COLUMN AND THEPAC CHECK NUMBERFOR EACH EXPEND I TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI CS & CAMPA I GN D I SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e s ame as o n S t a t eme n t o f O r g a n i z a t i o n )

SCHEDULEB MONETARY( Re v . 0 9 / 9 7 ) f EXPENDI TURE

CHECK T HI S BOX I FAMENDI NG FORM

T HI S BOX AP PL I E S TO CANDI DATES' COMMI TTEES ONLY :

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

Pu r c h a s e s o f c e r t a i n c ampa 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 . )E x p e n d i t u r e 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 , manag 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 mi z e d o nSc h e d u l e G b y t h e a mo u n t , p u r p o s e, an 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 mad e b y t h e p e r s o n i e n i 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 rSc h e d u l e G i n s t r u c t i o n s a n d f o wa C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

Page A

( / CANDI DATE NAME AND ADDRE S 9 ' TO WHOM PURPOSE AMOUNTDATE 1 0 NUMBER E X P ENDI T URE ( D ES CR I BE TRANSACT I ON) EXPENDED

EXPENDED ( 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( MM/ DD/ YR ) AND PACCHECKNUMBER

I D#CK# a -

CK# ~ ~_ _ _ 4 J UI D#CK#I D# ,

CK#I D#CK#I D#CK#I D#CK#


9/9

FOR I NSTRUCTI ONS, SEE BACK OF FORMCOMMI TTEE NAME ( Mu s t b e same as o n S t a t e me n t o f O r g a n i z a t i o n )

' D i s c l o s u 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 ec ommi t t e e . R e l a t i o n s h i p mu st b e s ho wn 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 sb y ma r r i a g e ) . ( S e e Pa g e 2 o f f o r ms p ac k e t . ) I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of a m i l i a l 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 .

SCHEDULEE I N K I ND( Re v . 0 6 / 9 7 ) 1 CONTRI $UT I ONCHECK T HI S BOX I FAMENDI NG FORM

Pa g e _ _ I o f( f o r Sc h e du l e E )

DATERECEI VED( MM/ DD/ YR) NAME AND ADDRESSOF CONTRI BUTORRELAT I ONSHI PTO CANDI DATE' ( i f a p p l i c a b l e )

DESCR I PT I ONOF I N K I NDCONTRI BUT I ONEST I MATEDFAI R MARKETVALUE

v I F FORFUND- RAI SCONTRI BUT I

. . ; ~_ Z 1 $ 9 ~ ~

T

Berry Deborah__1393__scanned

Documents

Berry Deborah1393scanned