Boettger Nancy890scanned

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

CO MI TTEE NAME ( Mu s t b e s ame 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 )

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I MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p or t i n g f o r :

( t ) S t a t e w i d e / L e g i s l a t i v e Ca 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 ou n t y / L o c a l Ca n d i d a t e( 5 ) C o u nt y PAC ( 6 ) B a l l o t I s s u e / F r a nc h i s e Co mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co mmi t t e e( 8 ) S u pp o r t S l a t e o f Ca n d i d a t e s

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I GNATUR

F TREASURER

p e r s o n f i l i n g t h i s r e p o r t )

EPHONE

DATE SI GNED

Pe n a l t i e s Due For L a t e F i l e d Repo r t s Range f r o m $10 t o X 4 0 , 0 ,

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :

I AM F I L I N G A

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6 C - .

REPORT FORAN/ A ( 1 ) ELECT I ON /

( r e p o " t e )

( ] CHECK I F AMENDMENT TO REPORT DATED

0C h 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 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 . )

ST ATEMENT OF CASH ON HAND

I n d i c a t e o

CASH 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 am o u n t MUST b e t h es a m e 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 mu s 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

X07-

ADD TOTAL MONEY TAKEN I N T HI S PER I OD

Sc h e d u l e A : C a 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 e d u l e A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FORM

DR- 2DI SCLOSURE( Re v . 1 1 / 9 7 )

REPORT

F o r O f f i c e Us e O n i v

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N- E LECT I ON YEAR .

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

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

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Fo r I n s t r u c t i o ns , Se e Ba c k o f F o r t h

. CONTRI BUTI ONS - MONEYTAKENI 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 )

SCHEDULE

A MONETARY

( Re v . 0 6 1 9 7 ) I

RECEI PTS

QCHECK T HI S BOX I F

AMENDI NG FORMCOMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f Or g a n i z a t i o n)

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TES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O N

NUMBER 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 ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: S e c t i o n 6 8B . 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 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 ny c ommer c i a l p ur 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 .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FOR

RECE 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 ) RAI SERNUMBER I NCOME

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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m

CONTRI 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 ni z a t i o n)

SCHEDULE

A MONETARY

( Re v . 0 6 / 9 7 ) IRECEI PTS

Q CHECK THI S BOX I FAMENDI NG FORM

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STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) . L I S T THE PAC I D EN TI F I CA T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : Se c t i o n 6 8 8 . 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 m a t i o n c op 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 ny c o mme r c i a l p u r p o s e b y a ny 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 ommi t t e e s .

DATE

PAC I D NUMBER

RECEI VED

( i f a p p l i c a b l e )

( MM/ DD/ YR)

AND PAC CHECK

NUMBER

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NAME ANDADDRESS OF CONTRI BUTOR

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Fo r I n s t r u c t i o n s , See Back o f Fo r m

CONTRI BUTI ONS - MONEYTAKENI 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 d on )

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : Se 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 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 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 ny c omme r c i a l p u r p o s e b y a ny p er 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 .

SCHEDULE

A MONETARY

( Re v . 0 6 1 9 7 ) RECE I PTS

CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR REL A TI ONSH I P AMOUNT J I F FOR

RECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECE I VED FUND-

( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI S ER

NUMBER I NCOME

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FOR I NSTF?UCTI ONS, SEE BACKOFFORM SCHEDULE

EXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT B MONETARY

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES . L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN ANDTHE CHECK T HI S BOX I F

PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.

C0?AM 7TEE 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 ) .

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI 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 PAC

CHECK

NUMBER

D#

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FOR. I NSTRUCTI ONS, SEEBACKOFFORM SCHEDULE

EXPENDI TURESB MONETARY

- MONEY SPENT FROM COMMI TTEE ACCOUNT( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE

CANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0 CHECK T HI S BOX I F

PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.

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 )

AR ?) or -- I ( 1 - T c v , i 4 c r 4A cS a

CANDI D E NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI 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 PACCHECK

NUMBER

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FOR I NSTRUCTI ONS, SEEBACK OF FORM

EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EGI SL AT I V ECANDI DATES, L I S T THE CANDI DATE I D ENT I F I CAT I ON NUMBER I N THE DES I GNATED COLUMN AND THE

PAC CHECK NUMBER FOR EACH EXPEND I TURE . A L I S T OF I D NUMBERS I S AVAI L ABL E FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

SCHEDULE

B MONET ARY

( Re v . 0 9 / 9 7 ) IEXPENDI TURES

CHECK T HI S BOX I F

AMENDI NGFORM

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 ni z a t i on)

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DATE

EXPENDED

( MM/ DD/ YR)

9 1 1 6 1 0 (

CANDI DAE

I D NUMBER( i f a p p l i c a b l e )

AND PACCHECK

NUMBER

CK# ,i o 0

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NAME AND ADDRESS TOWHOMEXPEND I TURE

( D i s b u r s e me n t ) WAS MADE

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( D ESCRI B E TRANSACTI ON)AMOUNT

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FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE

EXPENDI TURES B- MONEYSPENTFROMCOMMI TTEEACCOUNTMONETARY


STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE ORLEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I F

PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS b CAMPAI GN DI SCLOSURE BOARD .

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 an i z a t i o n )

f i er I f or Sf aj cSeh t l ~ c m1' y ) 1 f T c P_

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI 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/ DDNR) AND PAC

CHECK

NUMBER

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, FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT


STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I F

PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e s a m e 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 )

4 r ! L t - al ~dr c - C , u ~ . e

(CANDDAW NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPEND I TURE ( DESCRI BE TRANSACTI ON) EXPENDED


( MM/ DD/ YR) AND PAC

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NUMBER

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. F OR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE

EXPENDI TURESB MONETARY

- - MONEY SPENT FROM COMMI TTEE ACCOUNT( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VEOCHECK T HI S BOX I F

CANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBER FOR EACH EXPENDI TURE.A L I S T OF I D

NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NGFORM

ETHI CS & CAMPAI GN DI SCLOSURE BOARD .

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)

Na t v et t r f ` o r _ 5 9 ' a 1 C. - -Se QL e a I YL i L

CANDI D NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED


( MM/ DD/ YR) AND PACCHECK

NUMBERI D#

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FOR I NSTRUCTI ONS, SEE BACK OF FOR' -

COI I I I MI T TE E NAME ( Mu s t b e s ame 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 )

,

I -

NOTE : De b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p a i d mu s t b e i n c l u d e d o n t h i s

S c h e d u l e , a s w e l l a s an y n ew o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

SCHEDULE

D I NCURRED

( Re v 0 2 / 9 8 ) 1 I NDEBTEDNESS

0 CHECK T HI S BOXI F AMENDI NG

FORM

An ' i n c u r r e d d e b t ' i s a d eb t f o rDEBTSI OBL I GAT I ONS RE MA I NI NG THI S REPORT I NG PER I OD

g o o d s o r s e r v i c e s o r d e r e d o r

( DO NOT I NCLUDE LOANS - SHOWLOANS ON SCHEDULE F )

r e c e i v e d , b u t n o t p a i d f o r b y t h e

en d o f t h e r e p o r t i n g p e r i o d . ,

r e g a r d l e s s o f wh e t h e r an i n v o i c e

h a s b een r e c e i v e d .

DATE

I NCURRED

( MM/ DDNR)

NAME AND ADDRESS OF PERSON

TOWHOM DEBT OR OBL I GAT I ON I S OWED

BALANCE OWED AT

CLOSE OF

REPORTI NG

PERI OD'

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FORI NSTRUCTI ONS, SEE BACK OFFORM

COMMI TTEE NAME( Mus t b e same a s o n S t a t eme n t o f O r g a n i z a t i o n )

/ v d . h c c t ~~®~ ' ~~a~A 1 - e r . ~ ~ a , ~ ' ~ Se n a ~ " c Cd i ~ Y I vn ~ 7T e

NOTE : T h i s c h e du l e r e p o r t smomon ey l o a n e d t o t h e c ommi t t e e wh i c h i s d e p o s i t e d i n t h e c ommi t t e e a c c o u n t .

TOTAL UNPAI D LOANS FROM LAST REPORTI NG PERI OD $

PART 1 - MONETARY LOANS RECEI VED THM REPORTI NG PERI OD( O r i g i n a l s o ur c e o f l o a n , s u c h a s a b a n k , mus t b e sh o w n i f a t h i r d p a r t y i s

i n v o l v e d . I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

TOTAL ( PART I ) $ 200.

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' 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 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

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 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 ) an d a f f i n i t y ( r e l a t i v e s b y m a r r i a g e ) . ( S e e Pa g e 2 o f f o r ms

p a c k e t . ) I f su r name 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 o f a mi 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 umn w h e n i t a p p l i e s

PART 1 1 - MONETARY LOAN REPAYMENTS MADE TM REPORTI NGPERI OD( L o a n s f o r g i v e n must b e r e p o r t e d o n S c h ed u l e E - - I n - k i n d C o n t r i b u t i o n s . )

Page- - _ 1r s ~ , q ~ h > : . . - , . , - 1

SCHEDULE

F LOANS

( R e v . 0 8 / 9 6 ) RECEI VED

& REPA I D

0CHECK THI S BOX I F

AMENDI NG FORM

DATE

RECEI VED

( MM/ DD/ YR)

NAME AND ADDRESS OF LENDER

( I n c l u d e E n d o r s e r ' s Name, I f A p p l i c a b l e )

RELATI ONSHI P

TO CANDI DATE( I f A p p l i c a b l e ' )

AMOUNT

OF LOAN

~u I C( ~ 3 o ~ e ~ -

2 , 6 L~ 7 L ~

r o n c , ) 6 - CO

o t t ~ ( a PA

s S - ~ - ~

S

DATE PAI D

( MM/ DD/ YR)

NAME AND ADDRESS OF LENDER

( I n c l u d e En d o r s e r s Name , I f A p p l i c a b l e )

RELAT I ONSHI P

TO CANDI DATE'

( I f A p p l i c a b l e )

AMOUNT

REPAI D

Sc s 3 7

uS~

S

TOTAL CASH REPAYMENTS ( PART H) $

F r o m S c h e d ul e E - - TOTAL LOANS FORGI VEN $

TOTAL OUTSTANDI NG LOANS END OF REPORT PERI OD $ O

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