Campbell David1335scanned

8/7/2019 Campbell David__1335__scanned

1/8

FOR I NSTRUCTI ONS . SEE BACK OF FOR/

DI SCL OSURE SUMMARY PAGECOMMI TT~r yNAME ( Mu s t b e s am~ so n St a t e me n to f Or a n i z a t i o n )

I MPORTANT: I n d i c a t et y p eo fc o mmi t t e ey o ua r er e p o r t i n gf o r:

a(1 ) S t a t e w i d e / L e g i s l a t i v eC a n d i d a t e( 2 ) S t a t e w i d ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t y / L o c a lC a n d i d a t e( 5 ) C o u n t yPAC ( o) B a l l o tI s s u e / F r a n c h i s eC o mmi t t e e( 7 ) C o u n t y i C i t y C e n t r a lC o mmi t t e e( 8 ) S u p p o r tS l a t eo f C a n d i d a t e s

CANDI DATECOMMI TTEES ONL Y :

Ca n d i d a t eName , P o l i t i c a lP a r r y

O f f i c eS o u g h t D i s t r i c t( i fSe n a t e o r H o u s e )

- j - DU~~ ~ t ` -

El C h e c k i ft h i si sf i n a l( t e r mi n a t i o n )r e p o r ta n d a t t a c hN o t i c eo f D i s s o l u t i o nFo r m DR- 3.( Yo um u s t c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo f D i s s o l u t i o ni s f i l e d. )

ST ATEMENT OF CASH ON HAND

CASH ON HAND a t t h eb e g i n n i n go f t h er e p o r t i n gp e r i o d. ( T h i si s t h et o t a l o fa l l mo n i e s h e l db y t h ec o mmi t t e e. T h i sa m o u n t MUS T b e t h es a m e a s t h ec a s h o n h an da t t h ee n do f t h el a s tr e p o r t i n gp e r i o d ,o r m u s t b e z e r oi ft h i si s f i r s tr e p o r tf i l e d. ) .. . .. .. .. .. .. . . . .. . . . . .. .. . .. .. . $

FORM

( R e v. 0 1 / 2 0 0 1 )DI SCLOSURE

REPORT

F o r O f f i c eUs e On l y

Co mm . # J - 055

A u d i t e d - u l Z - -. r

Co mp u t er L

J AN 2 2 2 0 0 2

. 4( s- , 5 ) Z: 2- q7 0 o ~ zZ c a l

S TUBE O REAS ER W p e r s o nt i l i n gt h i sr e p o r t ) TELEPHONE DAT SI GNED

Ro u t i n eP e n a l t i e sDu e Fo r L a t eF i l e r !Re p o r t s R a n g e f r o m$ 2 0 t o $ 8 0 0

SEE I NSTRUCTI O NS ON SACK AND COMPL ETE T HE FOLL OWI NG SENTENCE :

I AM F I L I N GA ZI A_V . .. c; w A ZZ " 2LnZ REPORT FOR ANI A( 1 )ELECTI ON/ ( 2 ) NON- EL E CT I ONYEAR .

( r e p o r td a t e ) I n d i c a t eo n e

FJ CHECK I FAMENDMENT TO REPORT DATED L o c a lC o mmi t t e e s ,e n t e rD a t eo f E l e c t i o n

C o u n t y&L o c a lC o mmi t t e e s ,e n t e rCo u n t yi nw h i c hE l e c t i o ni sh e l d


2/8

p gp , p )

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

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

I COMMI T T EE NAME ( Mu s tb e s a me a s o n St a t e me n t o f Or g a n i z a t i o n )

V Vk ~ ~ wC~ O c s. S ~STATECANDI DATESNOTE: I FAC ON T RI B U T I O NI SR E CE I V E DFROMASTATEPAC( P OL I T I C A LA CT I ONC OM MI T T E E ) ,L I S TT HEPACI DE NT I F I CAT I O NNUMBER ANDT HEPACCHECKNUMBERI NT HEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI L A B L EFROMTHEI OWAE T H I C SANDCAMPAI GND I S C L O S U REBOARD.

C AU T I ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o wa Co d e ,p r o h i b i t st h eu s e o fi n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mm e r c i a lp u r p o s eb ya n y p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o m m i t t e e s.

SCHEDULEA MONETARY

( R e v. 0 6 1 9 7 ) R EC EI P T S

Q CHECKT HI SBOXI FA ME N DI N GFORM

DATE P A CI DNUMBER NAMEAND ADDRESSOF C ON T R I B U TOR RE L AT I ON SHI P AMOUNT J I FF ORRE C EI V E D ( i fa p p l i c a b l e ) T OCANDI DATE' RECEI V ED F UND-

( Mf WD D/ Y R)AND P A CCHECK( i fa p p l i c a b l e ) RA I S ER

NUMBER I NCOME

1 0 1 6 1 l o tI D#

CK# (o 6 7 1 1 4L 6-o v i l ~

~ d l

/Z S / c ~i

I D# k l ;. ~c ~ ~U

oCK# i ~ c S~ l 6 - v 1 $f ~

.

Ce ~ a. ~ ~ i 3 1s - L , r 4 ~ Z +k~2I D#

( ! t N l e1 1 1I0 1 Z5 / 6 CK # q3Zq- a , S p

o r t 5 b 6 5 1I D# 6 1 1 3 A F s t f t kF IT A

o ~ r c f L S ~i , ;3 1 3_I D# ~ a , r 0 1 ~ ~ ~ l e SS

I (l 0 3/ 0 1 CK # - r s o v +

` - f ~a Z _

r S lr E C ?.. i So 3 t ~I D# ~ , ~ S c - k v t. ~ 1l

f D~ L S~ o I CK # 5 C + ~ ' 3 = ` ~SP " k Cr s e ~ ~


3/8

Fo r I n s t r u c t i on 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 gc 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 ni z a t i o n)

C 6 , wk e ( o - e l l - ' ~l CL

4

STATE CANDI DATESNOTE: I FA CO NT R I B U TI O NI SRECEI VEDF R O M AS TATE PAC( P OL I T I C A LACTI ONCOMMI TTEE) ,L I S TTHE PA C I DE NT I F I C AT I ONNUMBER ANDT HE PA CCHECK NUMBERI NT HE DESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o wa Co d e,p r o h i b i t st h eu s e o f i n f o r m a t i o nc o pi e df r o m r e p o r t san d s t a t e me n t sf o r s o l i c i t i n gc o n t r i b u t i o n s o rf o ran y c o mme r c i a l p u r p o s e b y a ny p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e es.

SCHEDULE

A MONETARY( Re v. 0 6 / 9 7 ) R EC EI P T S

Q CHECK T HI S BOX I FAMENDI NG FORM

DATE P ACI DNUMBER NAME AND ADDRESS OF CONTRI BUTOR R EL AT I O NS HI P AMOUNT J I FFORR EC EI V E D ( i fa p p l i c a b l e ) TO CANDI DATE' R E CE I V E D FUND-

( MM/ D Df Y R ) AND PAC CHECK( i fa p p l i c a b l e ) R AI S ER

NUMBER I NCOME

I D# SVl " wICG . , ~ ur ' ~ s 5

1 0 l b ~~ ~I CK#1 1 1 1 5Z z

r s 1 ' Y lo t n - e 5 - L { 1 5 c > 3 1 3I D#

E I D o I CK#3 q 3 Ps

hPS r u t i t r Qs ~ ~ a 3 t 3ID#

GL t i t~% G h~

l HG~

CI C# 1 1 73 / 4o M 4 j~T4

C t l rS ~ ( i l t ~ UJ I t ' ~ \ ~ OI D#

I t 7 / Z~~~1 CK# . _- 6 o z o d

I D# t, i i ) j t i a t ' e.

Z4- 5 c > zoSf JS

a " -

I D# p c, o - f ( 1 ~ r Y Ss S

~ o ~ z b ~ o l CK# 9 Z 3 2 ; ~ ' ~ ~w~ n+ ~ e r o o - N4 Sn?u - Z


4/8

F o r I n s t r u c t i o ns ,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 gc a n d i d a t e ' s p e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s tb e s a me 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 )

STATECANDI DATESNOTE: I FAC ON T RI B U T I O NI SR E CE I V E DFROMASTATEPAC( P O L I T I C A LA CT I ONC OM MI T T E E ) ,L I S TTHEPACI D ENT I F I CAT I O NNUMBERANDTHEPACCHECKNUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVA I L A B L EFROMTHEI OWAE T H I C SANDCAMPAI GND I S C L O S U REBOARD.

C AU T I ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o wa Co d e ,p r o h i b i t st h eu s e o fi n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o m m e r c i a lp u r p o s eb ya n y p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o m m i t t e e s.

SCHEDULE

A MONETARY( R e v. 0 6 1 9 7 ) RECEI PTS

CHECKT HI SB OXI FA ME N DI N GFORM

DATE P ACI DNUMBER NAMEAND A D D R E S SOF C ON T R I B U TOR RE L ATI ON S HI P AMOUNT J I FF ORRECEI VED ( i fa p p l i c a b l e ) T OCANDI DATE' RECEI VED FUND-

( MI U UD D/ Y R)AND PAC

CHECK( i fa p p l i c a b l e ) R AI S E R

NUMBER I NCOME

I D# ~ o r 1 C . l y c he e ,I I/ Z OI U~C K# 36 ~ i v ~ S i ov ~ 6r ~v - ~

, , i VJ S35 F > 3I D# ~l

o

8e- yCK# ( 0 Z- 7 c l l , 4 6A ~~ -

e s ! Yl o 1 # 1e s Q? 0313I D#

v u a - Ve ~

r n o v ke - S s i , 313I D# ~~ ( c C~I G ao

l L l o Z / o +CK# 4 1 - 7 v k & w,i & c s - < u 3 1 5

ID# R. L , hC - - r J + L l r v l: 4 e - r s, 1Z l 0Z ~ / pI CK# ( , CJ De Iu ; Ht l ~ , , c J t ~l ` S

l t ~- ~G ~ G 5 Z Z " uI D# Ph ; + ( ; , , V - s A) Z ~ a z , 1 o l CK# 5 ( z s n l E- 6" " Cx l . ~ ~

S0 : 3 1 3 ZOD


5/8

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

CONTRI BUTI ONS- MONEY TAKEN I N( I n c l u d i n gc a nd i d a t e ' sp e r s o n a lf u n d s )

COMMI TT EE 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)

4 - r - T~~C' - k k ot ' s '.

STATE CANDI DATESNOTE: I FA CONTRI BUTI ONI SRECEI VEDFROM ASTATE PAC( P OL I T I C A LACTI ONCOMMI TTEE) ,L I S TTH E PA C I DE NT I F I C AT I ONNUMBERANDT HE PA CCHECK NUMBERI NTHE DESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEF ROM THEI OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON S e c t i o n6 8 B . 3 2 A ( 6 ) ,I o wa Co d e,p r o h i b i t st h eu s e o f i n f o r m a t i o nc o p i e df r o mr e p o r t sa nd s t a t e me n t sf o r s o l i c i t i n gc o n t r i b u t i o n so r

f o ra ny c o mme r c i a l p u r p o s eb y a ny p er s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SCHEDULEA MONET ARY

( Re v . 0 6 1 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE" RECEI VED F UND-

( MMI DDI YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA I S E RNUMBER I NCOME

I D# a . v ~ ~- f - ~e b v Y-Zw3wl CK#

'd 1 ! F ~ - f 3~ s Cp - t

c s / t i (o ~. ~ . S o 3I D# J i a .. ( c ' fZ

a z l o 4 / D! CK# 1 1S E a v ' x - 2 : Z~P ~ ~ C~ Dz , z l o

I D#/ Z fl )7 / , )I CK# ~ z b o AJW -1 1 1 Pl oda , , ~ 5 c t >Z l - 9 0

I D# 'p c . . j Rf ( ~ ~~ t 4 -

1 2 - 1 1Vol CK# ( 1 66 74 1

W- W ( ! UL v ~ _5 l o r e , ( l c - -- TX S 0 3 i

I D# t A +. r.. A S 2 w ^

dz / & 1 o lCK# Mc ) i

I D#c v `

r o / z e bu CK# ~ f ~ r l ~~

t ~ Y . _a a s s


6/8

FOR I N ST RUCT I ON S,SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEYSPENTFROMCOMMI TT EEACCOUNT( Re v . 0 9 / 9 7 ) EXPENDI TURES

TATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I VE, : A ND I D AT E S ,L I STTHE CANDI DATE I D EN TI F I CATI ONNUMBER I NTHE DESI GNATED COL UMN ANDTHE CHECK T HI SBOX I FPAC CHECK NUMBE R FOR EACH EXPENDI TURE . A L I ST OF I DNUMBERS I SAVAI LABLE FROM THE I OWA AMENDI NG FORME T HI C S& CAMPAI GN DI SCLOSURE BOARD .

COMMI TTE ENAME( Mu s tb e s a m e a s o n S t a t e m e n to f Or g a n i z a t i o n )

v i ~,( ( -C , ~,, 4, -"CAN DI DATE' NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM( D D/ Y R) AND P AC

CHECKNUMBER

I D #

A I Pr

. ~ h h s - ~ - r 4S~ I 3 (I D # '

l l ~ i 3 / o f fCK #P

S -f ~ . I v p Z8

. L ~G. h s 1 ' k 5 6 1 3 1

1 D #2 , 0 p-Z. L. -A41~ l Z j 1 of CK # 1 7 , (

9 1 7

CK # ZU03 t 7 3 5 l _G~~~~ c KU. G ~ ~ St ~ r n Sh s / l I L 1 v i E ' S s

I D#

~e . wv ~ 4. r t D

- , -

e Co r ~ l ~ 3v ~ CK# ZOO 1 LZ~ E - S- .. 8 ( 0:: 7 1 ~o` n 4 S= L s 4So !

ID #


7/8

FOR I NSTRUCTI ONS,SEE BACK OF FORM

COMMI T TE E NAME ( Mu s tb e same a s o n St a t e me n t o f Or g a n ae h o n,

NOTE : De b t sp r e v i o u s l yr e p o r t e dt h a tr e m a i nu n p a i dmust b e i n c l u d e do n t h i sS c h e d u l e ,a s w el la s a n yn e w o b l i g a t i o n si n c u r r e di n t h i sp e r i o d.

SCHEDULE

D I NCURRED( Re v. 0 8 1 9 8 )II NDEBTEDNESS

0 CHECK T HI SBOXI FAMENDI NGF ORM

An " i n c u r r e dd at e i sa d e b tf o rDEBT S I OBL I GAT I ONS REMA I NI NGT HI S REPORTI NG P ER I OD g o o d s o r s e r v i c e so r d e r e do r( DO NOT I N CL U DEL OANS - - SHOW L OANS ON SCHEDUL E F ) r e c e i v e d ,b u t n o tp a i df o rb y t h e

e n d o f t h er e p o r t i n gp e r i o d. ,r e g a r d l e s so f w h e t h e ra n i n v o i c eh as b ee nr e c e i v e d.

DATEI NCURRED

( MMI DD( YR)NAME AND ADDRESS OF PERSON

T O WHOM DEBT OR OB L I GAT I ONI SOWED

DE S CR I P T I ONOF GOODS ORSERVI CES PROVI DEDOR

PURCHASED

BAL ANCE OWED ATCLOSE OF

REPORTI NG

PERI OD*

3 , o fAAf ~~ L .4 , ( ,-r l n ! w

~ v t r _ Ql A ~ l , ~

q ' '4 C6 uC a r v ~

, - t~ t S c v J - - ,;

l C Uc ( ( e ~ , q 5 i ~ 3(3 - 1c x ~ 9

1 ' o-e e k e. ,. a , 1 1 ( c -, ~A4 0 4 - 7 Z ( 7 -~ 3 o 1

. , Er tr ~ F ~ ~ ,. ( L c ) c b6 t f e .

$' 7/ -

Av o l I~7 r Al w Y~S~ l r > Jv

-r l i 5~3

~3 I c x; ~

7 3 - 7 4z _ "65 t 5 r l


8/8

r v n n v oi n v i ,t w i v e s ,a c c o mt. n y r r v mv r

0 T HI SFORMI SUSEDBYCANDI DATES'COMMI T T EESONLY

COMMI TT EE NAME( Mu s tb e same a s o n S t a t e me n to fO r g a n i z a t b n )

PART i - ONGOI NG I N V EN T ORYOF CAMPAI GN PROPERTY

TO TA LVALUECAMPAI GNPROPERTYT HI SRE( TRANSFERTO SUMMARY PAGE) $

* I fe s t i m a t e d ,s h o we s t. b e s i d ef i g u r e.

R

I ' ( , 4 / t ( , 1 r v

PART I I - S A L E SOR TRANSFERS OF CAMPAI GN PROPERTY * *

SCHEDULE

H CAMPAI GN( R e v. 0 2 1 9 6 )I PROPERTY

AT TA C HSCHEDULEH TCEACHRE PORT, MA K I N G

CHANGESA S RE QU I RE D.

Q CHECK T HI SBOX I fAMENDI NG FORM

* *PROPERTYSALES&TRANSFERSTO TA L TOTALS $ $( T R AN S FE RT O SU MMA RYPAGE) $

( A t t a c hA d d i t i o n a lS c h e d u l e si fN e e d e d ) P a g e o f Pa g( F o rS c h ed u l eH )

D a t eP u r c h a s e d( S c h e d ul eB )

o rD a t eR ec e i v e d( S c h e d ul eE )MWDDYR

D e s c r i p t i o no fP r o p e r t y

1A V IP. t /

Acu r ed' R e p o r t

P u r c h a s eP r i c eo rE s t.V a l u eWhe n

C u r r e n tV a l u ea tF a i rM a r k e tT h i s

Campbell David__1335__scanned

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Campbell David1335scanned