F OR I NSTRUCTI ONS, S EE BACK OF FORM D I SC L OSU RE UM RYPAGE OM MI TT E NAME ( Mu s t b e e as on St a t e me n t o f Organization) l =7 i r i2iAJG AtLl P A%6 k ) s I M PO RTANT : Indicate type o f c o mmi t t e e youare reportingfor : ( 1 )Statemde/L islative Candidate ( 2 )Statewide P A C ( 3)StateParty ( 4 )County/Local Candidate ( 5 my P l o t Issue/Frar~yhis oy~nittQe~( 7)County/CityCentral C ommi t t e e ( 8 l a t f Cand _ 7/2-/36 ( f -1-rzR3 S I N URE O TREAS ER ( o r pqfsA(n filing this report) TE EPHONE Routine Penalties Du e F o r Late Filed Re p or t s Range from $ 2 0 SEE I NSTRUCTI ONS ON BACK AND COM PLETE THE F OLL OW I NGSENT ENCE : I AM FI L I NG A +d r U A 4 111, 2cw~ (report date) E] CHECK I F AMENDMENT TO REPORT DA TED REPORT F OR AN/ A ( 1 ) ELE C TI ON /(2)N Indicate o n e El Check i f this i s final (termination) report an d attach Notice o f Dissolution Fo r m DR- 3 . ( Y ou must continue t o file reports until a Not i c e of Dissolution i s filed . ) SUB TRACT TOTAL MONEY SPENT THI S PE RI OD STATEM ENT OF CASH ON HAND Schedule B : Ex p e n d i t u r e s total (Attach Schedule B) . . . . . . . .... . . . . . . . . . . . .... . . . . ....... . .... . .... . .... . .... . . Schedule F : Loan Repayment s total (Attach Schedule F ) . . .... . . . . . . .... . .... . . . . .... . .... . .... . . . . . . .... . . U NP AI D BI L L S ( Fr o m Sc he du l e D - Attach Schedule D) .... . . . . . . . . . . . . . . .... . .... . . . . . . . . . . . . . . ............ . . . . . . .... . . . . $ I N KI ND C ON TRI BUTI ONS ( Fr o m Sc h ed u l e E - Attach Schedule E ) ......... . . . . . . .... . . . . . . . .... . .... . . . . . . . . . . . . . . $ OU TSTAN DI NGLOAN S ( Fr o m Sc he d ul e F - Attach Schedule F) .... . . . . . . .... . . . . . . .... . . . . ................. . .... . . . . $ CAN DI DATE COM MI TT EES ONLY: CONSU LTANT BREAKDOW N (Schedule G At t a c he d ? ) VALUE OF CA MPAI G N PROPERTY (From Schedule H - Attach Schedule H) $ SU B- TOTAL . . . . . . $ FORM DR- 2 I DI SCLOSURE ( Re v .01/98) REPORT F o r Of f i c e Us e Only Comm. # Indexed Audited - Comput er , < 2 : - - /-/16 . e o DA TE SI G NE D $1~0(t i / i 1 . 7 1 4. . x . 77 . ~ 1 3 J AN , 2 , 2 1001 N- ELECTI ON YEAR. 7 1 (LED Local C o mmi t t e e s , enter Date o f Election County & Local C o mmi t t e e s , enter County i n wh i c h Election held CASH ON HAND a t t h e beginning o f t h e reporting period . (This i s t h e total o f a l l mo n i e s held b y t h e commi t t ee . T hi s amount MUST b e t h e sa m e a s t h e cashon hand a t t h e e n d o f t h e last reportingperiod, r must b e zero i f this i s first report filed . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . . $ 7 w 9 . AD D TOTAL MONEY TAKEN I N THI S PERI OD Schedule A : Cash Contributions total (Attach Schedule A) . . . .... . . . . . . .... . ....... . .... . ................... 7Z-J' 0 0 Schedule F : Loans Received total (Attach Schedule F ) . . . .... . . . . . . .... . . . . . . ....... . .... . ......... . . . . ...... Schedule H : Total Sales o f Campai gn Property (Attach Schedul e H) . . . . . . . . .... . .... . .... . . . . . . .... . . (Schedule H a pplies t o Ca n didates' Co mmi t t e e s On l v ) CASH ON HAND a t t h e en d o f this reporting period ( i f final report, balance must b e zero Attach DR - 3 . 0 2 / ' 6100 - 0 0
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e 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 )
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l o t I s s u e / F r a r ~ y h i s
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ER ( o r p q f s A ( n f i l i n g t h i s r e p o r t )
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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 p or t s R a n g e f r o m $ 2 0
SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :
I AM FI L I NG A
+d rUA4 1 1 1 ,
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E] CHECK I F AMENDMENT TO REPORT DATED
REPORT FORAN/ A ( 1 ) ELECTI ON / ( 2 ) N
I n d i c a t e o n e
El C 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 No t i c e o f D i s s o l u t i o n Fo r m DR- 3 .( Y ou m u s 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 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 . )
STATEMENT OF CASH ON HAND
FORM
DR- 2
DI SC LOSURE
( Re v . 0 1 / 9 8 ) REPORT
F o rOf f i c e Us e
On l yComm . #
I n d e x e d 42--
A u d i t e d
-
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, <2 : - -
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DATE SI GNED
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J AN 2 2 1 0 0 1
N- E L EC TI ON YEAR .71( L E D
L o c a l C o mmi 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 mmi t t e e s , e n t e r C o u n t y i n
wh i c h E l e c t i o n i s h e l d
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 hi s a m o u n t MUST b e t h e
sa me a s t h e c as 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 . )
Sc h ed 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 A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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 m
CONTRI BUT I 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 ( M u 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 )
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I V E D FROM A STATE PAC ( P OL I T I C A L ACT I ON C OM MI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .
CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , 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 m e 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 mm i t t e e s
SCHEDULE
A MONETARY( R e v 0 6 / 9 7 ) R EC E I P T S
0 CHECK T HI S BOX I FAMENDI NG FORM
D A T E PAC I D NUMBER NAME AND ADDRESS OF CON TRI B UTOR R EL A T I O NS H I P AMOUNT J I F FORR E CE I V E D ( i f a p p l i c a b l e ) TO C A N DI D A T E ' R E C E I V E D F U N D -
( MM I D D I Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R A I S E RNUMBER I N C O ME
I D #
_ _ 7 SQL ~L CL l i : 7 y Z ~ a u t 3 t I CAN ~ J Q f v ( i - f v
CK #
I D #6 06 ` I s c F 1 ~ u i t 4 t ~ i 4 r 7 i 2 f C
CK# 8 S - 2 - S l ~ " t o g ) OL S Au e , 4 81
a 3 c ~ l v 0 e S o i v t e ~ > 2A 03ZZ , d
< I D # GZEG f ~r ~7Ci 2
CK# ` c t ZMAP4 0 ~C i T ._~00
CK# i 6o c c t s ~ Gt u 6 t b Av e S - ` V e t c o~0 6 6 ' Z! 3 - ; SO c
r I D #z ~ - 7 S~ C - e f 1 1 i t , t ~ - ° ! a I L I c w ~ r ( t ; ~ r - s
CK# ( 4S ` / - 3 0 ' 1 ~ ' S t t e e f Sv e 2C/,
f ' ~ 3 n0 Q, - a . ' e . Rc kh es s A 5CZ( - _S d ~ , C lI D #
C D2 3 l q c t i SAt UTZ ) Cd I T i 2 - 4 - g - ' 5 1 Y i r - )
EXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TT EE ACCOUNT
( Re v . 0 9 1 9 7 ) EXPENDI TURES
STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI SLATI VE
CANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COL UMN AND THE 0 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 FORMETHI CS b CAMPAI GN DI SCLOSURE BOARD .
COMMI TT EE NAME ( Mu s t b e s a m e 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 )
( Z e p r l ~ tF7 ` r r , R / I U m i Ga 0CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT
DATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( 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( MMI DD/ YR) AND PAC
COMMI TT EE NAME ( M u s t b e s am e a s o n S t a t e m e n t o f O r g a n i z a t i o n )
r r 7 f = Qf u 6 Gamed
NOTE : T h i s s c h e d u l e r e p o r t s mo n e y l o a n e d t o t h e c o mm i t t e e w h i c h i s d e p o s i t e d i n t h e c o mm i t t e e a c c o u n t .TOTAL UNP AI D LOANS FROM LAST REPORT I NG PER I OD$
PART 1 - MONETARY LOANS RECEI VED_TH I SREPORT I NG PERI OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , m u s t b e s h o w n i f a t h i r d p a r t y i si 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 . )
T OT A L ( P AR T 1 )
$
' 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 ema k i n g a c o n t r i b u t i o n t o t h e c 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 fc 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 y ma r r i a g e ) . ( S e e Pa g e 2 o f f o r m sp a c k e t . ) I f s u r n a m e 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 f a m i l i a lr 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 m n w h e n i t a p p l i e s .
PART I I - MONETARY LOAN REPAYMENTS MADE_TH I SREPORT I NG PERI OD( L o a n s f o r g i v e n m u s t b e r e p o r t e d o n S c h e d u l e E - - I n - k i n d C o n t r i b u t i o n s . )
TOTAL CASH REPAYMENTS ( P ART 1 1 )
$
F r o m S c h e d u l e E - T O T A L L OANS FORGI VEN
$
TOTAL OUTSTAND I NG LOANS EN D OF REPORT PERI OD
$ r D l o o - 0 6
P a g e o f
o r S c h e d u l e F )
SCHEDULE
F LOANS( R e v 0 8 / 9 6 ) RECE I VED
& REPA I D
El CHECK T HI S BOX I F
AMEND I NG FORM
DATE P A I D( M M/ D D / Y R )
NAME AN D ADDRESS OF LENDER( I n c l u d e E n do r s e r ' s Name , I f A p p l i c a b l e )
RELAT I ONSHI PT O CANDI DATE'
I f A p p l i c a b l e )
AMOUNTREPA I D
DATERECE I VEDMM/ DD I 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 )