Richards Dot__1518__scanned

8/7/2019 Richards Dot__1518__scanned

http://slidepdf.com/reader/full/richards-dot1518scanned 1/4

" FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARYPAGE

COMMI TT EE NAME ( Mu s t b e same as o n St a t emen t o f O r g a n i z a t i o n )

Do Ri har dc f or at Ho >s

I MPORTANT : I n d i c a t e t y p e o f c o m mi t t e e y o u a r e r e p o r t i n g f o r :

(

F , I

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 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

CANDI DATE COMMI TTEES ONLY :

Ca nd i d at e Name P o l i t i c a l P a r t y

Dor n t h ) z Ri char ds Rep

O f f i c e So u g h t D i s t r i c t ( i f Se n a t e o r House )

qt at a H01 12 0 seat 8 5

\x&~( ( ~ y t i _ _ 5 6 3 - 3 8 6- 2 20 1S I GNAT I A E OF TREASURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TELEPHONE

L a t 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 n d c r i m i n a l p e n a l t i e s

n Chec 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 N o t i c e o f D i s s o l u t i o n F or m DR- 3 .( Y o u must 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 . )

STATEMENT OF CASHONHAND

SUBTRACT TOTAL MONEY SPENT T HI S PERI OD

Sc h e d 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 d ul e B ) ( " " a l s o s ee d e b t s an d l o a n s b e l o w ) . . . .

Sc h e d u l e F : L o a n Re p ay me n t s t o t a l ( A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SUB- TOTAL . . . . . $ 9 5 9 7 . 61

CASHONHAND a t t h e en 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 nc e must

b e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ J - 3 - 5 3 - 5 - 5

FORM

DR- 2 DI SCL OSURE

( Re v . 0 7 1 2 0 0 3 ) REPORT

F o r O f f i c e Us e O n l y - - - ~

JComm. #

L o g g e d l n

Scanned

C o mp u t e r _ - - - - - - - - _ __ __ __ ` _

A u d i t e d

l Awa r +° &c CAMI

= t - i - t , 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLL OWI NG SENTENCE :

I AM F I L I NG A 10 - 26 - 04 REPORT FOR A N/ A ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .

( r e p o r t d a t e ) I n d i c a t e o n e 1 - 1 1

CCHECK I F AMENDMENT TO REPORT DATED 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

w h i c h E l e c t i o n i s h e l d

CASHON 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 db y t h e c ommi t t e e . T h i s amoun t MUST b e t h e same a s t h e c a s h o n ha n d a t t h e en 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5 3Q-T . 6 1

ADD TOTAL MONEY TAKEN I N T HI S PERI OD

Sc 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 ee i n - k i n d b e l o w) . . . . . . . . . 4 29 0, 0 0

Sc h e d u l e F : L o an s Re c ei 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 S a l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - A-

1 S t : h e d u l e _ H a p o i i e s t o Ca nd i d a t e s' Commi t t e e s On i y l

J - _ _ - - - _ - - _ _ - _ _ -

" UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ - _ - 9 - _

' I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 7500 . 0 0

" OUTSTANDI NGLOANS ( F r o m Sc h e d u l e F - A t t ac h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ - - - - - - - - - - - - - - - - - - -

CANDI DATE COMMI TTEES ONLY :

CONSULTANT BREAKDOWN ( Sc h ed u l e GA t t a c h e d ? )

VALUE OF CAMPAI GN PROPERTY ( 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)

YES NO

$ _ _ _ _ _ _ _ _ - - - - - - - - - - - _ _ _ _

8/7/2019 Richards Dot__1518__scanned

http://slidepdf.com/reader/full/richards-dot1518scanned 2/4

P o r I n s t r u c t i o ns , Se e Back 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 St a t e me n t o f O r g a n i z a t i o n )

Dot Ri c h ar d s f o r St a t e House

Rese t I ` o r t n '

STATE CANDI DATES NOTE : I F A C ON T RI B UT I ON I S RECEI VED FROM A S TA TE P AC ( P O L I T I C A L A C T I ON COMMI TT EE) . L I S T T HE P AC I D EN T I F I C A T I O NNUMBER AND THE P AC 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 T HE I OWA E T HI CS ANDCAMPA I GNDI SCLOSURE BOARD .

CAUT I 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 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 mmi t t e e s .

SUB - TOTA L

TOTAL ( i f l a s t pa ge o f t h i s s c h ed u l e )

$A9can nn

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 mmi 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 m u 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 i 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 ) . I f s u m 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 Pa g e - . L - _ 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 r i t h e r e l a t i o n s h i p c o l u m n . ( f o r S c h e d u l e A )

SCHEDULE

A MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

QCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CAND I DATE' RECEI VED FUND-( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOME

1 0 - 1 5 - 0 4 I D# H . D . F i k e $ 5 0 . 0 0

C K # , 1 1 3 2 W. 5 3 r d St D2$

Da v en p o r t , I a 5 2 8 0 6

1 0 - 1 5 - 0 4 1 D # I A Rep Women Di s t # 5 $ 5 0 . 0 0

CK # 4 0 0 N . Bu r e a u St E]Cr e s t o n I a 5 0 8 0 1

1 0 - 1 5 - 0 4 I D" 6 2 3 7 ABATE P a c 1 0 0 0 . 0 0CK # 3 1 1 8 Ea s t e r n Av e N . E .

E]1 7 1 0 Cedar Ra p i d s , I a 5 2 4 0 2I D #

1 0 - 1 7 - 0 4 J i m Cu r t i s $ 2 0 . 0 0

CK# 3 1 0 Oak St E: 1E l d r i d e I a 5 2 7 4 8

1 0 - 1 7 - 0 4 I D#DuWay ee He l k e n n $ 2 0 . 0 0

CK# 2 5 2 6 Sh e f f i e l d Dr ElDaven or t I a 5 2 8 0 6

1 0 - 1 8 - 0 4I D#

1 5 1 8 I o wa P a c 1 0 0 0 . 0 0

CK # P . O . Bo x 3 5 EJ1171 Manch es t e r I a 5 2 0 5 7

1 0 - 1 8 - 0 4 I D# Rep Pa r t y o f I o wa $ 2 0 0 0 . 0 0

CK #6 2 1 - 9 t h StDe s Mo i n e s , I a 5 0 3 0 9

1 0- 2 0- 0 4 ' D# Dr . Ro b e r t Wa r d $ 1 0 0 . 0 0

CK#1 8 0 2 W. L o c u s t StDa v en p o r t , I a 5 2 8 0 4

1 0 - 2 5 - 0I D#

Way ne & Ka y Wa g n e r $ 5 0 . 0 0CK # 5 2 9 6 Coa c hman Rd

Rp t - i - p n 8o r f . , T A S2722I D#

CK #

8/7/2019 Richards Dot__1518__scanned

http://slidepdf.com/reader/full/richards-dot1518scanned 3/4

T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES ONL Y :

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 )

P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H . ( R e f e r t o S c h e d u l e H i n s t r u c t i o n s . )

$ 8 2 3 8 . 0 6

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 , 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 m u s t a l s o b e d e t a i l i t e m i z e d o nS c h e d u l e G b y t h e a mo 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 l 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 mm i t t e e . ( R e f e r tS c h e d u l e G i n s t r u c t i o n s a n d I o w a Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

P a g e o f __I - - -

( f o r S c h e d u l e B )

FOR I N S TRUCT I ONS , SEEBACK OF FORM R e s e t F o r mSCHEDULE

EXPENDI TURESB MONETARY

- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) E X P E ND I T ~ , ' R E S

STATE PAC COMMI TTE ES : NOTE : FOR C ON T R I B UT I O NS MADE T O STATEWI DE OR L E G I S L A T I V EC A ND I D A T E S , L I S T THE CAND I DATE I D E NT I F I C A T I O N NUMBER I N T HE DE SI GNAT ED COLUMN AND THE CHECK THI S BOX I : =PAC CHECK NUMBER FOR EACH EXPEND I TURE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA AMENDI NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD

COMMI TTE E 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 )

r r i r i : A _ * T .CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI 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( MM / D DI Y R ) AND PA C

CHECKNUMBER

1 0 - 1 5 - 0 1D#OP P r i n t i n g ( L e t t e r s & p o s t a g e $ 3 4 0 8 . 8 1 .

CK#P . O . Box 7 4 7 $Mu s c a t i n e , I a 5 2 7 6 1

1 0 - 1 5 - 0 4 1 D # One S t e p I n c b r o c h u r e s $82 9 . 25P . O . Box 5 6 2

CK#P o r t By r o n , I l 6 1 2 7 5

1 0 - 1 8 - 0 1D#Vi c t o r y E n t T . V . a d5 2 0 0 S . W . 3 0 t h S t

$ 4 0 0 0 . 00

CK#y

Da v en p o r t , I a 5 2 8 0 2

1D#

CK#

I D#

CK#

I D#

CK#

1D#

I

CK#

1 1 D #

CK#

SUB- TOTAL $ 8 2 3 8 . 0 6

8/7/2019 Richards Dot__1518__scanned

http://slidepdf.com/reader/full/richards-dot1518scanned 4/4

FORI NSTRUCTI ONS, SEE BACK OF FORM

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )

CHECK THI S BOX I FAMENDI NG FORM

' D i s c l o s u r e l aw r e q u i r e s c a nd 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 an 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 Page 1 _ o f 1

c o mmi t t e e . R e l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c o ns an gu 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 ( f o r Sc h e d u l e E)

b y ma r r i a ge ) ( Se e Page 2 o f f o r ms 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

f a m i l i a l r e l a t i o n s h i p , e nt 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 .

DATE

RECEI VED

( MM/ DD/ YR)NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI P

TO CANDI DATE

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

DESCRI PTI ON

OF I N K I NDCONTRI BUTI ON

ESTI MATED

FAI R MARKETVALUE

4 I F FOR

FUND- RAI SER

CONTRI BUTI ON

1 0 - 1 3 - 0 Rep Pa r t y o f I o wa6 2 1 E . 9 t h StDe s Mo i n e s , I a 5 0 3 0 9

( P r i n t i n g $3750 . 0 0

1 0 - 1 3 - 0 Rep Pa r t y o f I o wa6 2 1 E . 9 t h StDe s Mo i n e s , I a 5 0 3 0 9

Th e Ma i lHouse

$ 3 7 5 0 . 0 0

v

- -

SUB- TOTAL $

7 5 0 0 . 0TOTAL ( i f l a s t

p a g e o f t h i s

s c h e du l e )

$

7500.0C