Severson Gale1514scanned

8/7/2019 Severson Gale__1514__scanned

1/8

DEC-22-04 11 : 13 AM QUALI TY ACCT AND TAX SER

( 1 ) S t e t v w I d e / L e g l a l s t l 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 ( " ) C o u n t y A . O c a l C a n d i d a t e( 5 ) C o u n t y PAC ( e ) B a l l o t I e a u e l F r a n c h l e e Co mm i t t e e

7 C o u n t y / C l t y C e n t r a l C o mm i t t e e

CANDI DATE COMMI TT EES ONLY :Ca n d i d e t q Name .

P o l l l l P a r t y

D i s t r i c t ( i t S en a t e

FOR I NSTRUCT) ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e s ome a s o n S t a t e m o n r o f O r g e n I z o t l o n )

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

I AM F I L I NG A

OF TR l~U

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

( r e p o r t d a t e )HECK I F AMENDMENT 1 ' O REPORT DATED

&/ 1 2 g l o d C404

~ ' C h e c k i f t h i s I s f l n e 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 l s s o l u t l o n F or m DR- 3 .( Y o u mus t c o nt 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 $ f i l e d . )

STATEMENT OF CASH ON HAND

5639336416FORMDR- 2 DI SCLOSURE

( Re( Re v . 0 7 / 2 0 0 3)

REPORT

F o r OMe t Us e On l yComm a

1 5 j -L o g g e d I n . . . . _. . . . . . . . . . . . . . .

S c a n n a oComp u t e rA u d i t e d _ _ _ - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

,~33- .1, 9

- o A l

TELEPHONE

DATE SI GNED

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 s s 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 .D COMPLETE THE F OLL OWI NO SgNTENCEREPORT FOR AN/ A

ELECT I ON / ( 2 ) NON- E LECT I ON YEAR,

I n d i c a t e o n eL o c a l Co mml l l a b a , 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 b 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 nw h i c h E l e c t i o n l a h e l d

P . 06CASH ON HAND a t t h e b e gi 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 l e s h e l db 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 e s a me a s t h e c as h o n h a n d a t t h e e n d


2/8

DEC-22 - 0411 : 14 A h tQUALI TY ACCTANDTAX SER5639336416 P . 07FOR1NSTRUCI l CNS. SEEBACKOF FORM

COMMI TTEE NAME( Mu s t b e s ame as o n S f a r eme n f o f Or g a n '

l i o n )

SCHEDULE

( Rev 06197 )

- 1I N K I ND

CONTRI BUT101 4S

r

CHECK THI S BOX I FAMENDI NG FORM

DATE

RECEI VED( MM?DD' YR

RELAT I ONSHI P DESCRI PTI ONNAMEANDADDRESSESTI MATED

TO CANDI DATE OF I N K I NDOF CONTRI BUTOR FAI R MARKET' I f s o l i c a b i e CONTRI BUTI ON VALUE Iv I F FOR

FUND- RAI SERCONTRI BUTI ONI DI 2 6 ~ 0~ l ~4.~~y. ~ f 1 . ~ . ~ - 1 ' { ~ t~~~f LC~~I ~t i ~C~ c . . . v ' - i r c r . ~ ' 45~ . er o z L o ~ ~ f ' ~ ~o > L z

,/ c , V ,3 ML - a e - 3

aa


3/8

OCT- 29 - 04 0 2 : 1 5 P t ` 1 QUALI TY ACCT AND TA) : SER

FORI NSTRUCTI ONS, SEE13ACKOFFORMDI SCLOSURE SUMMARY PAGE( COMMI TT EE NAME ( Mu s t b e some a s o n S t a t e me n t o f O r g a r z a t i o n )

I MPORTANT I n d l c e t e t y p e o f , o mml t t e a y o u a r e r e p o n l n g f o r( 1 ) S t o t e w d e l l . e g l s i a l i v e C a n d l e e l s ( 2 ) S t a t e w i d e P A C ( 3 ) S t e t s P a r t y ( a ) C o u n t y l t o c a l C a n d i d a t e( 5 ) C o u n t y P A C ( 6 ) 9 e n o t l s s u s / F r a n c h i s e C ommi l l e s ( 7 ) C o u n t y / C i t y C e n t r e ) C o mmi t t e eCANDI DATE COMMI T T EES ONLY :C a n d i d a t e Name

P o l i t i c a l P a r t y8Pyerso r - i V L k b 1 - ' Ca

O f f i c e S o u g h t

D i s t r i c t ( i f S e n a t e

H o u s erv 4 a 4 e &. P r e s e r ' 4 a 4 - t ve

SEE I N TRUCT_ I ONS ONI AM F I L I N G A

VG' ~( r e p o r t d a t e )

[ CHECK I F AMENDMENT T O REPORT DATED~ ' Che 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 e 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 F o r m DR-( Y o u 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 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 CASH ON HAND

5639336416

)GN

URE OF

REAS

CR ( r

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

TEL EPHONE

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 l e s h e l d

FORMDR- 2( R e v 0 7 / 2 0 0 3 )Comm . # L o g g e d I n - - -S c a n n e d - -C o mp u t e r _ - - - -A u d i t e d

DI SCLOSUREREPORT

j a r - L ; ` ? - . 0 ' /

ECTI ON / ( 2 ) NON- ELECT I ON YEAR

C o u n t y R 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 nw h i c h E l e c t i o n l a h e l d

P- 0 2


4/8

OCT-29- 04 02 : 15 PP 1 QUALI TY ACCT AND TA} : SER 5639336416 P- 03Fo r I n s t r u c t i o n s , See 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 e t e ' a 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 e f 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 CONTR I BUT I ON I S RECEI VED FROM A S T A T E PA C ( P OL I T I C A L ACT I O N C OMMI T T E E ) , L I S T T HE PA C I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF 1 0 NUMBERS 1 8 A V AI L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARDCAU T I ON ; S e c t i o n 8 8 8 , 3 2 A ( 8 ) , 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 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 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 7 / 0 3 ) R ECE I P T SCHECK T HI S B OX I FAMEND I NG FORM

DATE PAC 1 0 NUMBER NAME AND ADDRE S S OF CONTR I BUT OR R E L AT I ONS HI P AMOUNT J I F FORRECE I V ED ( I t a p p l i c a b l e ) T O CANDI DATE ' R E CE I V E D FUND-( MM/ DD/ YR ) AND PAC CHECK ( I t a p p l i c a b l e ) RAI S E RNUMBER I NCOME1 0 # c Gt r 6 -

_ 1 2 4 1u . " - .1 C ~ ~ 5 ~ o D#

t l 1-aL ,

a r d o z 2~CK# / I r e . 5 a~c"Ed - Q- f e . u , ~~oS J00 DOI D# . 4 . AJl ~ ~ l , s 1 o ~ c K n , Se x - A 5 CI O

JD' 1 $ J oy CKa ( l ' CJ ~Vc~Y 4 3 ~ : ~ t ~ ~ / . OLDt oo

ffl o f t

l Ol ~ t pa i l CK# C6 e ' X . 1 5 7 ~


5/8

F o 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 o l 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 )COMI TTEENAME ( Mu s t be s ame as o n S t a t eme n t o f Or g e nl l a t l o n)

' j a. , t . T

- ( } . - , , kcL f ~ t , Q,

F - c , c d . ~ - ,

STATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE ) , L I S T THEPAC I DENT I F I CAT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T Or I D NUMBERS I $ AVAI LABLe FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t l o n t 3 B 8 . 3 2 A ( f 3 ) , 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 end 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 omme r c i a l p u r p o se b y any p e r s o n o t h e r t h an 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 .

SCHEDULEA MONETARY( R ev , 0 7 / 0 3 ) RECE I PTS


DATE PAC I O NUMBER NAME AND ADDRESS F CONTRI BUTOR RELATI ONSHI P AMOUNT 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 o p p l l c o b l a ) R A I S E RNUMBER I NCOME/ o/ z c

I D# . [ 1 ; 0 YV/ L . A . . " TLC' Y t ~ ' ) t r

I DS

I ON t r ~ 2~' G L

l 0 / / , , I C K#-76 I G -- 3 o

d ~~ 9I Da ~~? I I I ~ l Fr t 3 - a j t c z Lx. ~~. A . ( Q . t.' 14I D I ~ I ~ C I r ) CK# / VG~Jj r ? ~ J L C . L . . ac %~11 I r ` ~ J "A A 4 -c , 0 -


6/8

OCT-29- 04 02' 16 PM QUALI TY ACCT AND TAX SEP 5639336416 P . 05FOR / NS T 1 ? U C T i ON S, SE - E E I ACK OF FORM ' " ~ t e s e t Fo r m SCHEDULE

EXPENDI TURES . . - MONEYSPENT FROM COMMI TTEE ACCOUNT B MONETARe( R e v . 0 7 / 0 3 ) EXPEND I TURESSTATE PAC COMMI TTE ES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES L I S T T I I F CAND I DATE I D E NT I F I C A T I ON NUMBER I N THE DESI GNATED COL UMN AND THE D CHECK T HI S BOX i FPAC CHECK NUMBER FOR EACH EXPEND I TURE A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA AMEND I NG FORME T HI C S 3 CAMPAI GN D I SCLOSLRE BOARDCOMMI TT EE NAME ( M o s t 1 1 0 same a s o n S t a t e me n t o f Or g e n l z n t l o n )

CAND I DATE NAME AND A DD RE S S TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I TURE ( DESCRI BE TRANSACT I ON ) EXPENDEDEXPENDED ( i f a P P l r c a b l e ) ( Dl S bu r a e me n l ) WAS MADE( MMi DONRI A ND P ACCHECKNUMBERJ o ' s k r ) " L " t f - I LCK#

) 0 1 1 9 ) 0 1 . 1 CK# 4 e i LI D #CK # ~ L ~r ~ ~ E h - t _ f d t c - tD#CK #I D #CK #I D #


7/8

OCT-29-04 02 : 1 i PM QUALI TY ACCT AND TA? : SEP 56 . 39336416 P . 06CDR I NS 7 r ; < < , r r r t 3 NS : . q t = r 64Cx ~F

0 , q A d

, COMMI TTEE NAME ( Mu l l t ) s s ame a s On S t e t e me n t o t Or g e n r z a r ; n )~

i

4zt 9 4 - u - ~ 2 - - c . ~.. ).A. , * ' V - v. [ " Y ' L .


C' Ar E

kEi -. : r ! ' r F t 1At . , l D( ! ! Y . g 1

Nnr AE AND ADDF : ESSr ' c Cf ) NTNI BUTr ~R

REI ATI CNSHI PTC CANDI DATEl ^ F p hr a b l e )DESCRI PTI ONOF I N KI NDCONTRI BUTI ON

ESTI MATEDFAI R MARKETVALUE

: I F FORFUNDRAI SERCONTRI BUTI ON

A ~ r i J G 1 ' " ~ t , U- e V' 7 ) o

-VL C . ' d C r LC 1 - k J ~' e~w. C c ~i ' t - c . J i - L ' K 4Z L r% r

Cd-/

C- kLt


8/8

FORJOVSTRUCTKNVS, SEE t 7 A CK OF FORMCOMNf TTEE NANE( Abw b o same as o r t S J at e r r w x o f Ovgam2~ )

- GL , L - 4 , - , *NOTE : T h i s s c h e d 4 e r e p o r t s mon ey l o a ne d t o t h e o o m r t t i t l e e v A t c h i s d e po s i t e d t o t h e co nmCae a ct o u r gTOTAL UNPAXI LOANS FROM LAST f 2 EPORTN I G PER I OD S - - W) C- 1 DGPART I - MONETARY LOANS RECEI VED T HI S REPORTI NG PER I OD( O r x p n a i s o +x r e db an , s u dh a s a b a n k , must be shmmd a I J w d p a r t y ai r r v c N e d I n r l t s d e l a a 2s ho m c a n r + ! s " s , e r s o ^ . : ~ ' F ; CJ s J

TOTAL ( PART 1 ) - S -

Di sc kmwe r aw r e q u z e s c a n di d at e c o r r t r r i C e e s t o d s c b s e t h e rel at edan y r e t a t mma k i n g a c o n l n b u b o n t o Ct e c o mmi t t e e R r l a b o n s t t i p must b e sh own i o t h e G i r d d e g r e edc o ns at ~ i t y ( Wo o d r eW- ) an d a f Wn i t y ( r e 4Dve s t r y mon t a ge ) n s u r n amede o n i m b u i o r t sI t t e sa me a s c a n d i d a t e , t t a k l A e r e t s n o l a m A t a l t e f a t i o t t s h i p , o r V mq " n o t a p p k ab f e - i n fr e l a b o r i s h i p c u t u mn wAi e n i t a pp i r s

PART i - MONETARY LOAN REPAYMENTS OI ADE T HI S REPORTI NGPERI OD( L o a n s f o r 7 mn n xWb e r e pn r W o n SchedBe E E - - I n - k i n d Co n t n b u t i o n sj

TOTAL CASH REPAYMENTS ( PART I t )F r u m S c t t e d i l e E - TOTAL LOANS FORGI VEN S-

TOTAL OUTSTANDI NGLOANS END OF REPORT PEP" S C C t_ . c C

Page d( f o g S c h - A d e F )

SCHEDULEF LOAM( R ev 0 7 / 0 3 ) RECE I VED

6 REPA I D[ WI CHECK THI S BOX I FAMENDI NGFORM

DATE PAI D( t AWDD( YR )NAME ANDADDRESS OF LENDER

( I n c l u d e En d o r s e r s Name, I f A pp i c a b ' e )tKE LAT I ONSH I PTO CANDI DATE '

i M A p f K a b i e ~A Al J U NTREPA I D

S

DATERECEI VED( M h b ' DDl Y R

NAME AND ADDRESS OF LENDER( I r t d t r d e E nd o r s e r ' s Name, I t A pp i c a b l e )

RELAT I ONSH I PTO CANDI DATE( I f ' )

AMOUNTOF LOAN

S

Severson Gale__1514__scanned

Documents

Severson Gale1514scanned