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Ma-fil \/ . 82 sJ1 e'\ DPrvkoc rct r
Office Sought District (if Senate or House) d AN
Su12Prk%+SCS(2
12- Z-t - 6V
SIGNATU9 F TREASURER (or person fling this report) TELEPHONE DATE SIGNED
Late filed reports are subject to possible civil and criminal penalties .
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:
I AM FILING A OL r+k&c_.r c? Vv REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report dot
Indicate one
Local Committees, enter Date of Election
" CHECK IF AMENDMENT TO REPORT DATED
11- --c%`I
County & Local Committees, enter County in
which Election is held
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
(You must continue to file reports until a Notice of Dissolution is filed .) DCS Mc .neS Cc3,dX
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . $
0=
**UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . .$
*IN KIND CONTRIBUTIONS (From Schedule E-Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .$
**OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)
For Instructions, See Back of Form SCHEDULE
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# C)iFt,JnI~
2 Z~,6 W °7-5 '
Ave AV-9-
SI CK#
ID#
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CK# c
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i
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ID# je VA Cr
CK# /0_36C4 isS''~ = -r J 0
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ID#
CK#
ID#
~
CK# 1308 KeQS p~
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' ID# '
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL
* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no Page ~_ of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE
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CK#
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CK#
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" ID#
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1012V0
CK# Iy11
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1D# ~j O.Op -" 1,-41 ~.
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CK# P O c~c 7 Z ,,y-, f'.k rCk pct, Se r
e 2 0~ ~ L&i Ii ,~ -IaN ft Sz t 1\ « ~..slr.. . 33,00
ID#
do S Rl~~~pS C.~NI ewS
p. C) Q ax 11 - 7
CK#
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CK# 2 (c Z 2 ~v~ r ~'e eiJ ¢aM,~u ~ d~yCra Sir' J"plPlies.
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ID#
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CK#
SUB-TOTAL $
TOTAL (iflast page of this schedule) $ /
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(1) .)
(for Schedule B)