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a
For Office Use Only
(
IMPORTANT: Indicate type of committee you are reporting for. Comm . #
Logged fn
1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate
Scanned
( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee
(8)Support Slate of Candidates Computer
CANDIDATE COMMITTEES O
~i ~.'s Audited
Candidate Name ~f !;'~.M14
;- UP
Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
t AM FILING A iC f--4'6'V'- /,V, 2-06 ,9, REPORT FOR ANIA (1) ELECTION l(2)NON-ELECTION YEAR .
(report date) Indicate one
0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed .)
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . .
Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
SUB-TOTAL . . .. . . $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
5.0
Schedule B : Expenditures total (Attach Schedule B) ('"also see debts and loans below) . . .
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3
5-75. 9
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
8TA'M CANWOiATEB NOTE IF A CONTRlBUT10N IS RECENED FROM A STATE PAC (POLMCAL ACTION COVWTfEE)6 LIST THE PAC 1OENTtFICATION
NUMBER AND THE PAC CHECK NUMBER 1N THE VPSIWTED COUJUN . A LIST OF tD NUMBERS IS AVA"BLE FROM THE IOWA ETHICS AND CAMPAIGN
DSCWSURE BOARD. ,
CAUTION: Section 6t38.32A(S). lows Code, pnoMbrta the use of information copied front reports and statement for satiating contributions or
for " oxmnerdsl pups by any ( other than staEutwy pohdcW comnWAm.
_
DATE
PAC
113 R NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -4 IF FOR
RECEIVED (if apps) TO CANDIDATE' RECEIVW FiS(O-
IMIrAIDOYR) AND PAC CHECK lif appliaible) RAISER
NUMBER INCOME
CK#
(DO
CIC
`~
ID#
CK#
. IDx
CK#
ID*
.
CK#
(t3#
CK#
ID*
CK#
ID#
' CIIs
ID#
CK#
[DO
CK#
SUB-TOTAL
.
S. ~ S_ av
A(-
r,L.~ Aej, C ,,~ Zest .,,) (~ -, /;,',C"
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (DlaburssMOM) WAS MADE
(MMAXYYR) AND PAC
CHECK
NUMBER
ID#
be -s P4 a)19J P10 ' $o)/
CK# /0,0
S~3ib'-O~pl
ID# ~
Y4
yJ
CK# 1~i'd
Y111- 1 ~r~~C~s Q~ C".CP~'arAy'70w
ID# /
.7Sa 0
.~ safe so
CK#Id// pf033 ,~,'vq-as
s />zc,.u~s :~A Sc'3 . " l ll~~ pu~N~ T..4 sc~.zS
ID#
CK#
CK#
ID#
CK#
ID#
CK#
lD#
CK#
- -
SUB-TOTAL $
TOTAL (if last page of this seftaduie) 7 s~>
1$ y
THIS BOX APPLIES TO CANDIDATES' GOMMrrMES ONLY:
Purchases of certain campaign property costing $500 or moro must also be inventoried on Schhedule H, (Refer to Sdheduie H instructions.)
Expenditures to personslenMes providing consuiting, advertising, fund-raising, polling, managing. organizing services must ado bedetall hemmed on
Schedule G by the amount,purpose, and date of each type ofexpenditure made by the pemon/entity on behalf ofthe candidate's committee. (Refer do
Sdmdule G instrudfons and Iowa Code 56.8(3)(1).)
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