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CANDIDATE COMMITTEES sr
.1Zo
L3
Candidate Name 0ARD Political Party (if applicable)
JUN - Late reports are subject to
possible civil and Criminal
Office Sought FILEL)
District (if Senate or House) penalties .
778-78711 _111NF 7. =6
SIGNA UR OF PERSON FILING REPORT TELEPHONE DATE SIGNED
I AM FILING A MAY 1q, 7()ni REPORT FOR (1) ELECTION 1(2)NON-ELECTION YEAR
(report date) Indicate by #
Q Check if this is final (termination) report and attach Notice of Dissolution Form OR-3 . County 8 Loral Committees, enter County in
which Election is held
(You must continue to file reports until a DR-3 is filed .)
CAUTION: Section 66B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
forany commercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MhVDD1YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# '
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
CK#
CK# ~~
ID# '
CK#
ID#
CK#
i
SUB-TOTAL
$ 25 .95
TOTAL (if last page of this schedule)
' Disclosure law requires candidate commlHees to dlsdose the relationship of any relative making a contribution b the
ccmrniltee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contribute is the same as candidate, but theta )s no Page 1 of
familial relationship, enter "not applicable' In the relationship column, (for Schedule A)