FOR INSTRUCTIONS, SEE BACK OF FORM oT] DR-2 _ | oisctosune DISCLOSURE SUMMARY PAGE (Rev. 02196) |___REPORT 18 1003 [ror omnes use om (GOMIITTEE NAME (Must be same as on Slafement of Organization) TT) \comme Cow \ wry evn Insex utes IMPORTANT: Indicate type of commie you ae reporting for: [2] hear (1 statewideregitatve Candidate (2)Sltewte PAC (2 Site Paty (4Counyfca Candle {,etuny PAC {6 ato esuertance Commitee (7 YocunnCiy Canal Comte i Canaates 13/4 3L4 SHAE 7-17-63 SIGNATURE OF TREASURER (or person fling this report) TELEPHONE DATE SIGNED LS Penalties Due For Late Filed Reports Range from $10 to $400 SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE: VAMFIUNGA F-12203 REPORT FOR ANIA (1) ELECTION ((2)NON-ELECTION YEAR, (oper de) Indicate one [2] [OCHECK IF AMENDMENT TO REPORT DATED [Cocal Commitees, enter Date of Election County & Local Gommatiees, enter County in Bi Check if this is final (termination) report and attach Notice of Dissolution Form OR-3. | County & Loral Comm ‘(You must continue to fle reports until a Notice of Dissolution is fled.) STATEMENT OF CASH ON HAND CASH ON HAND at the beginning ofthe reporting period. (This isthe total ofall monies held by the committee. This mount MUST be the same as the cash on hand atthe end ofthe last reporting period, =n ‘or must be zero if his is first repor fled)... I. ADD TOTAL MONEY TAKEN IN THIS PERIOD ‘Schedule A: Cash Contributions total (Attach Schedule A) 00 ‘Schedule C: Fundraising Events total (Attach Schedule C). ‘Schedule F: Loans Received total (Attach Schedule F). ‘Schedule H: Total Sales of Campaign Property (Attach Schedule H) (Schedule H applies to Candidates’ Committees Only) SUB-TOTAL ‘SUBTRACT TOTAL MONEY SPENT THIS PERIOD Schedule 8: Expenditures total (Attach Schedule B). ‘Schedule F: Loan Repayments total (Attach Schedule F) CASH ON HAND athe end of his reporting pred fra repr, balance must be zero) (Attach DR-3) UNPAID BILLS (From Schedule D - Attach Schedule D). von IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E), ee 2 OUTSTANDING LOANS (From Schedule F - Attach Schedule F) sen s = CANDIDATE COMMITTEES ONLY: CONSULTANT BREAKDOWN (Schedule G Attached”) yes No VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) 8For Instructions, See Back of Form ‘SCHEDULE A MONETARY CONTRIBUTIONS -- MONEY TAKEN IN (rev. come) | RECEIPTS (including candidate's persona funds) 1 CHECK THis BOX IF [COMMITTEE NAME (Wust be same as on Statement of Organization) AMENDING FORM ‘STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) LIST THE PAC IDENTIFICATION [NUMBER ANO THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMEAIGN DISCLOSURE BOARD. CAUTION: Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions oF for any commercial purpose by any person other than statutory poltical committees. DATE PAC TO NUMBER TAME AND ADDRESS OF CONTRIBUTOR. RELATIONSHIP "AMOUNT RECEIVED (Fapplicabe) TOCANDIDATE: | RECEIVED qumopvR) | AND PAC CHECK (applicable) NUMBER, ha | | Memba ship dues [4.02 a Meerina Meals cEncome 199.co holes | (hewbers dunes 36.02 Ke oH cKe Ke TOF Ki 10F Ke SUBTOTAL TOTAL (if last page of this schedule) + Disosuce aw requires candidate commits to eiscose the relationship of any relative making a contibton to the Commitee. Relationship must be shown tothe third degree of consanguinity ood relatives) and aint (elaves by ‘ammage) (See Page 2 of fom packet). i sumame of contributor i the same as candidate, but theres no Page o_] {amialeationship, enter “not applicable in the relationship column, Tor SchecuieAY* FOR INSTRUCTIONS, SEE BACK OF FORM EXPENDITURES — MONEY SPENT FROM COMMITTEE ACCOUNT ‘STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE ‘GANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE PAC CHECK NUMBER FOR EACH EXPENDITURE. A UIST OF IO NUMBERS IS AVAILABLE FROM THE IOWA ETHICS 8 CAMPAIGN DISCLOSURE BOARD. (SCHEDULE (Rev.0907) | EXPENDITURES MONETARY DD CHECK THIS BOX IF ‘AMENDING FORM [GOWMITTEE NAME (isi bo samo as on Saioment of Organizaon) Aolhuson Cours OATE EXPENDED. (aaporvAy CANDIDATE. IDNUMBER. applicable) ‘AND PAC CHECK NUMBER, DF CKH 2 gy "NAME AND ADDRESS TO WHOM EXPENDITURE Goralo le =A Republica. Wamen "PURPOSE (DESCRIBE TRANSACTION) eating notices Copywonk& = ¥3L Postage 136 10F cK jen Lise Wachendoc® BO | Timber cm Coraly. se Ev postage oF oKH 1293 Lone star Meals alo 2nd Sr Covely Me Meanng Mails iF cke bt ke 1DF THIS BOX APPLIES TO CANDIDATES: COMMITTEES ONLY: Purchases of certain campaign property costing $500 oF moe must also be inventoried on Schedule H. (Relor to Schedule H instructions.) Expenditures to personsientiies provcing consulting, advertising tund-raising, poling, managing, organizing servicos must also be deta tized on ‘Schedule G by the amount, purpose, and date of each typeof expenditure made by the person/entty on behall ofthe candidate's Commitee. (Refer to Schedule G instructions and iowa Code 56.6(3)(.) BUBTOTALTS 215,63 TOTAL (iflast page of this schedule) [$5 13 a (tor Schedule 8)