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Comm . #
IMPORTANT: Indicate type of committee you are reporting for:
Indexe
( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate
(5 )County PAC (6 )Ballot Issue/Franchise Committee (7 )County/City Central Committee
Audited ;, 'q -0
( 8 )Support Slate of Candidates Computer C C-' 4 W
CANDIDATE COMMITTEES ONLY :
-
Candidate Name _ C) P r a . C tf- 0- Z~ T Lpolitical Party
Routine Penalties Due For Late Filed Reports Range from $20 to $800
El Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a Notice of Dissolution is filed.) which Election is held
CASH ON HAND at the beginning of the reporting period . (This is the total of all monies held
by the committee. This amount MUST be the same as the cash on hand at the end
of the last reporting period, or must be zero if this is first report filed.) . ....... .. .. .. ..... .............$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) .. .......
Schedule F: Loans Received total (Attach Schedule F) ....................... ..... .. .........................
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ....... .. .... .....................
(Schedule H applies to Candidates' Committees Onlv)
SUB-TOTAL...... $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) (**also see debts and loans below) .. .
Schedule F: Loan Repayments total (Attach Schedule F) . .. .. .. ......... ......................... .... .. ... .
3 ~. 7 s
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) ................... .. .............. .. .. ... .. .... ..... ......... .. ............................ . ... .... ... .. .$ Z Q3
**UNPAID BILLS (From Schedule D - Attach Schedule D) .. .. ....... .. ..... ............................. .. .. .. ....... ....$
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .............. ..... ........... .. .. .. .. ... .... ..$ 3 re, S y L '~
**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) .. .................................... .... ....... ..$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES X NO
-Lc ~` _ Ic L- - ZT S / 5
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LISTTHE 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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
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CK# /3 /1
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ID# (, v 7`j Z,r,t ~ .4 L
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ID#
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ID#
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CK#
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SUB-TOTAL
CAUTION: Section 686.32A(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 -d IF FOR
RECEIVED (it applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) ARID PAC CHECK (if applicable) RAISER
c '
NUMBER INCOME
ID# i,
CK# 7 2- J'5
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ID#
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ID#
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ID# GoSl
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CK#,
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SUB-TOTAL
CAUTION: Section 68B.32A(t3), 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 v ¬ F FOR s
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MAAlDD/YR) AND PAC CHECK (ifapplicable) RAISER
NUMBER INCOME
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:LCK#
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ID#
CK# _
ID#
CK#
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ID*
CK#
I D#
CK#
ID*
CK#
I D#
CK#
ID#
CK#
SUB-TOTAL
/ T-
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DDIYR) AND PAC
CHECK
NUMBER
ID# iD '? ~. ~. i2 Z N Tzr1 u : T w ~. i3 A Cr i
1u 73
3/03 CK# 1/S1 5c.r . 3'--u F~= Z~w~
i F- $ /C~ 3
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ID#
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CK# lib _
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CK# /l Lr L rt ~-
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ID#
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_ ID#
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Jlu v/ CK# 21 Lt
I D#
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CK#/<Lrf
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SUB-TOTAL $ //~ 7 1
r
TOTAL (iflast page of this schedule) $
Expenditures to personslentities 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)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
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CK# //7c
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CK# II ?
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ID#
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C K# %l -Z.C, -7-JL,;
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ID# r 'i "'L~L~
~( CK#
I D#
iv r c-1 ( . `l C, ; T- 1 ---
CK# (7 c
SUB-TOTAL
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
CK# L C
tJ C. i WiF' ardw:~
ID#
ID# T-&
I-lrliZc~L<)~
°~/i /fWw1LTR=i~ .
rl CK# l17f . 7 , tea ~Z~ T~c~ S tti
cl L 0 C-c
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ID#
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/Z
CK# i(vC : 3cc~ .- ., TCzr ,kn -c a L ~ n2 ~ ~i7 St 6t~r c w~
ID#
7:5-
I D#
CK#
SUB-TOTAL
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM
SCHEDULE
)AD
IlAG-IJ
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SUB-TOTAL 1 $
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page I of
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage) . (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .