Beruflich Dokumente
Kultur Dokumente
(712) 647-3490_
SIGNATU F TREASURER (or person filling this report) TELEPHONE DATE SIGNED
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON (BACK AND _C- PLETE THE FOLLOWING SENTENCE :
I AM FILING A T_ Z ~-1 -0-2-M EPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one
CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election
[] 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
"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?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
V_ Cc C
e V4 0 f 'Ll eP"Y u
For Instructions, See Back of Fr SCHEDULE
,A
CONTRIBUTIONS - MONEY TAKEN
(Including candidate's personal funds)
IN (Rev . 06/97) I MONE-ARY
RECEIPTS
STATE CANDIDATES NOTE IF *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 UST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 6813 .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 RELA71ONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DO/YR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
ID#
I CK# fit' $
ID#
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ID#
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ID#
gym/ CK#
g
G, o.~Z
CK# ~~
ID#
o CO/
Z CK# `r39 ~~ ''' ~~ y1
ID#
ID#
CK#
iD#4071
X03
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JID# -2,Lao C,
12 91
K# / 710 "' s0 3O
SUB-TOTAL
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to personsientitles 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) .)
Page _/ _ of __-Z
(for Schedule B)