Beruflich Dokumente
Kultur Dokumente
Late reports are subject to possible civil and criminal penalties . Pursuant to Iowa Code section 686 .32A(7)
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, 12 the
Individual responsible for filing timely and accurate reports .
14 .. I
Check if this i . t1nal (termination) report and attach Notice of Dissolution Form DR-3 . County 3 Local Committees, enter County n
(You must continue to file reports until a DR-3 is filed .) vlhich Cl()ctlon i5 held
ate D 0
ADD TOTAL MONEY~TAKE IN THIS PERIOD
~l vck C"oh& :or
Schedule A : 6trstr 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(ScheOmleH-apolies to Candidates' Comm lgees Onty)
SUB-TOTAL . . . . . . . .. . . . . S
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule E Expenditures total (Attach Schedule E) ("also see debts and loans below) . . . . ., . . . . . . aS . 9 0
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN 5750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD.
CAUTION: Section 1388 .32A(6),prohibits the use of information copied from reports and statement 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 ti IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID4
F p`t
a D1l © vt e
t; o CK#
I D#
C K#
ID#
CK#
I D#
CK#
C K#
I D#
C K#
I D#
CK#
I D#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL
Disuonure l9v. requires candidate commlllees to di^Gore the relationship of any relelive mgk.lnp a contribution to the
committee . Relatlon ;hip must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marringe) . If surname of contributor is the same as candidate, but there Is no Page of -
familial relationship, enter "not applicable' In the relationship column . (for Schedule A)
i :oIfIfJ I ; D HUDITOR P~~:aE ~
F3h : .~° ;'?I~lhS 1 . :1? 1-5h ;- ;8 -4753
Junes ID#
w~ h KQCN~ekcca,-, ,~
.
o l~se~yt ~'ogreC- s
ID#
CK#
ID#
CK#
I ID*
CK#
CK#
CK#
ID#
C K#
ID#
CK#
SUB-TOTAL $
Expenditures to personslontities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail Itemize on
Schedule G by the amount, purpose, and dale of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer 1i to
Sche dule G Instrur-tion n and low-,4 Code 08A ,402(3)(I) .) -_
Page of
(for Schedule 6)
llirltJ CO AUDITOR
d4p r I' I ID
pas+c~-Y~'~s 540-00
ID# KD EC
f~aee~~~o S',~~-~s /3S on
o"(0 0 ~o CK# D Ego Ya.~1 AV Q,Lt~S P ~rr1' /L y. S0
A-ii S
SUB-TOTAL $
Purchases of certain campaign property coating $500 or more must also be inventoried on Schedule H, (Refer to Schedule H instructions .)
Expenditures to person,/entities providing consulting, advertising, fund-raising, polling, managing . organizing services must of-so be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personlontity on behalf of the candidate's committee (Refe " to
Schedule G instructions and Iowa Code 6BAA02(3)(i) .)
Page of
(for Schedule R)