polk county republican women_9628_scanned

8/7/2019 Polk County Republican Women_9628_scanned

1/8

FOR I NSTRUCTI ONS,SEE BACKOF FORM

DI SCLOSURE SUMMARY PAGE

(1 ) S t a t e w i d e / L " i s l a t i v eCa n d i d a t e( 2 ) S t a t e w i d ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t y J L o c a iCa n d i d a t e( 5 ) C o un t yPAC ( 6 ) B a l l o tI s s u e / F r a n c h i s eCommi t t e e( 7 ) C ou n t y l Ci t y Ce n t r a lCommi t t e e( a ) S u p p o r tS l a t eo fCa n d i d a t e s

I AE THI CS&C I 4 f v ` s: 7GNDI SCLOSUREi w `,,. A S D

MAY2 3 2 0 0 6

SI GNATURE OF TREASURER ( o r p er s o n f i l i n gt b t r e p o r t ) TE L EPHONE DATE SI GNED

Ro u t i n eP e n a l t i e sDu e Fo rL a t eF i l e dRe po r t sRange f r o m$ 2 0t o$ 8 0 0

SEE I NSTRUCTI ONSON BACK AND COM PLETE THE FOL L OWI NG SENTENCE :

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FORMDR- 2 I DI SCL OSURE( Re v . 0 1 / 9 8 ) REPORT

m l` h , 00 { v . REPORTFOR AWA ( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR .( d a t e ) I n d i c a t eo n e

C h e c k i f t h i s i sf i n a l( t e r m i n a t i o n )r e p o r t a nd a t t a c hNo t i c eo f D i s s o l u t i o nFo r m DR- 3.( Yo umust c o nt i nu et o f i l er e p o r t su n t i la No t i c eo f Di s so k i d o ni s t i l e d. )

L o c a lCo nwl i t e s. e n t e rDa t e o f E l e c t i o n

Co u n t y3 L o c a lCo mmi t t e e s ,e n t e rCoun t yi nwh i c hE l e c t i o ni sh e l d

CASH ON HAND a t t h e b eg i n ni n go f t h e r e p o r t i n gper i o d. ( T h i si s t h e t o t a lo f a l lmo n i e s h el d b y t h e c o mmi t t e e. Th i s amoun t MUST b e t h es a me a s t h e c a s h o n h a nd a t t h e e nd o f t h e l a s t r e p o r t i n g p e r i o d , >o r must b e z e r o i ft h i si s f a s tr e p o r tf i t e d. ) .. . . . .. . .. . . . ... . . . . . ... . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . .. . . . . .. . .. . . . . . . . . .. . $ADD TOTAL MONEY TAKEN I NTHI S PERI OD

CASH ON HAND a t t h e e n d o f t h i sr e p o r t i n gper i o d { i ff i n a lr e p o r t ,b a l a nc e mustb e z er o ) ( At t a chDR- 3 ) . . .. ... . . .. . .. ... . . . ... . .. . . . .. . . . . . ... . . . . .. . . . .. . .. . . . . .. .. . . .. . . .. . . . . . . . .. . . .. . .. . . . . .. . . .. . . . .. . . .. .. $ 97 3

UNPAI D BI L L S ( F r o m Sc h ed u I 6D - At t a c hSc h e d u l eD) . . . ... . . . .. . .. . . . . .. .. . . .. . .. . . . . . . ... . . . . . . .. . . .. . . . . .. . . . . .. . .. . . $

NO

I N KI ND CONTRI BUTI ONS ( F r o mSc h e d u l eE - At t a c hSc h e d u l eE) . . .. . . . . . .. . . . . . . . . . .. . . . . . . .. . .. . . .. . . . .. . . . . . .$OUTSTANDI NG L OANS ( F r o mSc h e d u l eF - At t a c hSc h e d ul e F) . . . . .. .. . . . . . . .. . . . . . ... . . . . . . .. . .. . . .. .. . . . . . .. . .. . . $

CANDI DATE COMMI TTEES ONLY :

CONSUL TANT BRE AKDOWN ( Sc h e du l eG At t a c h e d ?) YES

VAL UE OF CAMPAI GN PROPERTY ( F r o mSc h e d ul e H - At t a c hSc h e d u l eH) $

Fo rO f f l a eu s . On i vq~ s2. : - . e . : 4 : y i. Co mm . #

I i I n d ex e d

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I MPORTANT: I n d i c a t et y pe o f c ommi t t e ey o ua r er e p o r t i n gf o r FZ I Compu t e r

Sc h e d ul e A : Cash Co nt r i b ut i o nst o t a l( A t t a c hSc h e d u l eA) . . . . .. . . . . . . . . . .. . .. . . . . .. . . . . . . . . . . . . . . . . . .. . . . .

Sc h e d u l eF : L o a ns Re c ei v edt o t a l( A t t a c hSc h e d u l eF ) . . . . . .. . .. . . . . . . .. . . .. . .. . . . . .. . .. . . . . . . ... . . . . . .. . . . .

Sc h e d ul e H: To t a l Sa l e s o f Camp a i g n Pr o pe r t y( A t t a c hSc h e d u l eH) . . . . . . . . .. . .. . . . . .. . .. . . . . .. . . .. .

( Sc h ed u l yH s nc l i e s t o ' Co r r md t t a esOn l y )

O

SU13 - TOTAL . .. . .$ . 5 X9 9 . - 2. . 3SUBTRACT TOTAL MONEY SPENT THI SPERI OD

Sc h e d u l eB : Ex p end i t u r e st o t a l( A t t a c hSc h e d ul e 8 ) . .. . .. . .. . . . . . .. . . . .. . . . . . ... . . . . .. . .. . . . . . . . . . . . . . . .. . . . . i ~a . 3 9

Sc h e d u l e F : L o a n Re p a y me n t s t o t a l( A t t a c hSc h e d u l e F ) . . . . . . . . .. . .. . . . . . . ... . .. . . . . . . . . . . . ... . .. . . . . . . . . . O


2/8

Fo r I n s t r u c t l o n s ,Se e Ba c k o f F o r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

I COMMI TTEENAME ( M u s tb e s ame a s o nS t a t e m e n to fOf g an f z a t i o n )

G11~ e z z l - ~

SCHEDULE

MONETARY( R e v. 0 6 1 9 7 ) RECEI PTS

CHECKT H I SBOXI FAMENDI NGFORM

S TATECANDI DATES NOTE: I FACONTR I BUT I ONI SRECE I VEDFROMASTATEPAC( P O L I T I C A LACT I ONCOMMI TTEE ). L I S TTHEPACI D E N T I F I C AT I ONUMBER ANDTHEPACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVAI LABLEFROMTHEI OWAETHI CSANDCAMPA I GND I S C LO SUREBOARD.

CAUTI ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,I o w aC o d e ,p r o h i b i t st h e u s eo f i n f o r m a t i o nc op i e d f r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL$ 0 ? 5. o 0

TOTAL( Hl a s tp a g e o f t h i ss c h e d u l e )$

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s et h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt ot h eCommi t t e e. R e l a t i o n s h i pmu s t b es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f l k w t y ( r e l a t i v e sb ym a n a g e )( S e eP a g e2 o ff o r m sp a c k e t. ). I fs u r n a m eo fe o n y i b L r t o ri st h es a m ea sc a n d i d a t e ,b u tt h e ni sn o P a g e o ff a m i l i a lr e l a t i o n s h i p ,e n t e r' n o ta p p l i c a b l e 'i nt h er e l a t i o n s h i pc o l u mn. ( f o rS c h ed u l eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

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3/8

Fo r I n s t r u c t i o ns ,Se e Ba c k o f Fo r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b es ame as o n St a t e me n t o fO r g a n i z a t i o n )

f o ra n yc o mme r c i a l p u r p o s eb y a n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

3 - 1 3 - o l , S c ' 7 ' ' 7 K ;wt 5 0 - I t>Ka . - L t '

SCHEDULE

MONETARY( R e v. 0 6 1 9 7 ) RECEI PTS

CHECKTHI SBOX I FAMENDI NGFORM

STATE CANDI DATESNOTE: I FACONTRI BUTI ONI SRECE I VEDFROMA S TATEPAC( P O L I T I CA LACTI ONCOMMI TTEE ) ,L I S TTHE PACI DE NT I F I CATI O NNUMBERANDTHE PACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVA I L AB L EFROMTHE I OWAETH I C SANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o w aCode , p r o h i b i t st h eu s eo fi n f o r m a t i o nc o p i e d f r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so r

SUB- TOTAL

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s c h e d u l e)

W. S.o 0$ l yl gw

3Di s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt ot h e

c o mmi t t e e. R e l a t i o n s h i pmu s t b es h ownt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e )( S e eP a g e2 o ff o r m sp a c k e t. ). i fs u mame o fc o n b l b u l o ri st h es ame a s c a n d i d a t e ,b u tOwn i sn o page J - , o ff a m i l i a lr e l a t i o n s h i p ,e n t e r ' n o ta p p l i c a b l e 'i n t h er e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

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4/8

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf i x o d s )

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme nt o f Ot p an i z a t i o n)

STATE CANDI DATES NOTE: I FA CONTRI BUTI ONI SRECEI VEDFROMA STATE PAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHE PACI DE NT I F I C AT I O NNUMBERAND THE PACCHECKNUMBERI NTHEDESI GNATEDCOLUMN. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHEI OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : S e c t i o n68 8 . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h eu s e o f i n f o r m a t i o nc op i e d f r o mr e p o r t sand s t a t e me nt s f o rs o l i c i t i n gc o n t r i b u t i o n so rf o ran y c o mmer c i a l p u r p o s eb y an y p e r s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e es.

SUB- TOTA!

TOTAL ( i fl a s tp a g e o f t h i ss c h ed u l e )

Di s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i r Va c o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmus tb e s h own t o t h et h i r dd e g r e eo f c o n s a n p u i n i l y ( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ymamage) ( Se ePage 2 o f f o r ms p a c k e t. ). I f s u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h en i s n o Page . 3f a m i l i a lr e l a t i o n s h i p ,e n t e r' n o ta p p l i c a b l e 'i n t h er e l a t i o n s h i pc o l umn. ( f o rSc h e du l eA)

SCHEDULEA MONETARY

( R e v. 0 6 / 9 7 ) RECEI PTS

CHECK TH I SBOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DO/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEID# ' s a r ah w l 7/o r 7

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5/8

Fo r I n s t r u c t i o n s ,Se e B a c ko f Fo r m

CONTRI BUTI ONS- MONEY TAKEN I N( i n c l u d in g c a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI T TE E NAME ( Mu s t b e s ame a s o n St a t e me n t o fOf g a n i z a 0 o n )

STATE CANDI DATESNOTE: I FACONTRI BUTI ONI SRECEI VEDFROM ASTATE PAC ( P OL I T I C ALACTI ON COMMI TTEE) ,L I S TTHE PACI DE NT I F I C AT I O NNUMBER ANDTHE PAC CHECKNUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROM THE I OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : Se c t i o n6 8B. 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h eu s e o f i n f o r m a t i o nc o p i e df r o mr e p o r t sa n d s t a t e me n t s f o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n y c o mme r c i a lp u r p o s e by a n y p e r s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmu st b es h ow n t o t h et h i r dd e g r e eo f c o ns a n g u i n i t y( b l o o dr e l a t i v e s )a n d a f f i n i t y( r e l a t i v e sb yma n a g e ) ( Se eP a g e 2 o f f o r m sp a c k e t. ). I fs u ma r n e o fc o n t r i b u t o ri s t h es ame a s c a n d i d a t e , b u tt h e r ei sn o P a g e _ o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a pp l i c a b l e "i n t h er e l a t i o n s h i pc o l umn. ( f o rSc h e d ul eA)

SCHEDULEA MONETARY

( Re v. 0 6 / 9 7 ) RECEI PTS

CHECK THI SBOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MWDDI YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI S

NUMBER I NCOME

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6/8

THI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :

Pu r c h a s e so f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o rmo r e mus t a l s ob e i n v e n t o r i e do n Sc h e d u l eH . ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )

Ex p e n d i t u r e st op e r s o n s / e n t i t i e s p r o v i d i n gc o n s u l t i n g ,a dv e r t i s i n g , f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g a n i z i n g s e r v i c e smus t a l s ob e d e t a i li t e m i z eoSc h e d u l eG b y t h eamoun t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emad e b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h e c a n d i d a t e ' sc o mmi t t e e. ( R e fSc h e d u l eG i n s t r u c t i o n sa n d I o waCode 5 6. 6 ( 3 ) ( 1 ). )

( f o rSc h e d u l eB

FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDUL E

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THE CHECK THI S BOX I FPACCHECK NUMBER FOR EACHEXPENDI TURE. 'A L I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .

COMMI TT EENAME( Mu s t b es am e a s o nSt a t e me n to fO r g a n i z a t i o n )

&, aU L = L , ~AqMe ~~CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D# '

CK# 1 2, 3 O X7 7.. v Le v ~ v y t ~a $ a o . o0i 9 o r o / i o n , a 2 ~, ~ " v ~ o 3 lID#

Cvf f ~~Z~ 2 a C '

4. 4 l. CK# 11 0 4 4 - , t o m~ ' l Z. a. ~ .. S` 0 3 l , S / o O . D1D#~ l a - Q 2 - c - rd ' Q7 ~/ CK# / l o S

` ~ ~l d l o ~ ' ~ r1D#

r l SDl + vc #

l l 0 ( A " UL ~ ~ n~ . S a 9 ~ ~I D#

0 ~CK#

4 2 x , Yh A4~ p Qv 4- . ` 2 - ~ v 7 0 . a CI D#

l 1 e C -%~

CK#l l 0 8 y Y t. a. - ": -

"

g a s o , 3 3 0 0 . o

c K#~l o q ka ZA- ,w . t ~ I d s

I D#

l 0 0 1 ' 1 8 - c ~ o u.L 4 A; 0-,CK# ' S ~ 7 v z3 r 0 a&

SUB- TOTAL $ 6 ,S 41 , 2 -

TOTAL ( i fl a s t page o f t h i ss c h e d u l e ) $


7/8

FOR I NSTRUCTI ONS,SEE BACK OF FORM

EXPENDI TURES - -MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VECANDI DATES,L I STTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE. 'A L I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWAETHI CS&CAMPAI GNDI SCLOSUREBOARD .

SCHEDULE

B MONET AR' .

( R e v. 0 9 / 9 7 ) EXPENDI TU

CHECK THI S BOX I FAMENDI NG FORM

COMMI TTEE NAME ( Mu s t b esame a s o n St a t eme n to fOr g a n i z a t i o n )

3 ~a I l c y ,CK#

I D#

CK# r l r7

NAME AND ADDRESS TO WHOMEXPENDI TURE

( Di s b ur s e me n t ) WAS MADE

l ADO 3 , ~~ ~f t c . ~~9 JAN19a . s -o af ~ S

~ io , ~ 9 3 . 1o Ql t Ja r r ~ ~~ ~ o , ~ , S

3 / 9 o i 0 o . t A_"

l J ` ~+ 50 3 ~.:

z F &, . J. 3 7i 7 i g o ~c. Q& . e e *

. ~i ~0 3 ~ o , t r c. CGee. d ~- c aa

PURPOSE( DESCRI BETRANSACTI ON)

SUB- TOTAL

TOTAL ( i fl a s tp a g e o f t h i ss c h e d ul e )

AMOUNTEXPENDED

X75 . ~O

I 7 a . ~

' 3 5 . 0 4

$.

. 5 3( 1. S

THI SBOX APPL I ESTO CANDI DATES' COMMI TT EES ONLY :

Pu r c h a s e s o f c e r t a i nc ampa i gn p r o p e r t yc o s t i n g$ 5 0 0 o r mo r e must a l s obe i n v e n t o r i e do n Sc he du l eH . ( R e f e rt o Sc h e d ul e H i n s t r u c t i o n s. )

Ex p en d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d v e r t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g a n i z i n gs e r v i c e smust a l s ob e d e t a i li t e m i z eoSc h e d ul e G b y t h eamoun t , p u r p o s e ,an d d a t eo f e a c h t y p eo f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e fSc h e d ul e G i n s t r u c t i o n sa n d I o waCo de 5 6. 6 ( 3 ) ( 1 ). )

( f o rSc h e d ul e B

DATEEXPENDED( MM/ DD/ YR)

I D( i fAND

CANDI DATENUMBERa p p l i c a b l e )

PACCHECKNUMBER

I D#

. 3 1 / 0 16 ) & CK# / l ( /

I D#

CK#

1 D#

CK#

1 D#

~ / r y o( o CK#

1 D#

3 / ~ ~0 6CK#

1 D#


8/8

THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :

Pu r c h a s e so f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o rmo r e mus t a l s ob e i n v e n t o r i e do n Sc h e d u l eH. ( R e f e rt oSc h e d u l eH i n s t r u c t i o n s. )

E x p e n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d v e r t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g a n i z i n g s e r v i c e smus t a l s ob e d e t a i li t e mi z eoSc h e d u l eG b y t h eamoun t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emad eb y t h e p e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc ommi t t e e. ( R e fSc h e d u l eG i n s t r u c t i o n sa n d I o waCo d e 5 6. 6 ( 3 ) ( 1 ). )

P a g e _ 5 - 3

( f o rSc h e d u l eB)

FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 1 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLAT I VECANDI DATES,L I STTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THE CHECK THI S BOX I FPACCHECK NUMBER FOR EACHEXPENDI TURE. ' AL I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .

COMMI TTEE NAME ( Mu s t b es ame a s o n St a t e me n to fOr g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D# s F . P 3

CK#i 9DA ~ $

Z 1~ . 5-/ &39I D# 3

~ . i l o C7 3/ D~( ,CK# 3 1 1

I D#

4 CK#/ / f a t , ( a , , ,

CK#

I D#

CK#

I D#

CK#

I D#

CK#

ID#

CK#

SUB- TOTAL $a3~ . 5 '

TOTAL ( i fl a s tp a g e o f t h i ss c h e d ul e ) $ ~~Oo Z

. 39

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