state police officers council pac6272scanned

8/7/2019 State Police Officers Council PAC__6272__scanned

1/5

FOR I NSTRUCTI ONS, SEEBACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f Or g an i z a t i o n)

S t a t e Pol i c e Of f i c e r s Co u nc i lI MPORTANT I n d i c a t e b y # t y p e o f c ommi t t e e y ou ar e r e p o r t i n g f o r 1 2J( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a nd i n g f o r Re t e n t i o n Ca nd i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) Co u nt y C e n t r a l Commi t t e e ( 5 ) Co un t y Ca nd i d a t e ( 6 ) C i t y Ca nd i d a t e ( 7 ) S c h oo l B oa r d o r Ot h e rP o l i t i c a l Su bd i v i s i o n Ca nd i d a t e ( 8 ) Coun ! . v , , f t C ( 9 ) C i t y PAC ( 1 0 ) S c h o ol B oa r d o r Ot h e r P o l i t i c a lSu bd i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t

L a t e r e p o r t s ar e s u b j v i l an d c r i m i n a l p e n a l t i e s . P u r s u a n t t o I o wa Co d e s e c t i o n 68B. 3 2 A ( 7 )t h e c a n d i d a t e , f o r a 0Ps c o mmi t t e e , an d t h e c h a i r p e r s o n , f o r an y o t h e r t y p e o f c o mmi t t e e , i s t h ei n d i v i d u a l r e s p on s i b l e f o r f i l i n g t i m e l y an d ac c u r a t e r e p o r t s .SI GNATUREOF P

I AM F I L I NG A May 1 9

F I L I NG REPORT TELEPHONE

( r e p o r t d a t e )I F AMENDMENTTOREPORT DATEDMay 1 9

0 C h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t an d a t t a c h No t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Y ou mus t c o nt i n ue t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )

SUBTRACT TOTALMONEYSPENT T HI S PERI OD

Re s e t F or m

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

D i s t r i c t ( i f S e na t e o r House )

_ 5 ' ~ s 3 a ~ - G s c ~ 3

REPORT FOR ( 1 ) EL ECT I O N / ( 2 ) N ON - E L ECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b eg i nn i ng o f t h e r e p o r t i n g p e r i o d ( T o t a l o f a l l f u nd s h e l d b y t h ec ommi t t e e . T h i s amount MUST b e t h e s ame as t h e c a s h on h an d a t t h e e n d

o f t h e l a s t r e p o r t i n g p er i o d o r mu st b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N T HI S PERI ODSc h e d u l e A : Cas h Co n t r i b u t i o n s t o t a l ( A t t a c h S c he d ul e A) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . .Sc h e d u l e F: L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he d ul e H : T o t a l S al e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h e d ul e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e d u l e H ap p l i e s t o Ca nd i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $ 3 , 5 5 0 . 5 6

S c he d ul e B : Ex p e nd i t u r e s t o t a l ( A t t a c h Sc h e d ul e B) ( * * a l s o s e e d e bt s an d l o an s b e l o w) . . . . . . . . . . . . . . . . .S c he d ul e F L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASHON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b al a nc e mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * U NP AI D B I L L S F r o m S c he d ul e D - At t ac h Sc h e d u l e D $ 0 . 0 0* I N KI N D CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h S c he d ul e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0* * OUTSTANDI NGLOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0

FORMDR- 2 DI SCLOSURE( Re v . 1 2 / 2 0 0 5 ) REPORTF or O f f i c e Us e On l yComm . #L o g g e d I nS c a n n e dCompu t e rAu d i t e d

F i l e w i t h :I o wa E t h i c s an d Campa i g nDi s c l o s u r e B oa r d5 1 0 E. 1 2 ' " , St e . 1 ADes Mo i n e s , I o wa 5 0 3 1 9F a x 5 1 5 - 2 8 1 - 3 7 0 1

578 . 0 00 . 0 00 . 0 0

0 . 0 00 . 0 0

- - r ' I : , / S a vv ( oDATE S I G NED

L o c a l Commi t t e e s , e n t e r Da t e o f E l e c t i o n

Coun t y & L o c a l Commi t t e e s , e n t e r Coun t y i nwh i c h E l e c t i o n i s h e l d

2 , 9 7 2 . 5 6

3 , 5 5 0 . 5 6

CONSULTANT BREAKDOWN ( S c h ed u l e G At t a c he d ? ) - YES VNOCANDI DATE COMMI TTEES ONLY:VALUEOF CAMPAI GN PROPERTY ( F r o mS c he d ul e H - A t t a c h S c he d ul e H) $STATE COMMI TTEES : Su bmi t a r e c o n c i l e d c amp a i g n a c c o u n t bank s t a t e me n t i n J a n ua r y o f e a c h y e a r


2/5

Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )

S t a t e P o l i c e O f f i c e r s Co un c i l

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSEJ CHECK TH I S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETH I C S AND CAMPAI GNDI SCLOSURE BOARD

NOTE : ANY PERSON, OTHERTHANAN I N D I V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TOYOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARDCAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ 5 7 8

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 s b y 1 1m a r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Page o f _f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D# P a y r o l l De d u c t i o n s ( $ 1 t o $ 10 / mo n t h p e r membe r ) $ 3 8 61 / 3 0 / 0 6 CK# C h e c k f r o m S t a t e o f I o waI D# P a y r o l l De d u c t i o n s ( $ 1 t o $ 10 / mo n t h p e r membe r ) 1 9 2 . 0 03 / 3 / 0 6 CK# C h e c k f r o m S t a t e o f I o waI D#CK#I D#CK#

I D#C K#I D#C K#I D#CK#I D#CK#I D#C K#I D#C K#


3/5

IMay 1 9 0 6 0 3 : 4 1 p Hea t he r St ubbe

FORI NSTRUCTI ONS, SEEBACKOFFORMDI SCLOSURESUMMARYPAGE

COMMI TTEE NAME( Mus t be same as o n S t a t eme n t o f O r g a n i z a t l i o n )

S t a t e P o l i c e O f f i c e r s C o u n c i l PAC F u n dI MPORTANT I n d i c a t e b y # t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r .( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r Re t e n t i o n C an d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l C ommi t t e e ( 5 ) Co u n t y Ca nd i d a t e ( 6 ) C i t y Ca nd i d a t e ( 7 ) S c h o o l B o ar d o r Ot h e rP o l i t i c a l S u b d i v i s i o n C an d i da~-) Ga u nt y PAC ( 9 ) C i t y PAC ( 1 0 ) S c h oo l B o ar d o r Ot h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 1 L o c a l t 1 lb t I s 1CANDI DATECOMMI TTEE O Y:

O f f i c e S o u g h t

I AM F I L I NG A May 1 9

SI GNATURE OF PERSON FI L I NG REPORT

( r e p o r t d a t e )CHECK I F AMENDMENT TO RFFCRT DATED

SUBTRACT TOTALMONEYSPENT THI S PERI OD

R e s e t Fo r m

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

D i s t r i c t ( i f S en a t e o r H o u se )

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l an d c r i m i n a l p e n a l t i e s . Pu r s u a n t t o I o wa C o d e s e c t i o n 68B . 3 2 A ( 7 )t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mmi t t e e , an d t h e c h a i r p e r s o n , f o r an y o t h e r t y p e o f c ommi t t e e , i s t h ei n d i v i d u a l r e s p o n s i b l e f o r f i l i n g t i m e l y an d ac c u r a t e r e p o r t s .

C h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t an d a t t a c h No t i c e o f D i s s o l u t i o n Fo r m DR- 3 -( Yo u must c o n t i n u e t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )

5152234762

_95- Z23- 1 1 7 ( o 1 5 " 1 1 9 1 DTELEPHONE DA SI G

REPORT FOR ( 1 ) ELE CTI O N 1 ( 2 ) N ON - EL E CT I O N YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HANDCASH ONHAND a t t h e b eg i n ni n g o f t h e r e p o r t i n g p e r i o d ( T o t a l o f a l l f u nd s h e l d b y t h e

c ommi t t e e . T h i s amou nt MUST b e t h e same as t h e c as h o n h an d a t t h e en do 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 mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTALMONEYTAKEN I N THI S PERI ODS c h ed u l e A. C a s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A) ( ' a l s o s ee i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . . . .S c h ed u l e F: L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h ed u l e H: T o t a l S al e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .

( Sc h ed u l e H ap pl i es t o Can d i d a t e s ' C o mmi t t e es On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . .$ 3 , 7 4 2 . 5 6

S c h ed u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h S c h ed u l e B) ( " al s o s ee d eb t s an d l o an s b e l o w) . . . . . . . . . . . .S c h ed u l e F: L o a n Re p ay me n t s t o t a l ( A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ONHAND a t t h e en d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b a l a n c e mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

" UNPAI D B I L L S ( F r o mSc h e d u l e D - A t t a c h S c h ed u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $' I N KI N D CONTRI BUT I ONS ( F r o m S c h ed u l e E - A t t a c h S c h ed u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" OUTSTANDI NG LOANS ( F r o m S c h ed u l e F - A t t a c h S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULTANT BREAKDOWN ( Sc h ed u l e G A t t a c h ed ? )CANDI DATECOMMI TTEESONLY :VALUEOF CAMPAI GN PROPERTY( Fr om Sc h e d u l e H - A t t a c h S c h ed u l e H) $S T A T E C OMMI T T E E S Su bmi t a r e c o n c i l e d c ampa i g n a c c o u n t b a n k s t a t eme n t i n J a n u ar y o f e a c h y e a r ,

P . 2FORMDR- 2 DI SCL OSURE

( Re v . 1 2 I 2 0 0 5) I REPORTFo r O f f i c e Us e On l y IComm. # IL o g g e d i nS c a n n e dC ompu t e rAu d i t ed

a ~ . - 2F i l e w i t h :I o wa E t h i c s an d Campa i gnDi s c l o s u r e B o ar d5 1 0 E. 1 2 " ' , St e . 1 ADes Mo i n e s , I o wa 5 0 3 1 9Fa x : 5 1 5 - 2 8 1 - 3 7 01

L o c a l C ommi t t e e s . e n t e r Da t e o f E l e c t i o n

Co u n t y S L o c a l Commi t t e e s , e n t e r C o un t y i nwh i c h E l e c t i o n i s h e l d

YES

2 , 9 7 2 . 5 6

7 7 0 . 0 00 . 0 00 . 0 0

0 . 0 00 . 0 03 , 7 4 2 . 5 60 . 0 00 . 0 00 . 0 0

NO


4/5

May 19 06 03 : 41 p Heat her St ubbe 5152234762

F o r I n s t r u c t i o n s , Se e Bac k o f F o l r r nCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z at i o n )j -- N i me P - zmc t - O~~f c P v s Cbwj l PAL 1 ~ukd

Re s e t Fo rm SCHEDULEA i MONETARY( Re v 0 7 1 0 3 ) RECE I PTS0 CHECK THI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I ST THE PAC I DEN TI F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S 1 OF I D NUMBERS I S AVA I L A BLE FROMTHE I OWA ETH I CS AND CAMPAI GNDI SCLOSURE BOARDNOTE: ANYPERSON, OTHERTHAN AN I NDI VI DUAL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAYHAVE F I L I NGRESPONSI BI L I T I ES ANDSHOULD I MMEDI ATELY CONTACT THEBOARD.CAUTI ON : Se c t i o n 68 B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i ed f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc o mme r c i a l p u r p o s e b y a n y p er s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

p . 3

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) I f s umame o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b ut t h e r e i s n o P a g e 1 o f _If a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A)

DATE PACI D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( l f a p p l i c a b l e ) TO CAND I DATE ' RECEI VED FUND( MMI DDI YR) ANDPACCHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI I ? # P ay r o l l De d u c t i o n s ( $ I t o $ 1 0 / mo n t h p e r membe r ) $ 3 8 6 . 0 00 1 / 30 / 0 6 CK# Chec k f r o m S t a t e o f I o waI D#

P ay r o l l De d u c t i o n s ( $ I t o $ 1 0 / mo n t h p e r membe r ) $ 1 9 2 . 0 03 / 3 / 0 6 CK# Check f r o m S t a t e o f f o waI D#

P ay r o l l De d u c t i o n s ( $ I t o $ 1 0 / mo n t h p e r membe r ) $ 1 9 2 . 0 04 / 6 ! 0 6 CK# Chec k f r o m St at e o f I o waI D#CK#

I D#CK#

I D#CK#I D#CK#I D#CK#

aI D*CK#I 0 #CK#


5/5

May 1 9 0 1 3 0 3 : 4 2 p Hea t h e r St u b be 5152234762 p . 4

THI S BOX APPLI ESTOCANDI DATES' COMMI TTEES ONLY :P ur c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0Q o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H. ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e nd i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c 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 s mus t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e Gb y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p en d i t u r e ma d e b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e ( R e f e r t oSc h e d u l e Gi n s t r u c t i o n s a n d I o wa Code 6 t 3 A . 4 0 2 ( 3 ) ( i ) . ) -

( f o r Sc h e d u l e B )

FOR I NSTRUCTI ONS, SEE BACK OF FORM Res e t Fo r m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHE D CHECK T H I S BOX I FPACCHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPA I GN DI SCLOSURE BOARD,COMMI TTEE NAME ( Mu s t b e s am e a s o n $ t a t e r n e n t o f O r g a n i z a t i o n )S t a t e P o l i c e O f f i c e r s Co u n c i l PAC F u n d

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WASMADE( MM/ DDI YR) AND PACCHECKNUMBERI D# No t h i n g t o r e p o r t No t h i n g t o r e p o r tCK# $I D #

CK#D#CK#D#CK#D#CK#i D #CK#D#CK#D#

C K #SUB- TOTAL $ 0

TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ p

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