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This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.
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  FOR INSTRUCTIONS . SEE BACK OF FORM COMMITTEE NAME (Mustbe same as on,Statement of Organizzationj- if p IMPORTANT : Indicatetype of committee you are reporting for : (t )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate ( 5 )County P  ( 6 )B  Issue/Franchise Committee ( 7 )County/City Central Committee ( 6 )Su  late-  didat .-  ,-- J DISCLOSURE SUMMARY PAGE a-~ NATURE TR'  kIRER (o~ p~erson iling thisreport)  TELEPHONE Routine Penalties Due For Late Filed Reports Range from$20 to $800 SEE INSTRUCTIONS ON BACK AND COMPLET E THE FOLLOWINGSENTENCE : I AM FILING A -  - (rrepori date) OCHECK IF AMENDMENT TO REPORT DATED 0 Check if this is final (termination)report and atta~ (You must continue to file reports until aN r A v :=' . r- ''~ 01181MA6m 80m t ,Tr-frr~v - ~~ d Dissolution Form  -3 . STATEMENT OFCASH ON HAND CASH ON HAND at the beginning of the reporting period . (This is the total of all monies held by the committee . This amount MUST be the same as the cash onhand atthe end of the last reporting period, or mustbezero if this isfirst report filed .)  . . . . .. . . . .. . . . .... . . . . . . ..... . . . .... .. .. . . . . . . ... ... . . . . . . . . . . . . . . . . . . . . . . . .$ ADD TOTAL MONEY TAKEN IN THIS PERIOD Schedule A : Cash Contributions total (Attach Schedule A) . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . . Schedule F : Loans Received total ( .Attach Schedule F) ... . . . . . . . . . ..... . .. . . . . . . . . . ... . . . . . . . . . ..... . . . . . . . . . Schedule H : Total Sales of Campaign Property (Attach Schedule H) .. ......... .. .. .. . .. .......... . . . . (Schedule H applies to Candidates' Committees Only) SUB-TOTAL ...... S SUBTRACTTOTAL MONEY SPENT THIS PERIOD Schedule B : Expenditures total (Attach Schedule B) . . . . . . . .. .. . . ... . . . . . . .. ..... . . . . . ..... . . . . . . . . . . . . . . . . . . . . Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . .. . . . . . ..... . . . . . . . . . . . . . . . . . . . ...... CASH ONHAND at the end ofthis reporting period (if final report, balance must  . .  .  . .  . be zero) (Attach D R-3) . . . . .. . . . .. . ... . . . .... . . . ... . . . . . ...... . .... . .. . . . . . . . .. .. . . ..... . . . . . .. . . . ... . . . ... . ... . . . ... . . . . . . . . . . . .$ IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .......... . . . ............ . .. . . . . . ..... . . . . . . . .. .$ FORM DR-2 (Rev . 01/98) For Office Use Only So 9a Indexed Audited  ~~ t) -0  `1 Computer (-  11 .1 Comm . a DATE SIGNED (1) ELECTION /(2)NON-ELECTION YEAR . Indicate one Local Committees, enter Date ofElection County 8 Local Committees, enter County in which Election is held DISCLOSURE REPORT UNPAID BILLS (From Schedule D - Attach Schedule D) ...... . .... . . . . . .. . ... . .. . . . . . .. . . . . . ... . . . . . ..... . . . . . . . . . ... . . . . .$ OUTSTANDING LOANS (FromSchedule F - Attach Schedule F) . . ... . . . . . . . .................. . . .i .... . ............. .$ CANDIDATECOMMITTEES ONLY : CONSULTANT BREAKDOWN (Schedule G Attached?)  YES  NOVALUEOF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)  $  FOR 1NSTHUG 1IONS, ;Lt UACK OF FORM COMMITTEE NAME (Must be same as on Statement of Organsradon)- .. . ~a ~ '~-l  . .a, ~~1x-` ¬ ~-'tom- . NOTE : This schedule reports money loaned to the committee which is deposited in the committee account . TOTALUNPAID LOANSFROM LASTREPORTING PERIOD $  - __ .-- .-  .- . .- PART I- MONETARYLOANS RECEIVEDMS REPORTING PERIOD (Onginal sourceof loan, such asabank, mustbe shown it a third party is involved . Includeloans fromcandida te's personal funds-) TOTAL (PART 1) 'Disclosurelaw requires candidate committees to disclosethe relationship of any relative `making a contribution to the committee . Relationship musl be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by marriage) . (See Page 2 of formspacket .)If surname of contributor is the same as candidate,but there is no familial relationship, enter not applicab le in the relationship column when it applies . SCH~ EDULE F LOANS (Rev . 08/96)  RECEIVED 3 REPAID [] CHECK THIS BOX IF AMENDING FORM PART 11- MONETARYLOANREPAYMENTS MADETI  REPORTING PERIOD (Loans forgiven must be reported on Schedule E -- In-kindContributions . I TOTAL CASH REPAYMENTS (PART 11) Page __ of (for Schedule F) From Schedule E -- TOTAL LOANS FORGIVENTOTAL OUTSTANDINGLOANSEND OF REPORT PERIOD  $  bdl DATE RECEIVEDMNUDD/YR NAMEANDADDRESSOF LENDER (Include Endorser's Name, It Applicable) RELATIONSHIP TO CANDIDATE II A AMOUNT OF LOAN DATE PAID (MMDD/YR) NAME AND ADDRESS OF LENDER (Include Endorser's Name, If Applicable) RELATIONSHIP TO CANDIDATE' If Applicable) AMOUNT REPAID  NOTE : Debts previouslyreported that remain unpaid mustbe inclined on this Schedule, as well as any new obligationsincurred inthis period . SCHEDULE D )NCURRED (Rev . 08M INDEBTEDNESS O CHECK THIS BOX IF AMENDING FORM An 'incurred debt' is adebt for DEHTSJOBLIGATIONS REMAINING THIS REPORTING PERIOD  goods orservices ordered or {DO NOT INCLUDE LOANS - SHOW LOANS ON SCHEDULE F)  received, butnot paid for by the and of the reporting period . . regardless of wMthar an invoice has boon received, 'it actual figure is unknown, show 'estimated beside the figure .  Page  (ton Schedule0) CANDIDATE COMMITTEES NOTE : - Incurred indebtedness alsoincludes each persorventitywith whom the candidaWs committee has entered into a contract during the reporting period for future orcontinuing performance . Enter the name of theconsultant who provides or procures services for items such as advertising . fund-raising,polling . managing . or organ izingservic es Re port on Schedule G the na tureof performance and the estimated performance reasonably expected of the consultant . DATE INCURRED (MWDDIYR) NAME AND ADDRESSOFPERSON TO WHOM DEBT OR OBLIGATION IS OWED DESCRIPTION OF GOODS OR SERVICES PROVIDED OR PURCHASED BALANCE OWED AT CLOSE OF REPORTING PERIOD' ~l 141 q _ - SUBTOTALS TOTAL DEBTS OWED BY COMMTTEEE AT THE END OF THIS REPORTING PERIOD S 13 1

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Nov 22, 2017
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