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SIGNATURE ON FILING REPO TELEPHONE DATE SIGNED
I AM FILING A .r J
0 A'7 /9 t
°, REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by©
#
STATE CANDIDATES NOTE : IF A CONTRIBUTl9N IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 68B .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 RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
r~ ~_
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
CK#
a
j Ad
s4 ~
$
~ZS; 40
ID#
/bOr 00
ID# _
CK#
CK#
lc#
CK#
ID#
CK#
ID# _ .
CK#
ID#
CK# ,
ID#
CK#
ID#
CK#
SUB-TOTAL
' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page --L_- of - --
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
,C. ® Q. h _F0 4 -
CANDIQATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
tXPENOED (if applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
1D#
rew C7its4o .- CSO- o v,+
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CK# > CAn~ ~° (job $ Id0,06
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ID# :P-eji t -5 r a`U ~LJS C
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1
enisa =~~1 S
ID# ~~ 6
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C K#,' q
ID#
CK#
I D#
CK#
I D#
CK# -
ID#
CK#
_, ID# -
CK#
SUB-TOTAL $ 1 S
TOTAL (if last page of this schedule)
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to persons/entities 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 68A.402(3)(i) .)
(for Schedule B)