I
FORM
DR-2 DISCLOSURE
DISCLOSURE SUMMARY PAGE (Rev . 01/98) REPORT
41-L P el'si - 6 oz
SIGN TUR OF TREASURER (or person filing this report) TELEPHONE DATE S GNED
Routine Penalties Due For Late Filed Reports Range from $20 to X806 `- . _ : ,.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE : FEB 1 1 2002
i_ z z
~m
I AMREPORT
FILING A A FOR AN/A (1) ELECTION /(2)NO e!~-E . TION YEAR .
(report date) _200 l Indicate one
0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed.)
Schedule F: Loan Repayments total (Attach Schedule F) ........ .... .. .......... .. ....... .. .. .. .. .. .. .. ....
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . .. . . . .. .. .. . .. .. .. .. .. . . ..... ..... .. .. ... ....... . .... .. ........ .. .. .... ..... ..... ......... . . .. ...... . . ...$ 1, .--.211, 7/
l °n r
UNPAID BILLS (From Schedule D - Attach Schedule D) . ... .. .. ..... .. .. .......... .. .... ...... .. .. ....... .. .. .. .. .. .- .. .. .$
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . .. .. .. . . ... .. .. ..... ... .. ... . . . ....... .. .. ..... .$
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) .. .. . . . . . .. ... .. .. .. ... ... .. .. .. .. . . .. . .... .. .. .. ... .$ °qQrj. 0
CANDIDATE COMMITTEES ONLY :
/YES
CONSULTANT BREAKDOWN (Schedule G Attached?) ' NO
CAUTION: Section 688.32A(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 (it applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER
t
INCOME
ID# /,0-// X~survnce Zndusfry PAC
5706 `LIe5TC)L-Ul'1 `~'~3rkcuac~ 3
Vo3101 CK# laa .06
3665 1lles/ yes AO ; -TA Sa-'E2 /
ID# 4 .Z q l Iowa /NoSp, tal Associa lion 'PA C
/00 cf . 6rand, SCc~`fe 106
6 V'9 3161 CK# 7,16 -z,so,00
yes A7oi 171'3, -ZA S03U 9
ID# //,? .Zvc .ua Opfornez~r~c ASSOC_, ation PAC.
6i/661al l'fSi~-36y -h St, Sv~fe .ZOtl
CK# lDO,D6
l)esi JJes Aloir7e5, .1. A ,S0266
ID# ~0 70 u_ia Lawpac
)~06 /-/omes fead 81d g ., ,363 4ocus
CK#
1568 J)es Avl'nes, 2"A ,5-6309
ID# , Toroth`/ A,'lenbe!rq
6810 716 CK# /2 79 - 7Y-h u0 . /Uorfh
,2500
Fart ~vd q e, .ZA ~WSO I
ID#
fern efa /3als le ~
68/0 710 l CK# /005 %u S'fre ~~ ~3,5, OQ
la seer .ZA Sh59S
ID#
Earbara Unpp
4810 7`61 CK# 3366 - :I 96 )LA sheef 25.06
,5rSiS- 7601
ID# /1'/Ur/ o, 13 ~e%
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE). LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A UST OF ID NlM 66RS IS AVAILABLE FROM THE IOWA ETHICS ANDCAMPAIGN
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-
(MMMO/YR) AND PAC CHECK (# applikable) RAISER
NUMBER INCOME
/}.6>z . k-arson
j00,/, AUon Sf ) /0013,,x ley S
681' 6 710 / CK# 2,5766
Sera tfard, .z-A 562 y 7
ID#
Loendell Car/son
vff10ff/o1 CK# 56.00
Boo n e, Its .56031r
ID#
Paul C? . .l1~ees e-
Oe109/01 CK# 866 Gol cls `ni M, )060 0136 x / 03
07166
Sfra t forcl, -TA} 5C)2y q
ID#
F(lu~i~ ~sakson
D #6 yo 1 CK#
66-27 -~z35t S
,26-.06
Duncombe, ~Siq 505-J2- T5"98
ID# S'hirle~'7~ Granf
0811 a 976 / 21~y /l-/,7 sleL/ ~c. . .Z6, 00
CK#
Rockaue11 '~-,q SaS77
ID#
1L)il1iaM C. a7aCOLOn
I'll Seauer lz,dye brJUe S~.
m!b 910 I CK# .2,5-,60
Cedar Rapids, -,2g03
ID#
konald '7aekso1-I
o8/07/6-1 CK# 2IScF . Court- S*,ee-t /0 .00
)eockuIell fl hy, L4 =05 9-11001
ID# 4eterne Aluestacll
0X///6101 CK#
..z6yy 11,) l Aernue .z5, as
CC; lliams, r,4 5627/
ID#
Trevor ear/son
091161o) CK# l0,31 Uryden , }?0, i3ox/33 jo, oC?
05-raffard, TA .5-0.2-5!9
ID# Shirley /'oolJ -Ole
08111/0 I CK# S-yS loan k S "ee,-t .4,5=00
lJeh5ter C ; ~j i TA
SUB-TOTAL 303; 00
STATE CANDIDATES NOTE : IF A CONTRIBUTION 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 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION: Section 688 .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-
(MMIDD/YR) AND PAC CHECK (it applicable) RAISER
NUMBER INCOME
ID#
Gerald 1,0hisler $
08/)1/6 CK# 669 ,-yrndaleOr. .Z506
ldehsferC~ -f~l, .Z~A 50595-i~zD
ID# Carol Sper)eer
.2167 7dnyclefool",Lan,_
08~1~a ~ CK# l0 . 06
lie f-fendorf-, 1_~4 .3"Z 721- Z 77 /
ID# Piehard Pou.%son
0 ~'/l ~`Ol 1"23 76 W Oh ;o Cirde
CK# .5-
O.DO
>! aketuovd, Co
ID# 130b vah ,O;es f
09/4/0 1 CK# 1"136 - Z26tA Street, P b, f3ox !c 16 lOD,Ob
GUehsfe.r elk, I~ ~50T9S
ID# r/orls .Frf
q,/0 1&6s)-er
08fl5~0 l CK# _2S oa
14)elbs1'er & ty, .z""9 5D.5-Y5
ID#
Am a aa rro ll
08`l5f0 i Z, 3D Shakespeare, P0 .$oY 172.
CK# .Z5. (J6
ska tic I^d, _ZA 50 ,z)/ 9
ID#
fan E. C-hrlsfensen-sued
0#lh`0 1 CK# 7_3-5 N. Gln;on load 5V.oo
Cedar Fa lls, .Z"A SO l l 3
ID# Paul Co ;eck
MI17f01 gez Crlsman Sf;,ee-) PC, Boy- 250 ..ZS, 06
CKII
J)ysart, Sfl - .5.22,2-/
ID# john ~cC'o
09117101 CK# //S Lu0OdsAock ~oad .25;66
(JUai-erloo, 174 X6701
ID# &uee- Graves
/05 5 . J-nd Shyer
0kll8k 1 CK# ,_6,66
U)es . ~ De's Aolnes, .56265
SUB-TOTAL 385: 00
S
TOTAL (If last page of this
schedule)
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
)mmitlee. Relationship must be shown to the third degree of consanguinity (blood felatives) andaffinity (relatives by
arriage) (See Page 2 of forms packet.). If surname of contributor Is the same as carxJidate. but there is no Page -,,3 _ of
rnilial relationship, enter -not applicable" in the relationship eotumn . (for Schedule A)
I
rut uIZtrulalons, bee CIacK of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEI (Rev . 06197) RECEIPTS
` (trrdudfnp can0doWs personal katds)
[] CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
_
0
STATE CANDIDATES NOTE: IF A CONTRIBUTION 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 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 688 .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 RELATKNISHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DO/YR) AND PAC CHECK (# applikab4e) RAISER
NUMBER INCOME
ID# Dav;d oun
s ef $
og/z~~o 1 CK# 20 31- 330 56,60
>5-6246,
Sianhope, TA
i
ID#
Daniel 4ellmar,
a8~,Z3~01 CK# 1508 Hull AUenu-. 00
Ferry, ZA .50220
ID#
1d uhn Sea4on
CK# l62 ~resfioood C%ro-le Loo
Ar es, .Z.,4 50016,
ID# ~W33 FA C Co . PAC for Response We S~ak Gz,v.
717 /V1,, lb errV Sf
CK# 1762 .ZS 0 D
lies Alo ;n es, 1-A .5730
ID# Gordon Madson
Db~~3 I,Ci I CK# 1303 C'our,fi^y C'1u bane, PC,13o/[ 7ff lGD . D O
.lv1an son, ..Xsf -6Z,5-6 3 .-d 788
ID# F . C8 ;11) lUe-hs fer
(?66- (oM 5f ef ti . Gd .
09/0Vo I CK# 35,04
lti~a UFr/~/, - 19 071 7 7
ID# 6027 Deere PAC .Y"o1 .0a .
CK# ~8 ~6(o Gravid .~venue, Strife /707
69161161 9 .z5o, o0
Des .I)Volnes, .rA .5Z)367 --250 7
ID# Pa rrl e:fk
P.O. o 78F
CK# ..25.00
~Sfa n h ope, .~A x`-02 ~,! (o
ID#
Jane- S~anle~
0 9/ON1o ( CK# 31&0 -230tk S+Pef ZS.UO
jlavnsorn, .YA. .505"63
ID#
/j/anct 015Un
CK# 208'7 ~/U- F. lZolrn Za keS, P6. ,fox 1.32 -2.5760
1-~Omero y , I~ 50.57.5"
SUB-TOTAL ~ za.o d
s
TOTAL (Nlastpage of this
schedule)
Disclosure law requires candidate committees to disclose the relationship of any relative making a contnihution to the
>mmittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
arriage) (See Page 2 of forms packet .) . If surname of contributor Is the same as candidate . but there is no Page _~ of
milial relationship, enter 'not applicable" in the relationship column . (for Schedule A)
I
rut it rsuuutions, aee csacK of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKES J (Rev. 06177) RECEIPTS
' (Including cenddele's persorml hrnde)
O CHECK THIS 13OX IF
i COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
CAUTION : Section 6t36 .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-
(MMOD/YR) AND PAC CHECK (11 applicable) RAISER
NUMBER i INCOME
ID# ~ 0 7 .Xowa ,C fe Z"nsura ice hduslry PAC
,5100 G1Jesfo~ n ~ rk ula
0 9/0s/61 CK# 3070 l00- 06
Nes~DesAoines, ~~ SOZ~(r-
ID#
Decker 7`ruesdell
6916616) CK# /61Z Grand Court lD .OL)
OaLenporf, TA v`. 03 . .Z5 ~l
ID#
Achard kan3don
6/z Gl enV ; eLc.j 6- . .sa .bo
0 9/01, /01 CK#
&5AO~ne's, IA ,503/-2
ID#
lc0 er 7. S1efson
69/0 ,7/6/ CK# "Inl Brcekv ;eto ,fir . .50.n0
GUesf lies 1~1ain es, _Th 501 5
ID# tai"- of- A%5
,John 4 .,4jcellntock eenf+°e
lbcc>'r' was -{or Pai-
hfh Floor-Fle. min aldy .
6911J1(-)1 CK# ,Z! Si K flue . ~he~ Comm ' hf-e e . S--e 10106
~2sL2oir~>vS . TA~SD309
.-he-0-k4 0z
C on scti. B.
ID# bav ;d 47e rL'Lun
0/01 803 Flern~n9 81 cI3 .
CK# 50.06
~e5J~oine6, TA 503(j 9
ID# Edgar Pansell
D 9// 0/0 I CK# 139- .37-th Sf .
50.06
&slfloines, -rR .S03i~ - y363
ID#
10tllr'am D . Scalerle
09/l0% I CK# #0F'0'5- flarwood 6r . 50,06
4eSI'loineS . rA .5-~03Iz
ID# Roherf-J: Baudlno
S116 5hriVer -Aug,
.
0910161 CK# lOU.C+6
Jes_J))oine6, r,9 5O3/ :Z
ID#
,gara f4ard ;n,g
3,2l! 1. ;rlcoln Plac e
-
09/10101 CK# 5Z'-00
&s,Molne s ; Y"A 503! .2
SUB-TOTAL 5(0.00
CAUTION : Section 688.32A(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 poflt)cal committees.
I
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applcbable) RAISER
NUMBER INCOME
John C, Schae-h ferl e
09/lo/0I .317 Sixth #venue , ,5u.J & 7-510
5v, 00
CK#
,(JesAc;nes, _TAl 5030_9
ID# fo6S-9 "L .dU_1C3 (?Ornmi ff'e~ c~>L ~tc7~amOfiU~ ,lCr7olil s
0911a/o1 CK# .20 9 7 l00. GO
wes~ Des Jy1o;17es, -4 56-
Disclosure law requires candidate committees to disclose the relationship of any relative making a contrWion to the
)mmitlee . Relationship must be shown to the third degree of consenguit* (blood relatives) and affinity (relatives by
arriage) (See Page 2 of forms packet.) . If surname of contributor Is the same as candidate . but there is no Page 6 of.zL._
milial relationship, enter 'not applicable' in the relationship column . (for Schedule A)
rut rrmat uctions, bee CJacK of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKES J (Rev. 06/97) RECEIPTS
' (b+dudlnpcoteldsb's pena+N funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Olyenkation) AMENDING FORM
STATE CANDIDATES NOTE: IF A CONTRIBUTION 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 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AM CAMPAIGN
DISCLOSURE BOARD.
CAUTION : Section 686.32A(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-
(MM/DD/YR) AND PAC CHECK (# applicable) RAISER
NUMBER INCOME
ID# Rriari W1'rl
3232 .Tohn kyr)de 4aiio/ ,25,00
09//&/0) CK#
dies 1~uiries, T, .SD3/2-
ID# 41,3nU-faC- ' ureol llous';n9 P-4 C
A MONETARY
CONTRIBUTIONS - MONEY TAKEN .. (Rev. 08971 RECEIPTS
(h+ehtdlnp candldafe'a persalel dtrnda)
0 CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of OrpaNtation) AMENDING FORM
STATE CANDIDATES NOTE : IF A CONTRIBUTION 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 AVAR-48LE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 688.3211(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 (it applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DO/YR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
Dr. J: C . 4-nc(erso n
0Y)O/ol CK#
(0-21 Sory ,S -1hee=t
Boon e, .7- A .50036
ID# (a& 9 .Toroa Tvd us4-ry Pro C
9/1 0/01 CK# 1 ~2 q 90~ Ctl~lnuf, S~~fe lOd 160. CC)
es /f10 ; n e s, .~A 5D30?-35-63
ID# Z,66 3 .IDUJa ~Oev~ fa 1 .,l~ssoel a ~:c~r> /SAC
9/1 l/o 1 CK# 1,,q5-
,5v,5- - 6W Ate- . ) -Av- 333 1()0 .66
Des l)10Jnes ; -Z-A 5Z)36?--2379
1D# 600-Y Assoeiaied CYel~eralConfYactors of
~ocua /o-4c
9/11/61 CK# 7 N. ROY 7s -7
/66.00
3S,0
,)es Aoin es- I-0 .50.30 3
ID# . Lttc ; lle E_ , L1o~g e l
/5/!p CT;yen J,~oe . zs o6
9/1 i~o I CK#
AI lkord , 1-".9 -13,-/
ID# ,Ella Fra-h m
CK# 2 ,139 'E . .vz" M S~ /600
1/11/o I
Dabe*ipor~' .I-4 ,5-.2807
ID#
Tack Lohari-on
U 9~11/o f CK# -t/0S-~, f-h /4ue ., Su i fe 70 0 z6Sa6
be5AL0 ;r-)CS, Z,4 5-6309
ID# HckltMan eornpan
9/1z/0l /.ZOO .- 6-7th Sfvee~ X0.60
CK#
U)esf J~es1)'101nes, -q 502 (p
ID# 6 05"8 oc~a Ch .ro~racf~c Soc ;e` 7 P,4C
1&,-IS- N . A,ken V ,Qlud, 50<h 106 /06100
d 91130 I I CK# /6),7 -
'1~f7Aerl y, r~ S062I ~ (/s'7
ID# ka sse / C . lerl u -1)
09,1 X10 1 I I 0 tua I n ufi,'-. A box SS'7 I
rl} - ZS00
'5
CK#
j)eSofo I 0SS7
SUB-TOTAL
A MONETARY
CONTRIBUTIONS - MONEY TAKEN (Rev . =97) RECEIPTS
(tndudlng cernldeb'e penorlef lands)
0 CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organ(zation) AMENDING FORM
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 688.32A(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 I AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMUDt1YR) AND PAC CHECK (S applicable) RAISER
NUMBER INCOME
ID# Bruce N. St-0/tze
S
0 9/1y/01 CK# .SSG - 39-t-h Sli e e~t 1,i-o,00
,Des Ao ;rues; .Th 5031~7 -35,29
ID# (9-oodm a r
Te qre~~/ Z .
0 4115/61 CK# 3909 W013ms A1ie . 1100 .60
BesAoinez, 1"/4 50310
ID#
.Zou.~a /1/'urses tlSSG~ei~tioU'i PAC
09// 01 CK# 1 /, 9 /501 ,Zno( ~f,, S'te . y71 6-6 .6 0
Guest Bes/loines, rA 50 .2/0 %
ID# ~,yy5" k1 ber PAC
0915/6 r CK# ~YJO (-c - 3rd sf. l6c,oe~
l08/
UubuRue, -TA 5°200/-023 95
ID# n
Ceor, ge Carr
U 1/.23
-/
- o1 CK# u_tA ri e AUC .
,2560 X Gu_tA ,50-00
&sAoines; -LA 50317- .Y054
ID# Ric%ard 0arlsco
6 g~.~5/01 CK#
401 Brewer Sh ee_i 3.x;00
G6e.hSler C° ;f9, rA 2575 9S
ID#
Pa ~ 0' ~r y a
1of0ozlo 1 CK# 3C0 aa Street, Suite /1025 -25.00
D es Aai n eis, YA ,5-03,0?_
ID#
A, Tean cichhorn
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
)mmillee. Relationstqp must be shown to the third degree of consanguinity (blood relatives) and alli ity (relatives by
arnage) (See Page 2 of forms packet.) . If surname of contributor Is the same as candidate, but there is no Page ~_ of
milial relationship, enter "not applicable" in the relationship column . (for Schedule A)
V021191
c//10/o
f0
VD
any
relationship,
7/0
(o/D
ur3u
(See
fo
CANDIDATES
commercial
AND
Relationship
(law
/11)lPage
uc
Section
BOARD
requires
THENAME
,~~c~~orh
2PAC
enter
ofcendldsle'e
purpose
688
candidate
must
forms
NOTE
CHECK
see
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g2,5-1
(Must
PAC
Y3(n
IDbe
MONEY
packet
applicable"
NUMBER
aacK
shown
IFCHECK
NUMBER
bypersorwl
committees
Abe
any
CONTA09UTION
Iowa
same
~r
toof
person
IfTAKEN
the
INsurname
inhinds)
Form
Code,
THE
third
the
as
toes/o
U,
disclose
other
PS
on
DESIGNATED
11
relationship
(,urJ
degree
/l?oin
prohibits
/?
s/-Yan
of
/IS
AD
Statement
her
dZ,2igM
q1
-I)ark
contributor
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lln
than
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Falrbailk's
RECEIVED
~"!~
e,
J,yh
"ofeh
><
'PeJerson
the
2lof
70
lY"h
al~8
Secor
n
&esk
es,
YA
ftliU
consanguinity
statutory
ies,
the
relationship
AND
)4c~eHan
lt-h
Second
Sfi'ee-j
es,
lv'
bard
column
500
COLUMN
Sf
-'TA
Jlo
IAZ-A
~-~'~~
use
S,
of
X02020
~715~l
FROM
-7"Al
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ADDRESS
Sf-lsf
Organtzatfon)
s7
the
of,political
Al
/~0
Ave,
information
of
AA'C
56,3
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Asas9s
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STATE
LIST
any
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as
relative
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PTO
OF
Suife
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PAC
rant°e
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-~'(ooz0
y5~5-
CONTRIBUTOR
-ID copied
NUMBERS
(POLITICAL
7SS~
making
~~
2a2
andCompany
from
but
--
aalfmtty
ISAVAILABLE
contribution
ACTION
there
reports
(relatives
is(!fno
COMMITTEE),
and
lastpage
toFROM
the
bystatements
CANDIDATE'
applicable)
-la
THEAir
of
LIST
wIOWA
this
THEETHICS
for soliciting
0&97)
PAC IDENTIFICATION
AND
Schedule
1-1,5,6
contributions
MONETARY
CAMPAIGN
THIS
aoD
o6
ao~J
oFORM
GA)
lBOX or
IF
IF FOR
CAUTION: .32A(6),
for .
ID#
Bob
IV6710 >y.3~ /De.
CK#
l,)eb
ID# Sieve ;
/o ;verset-y .
( CK# /00-00
,D . .,o32,-
SUB-TOTAL 1,2
S
TOTAL.
schedule) s
Disclosure
)mmittee. 1~
arriage) .). . Page of
milial . (for
.nor is n~uui.:uons, bee tfacK of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKE
. .N (Rev. 06097) RECEIPTS
(Inckadirg cenddrde's poem kmxb)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE). LIST THE PAC IOENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 688 .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-
(MMMD/YR) AND PAC CHECK (if amble) RAISER
NUMBER INCOME
ID# 1J;Cki IUerSon
IV6floi 362.0 dours-Lu,11, ams
CK# 56 . 00
DcW.`], 1-A .` 00`71 - 7- s--'
ID#
Sh ;r%ecf doo/ ; /-He
IV1210i CK# Bank Sh-eel .2s-.66
AJe h,5 Aer C'. fy ZW 5-a:5- 9,5"
ID# ea ye CAe/esu :j
102/0) CK# U. ,ac X / 4,5
2S. 00
~elrrav~d, S.9 ~D~2/
ID#
D el rne i^ Goo s s
11// Z./o i CK# /,5-22 - 2,V0 M 5f: -z5,oo
Eagle Grove, 2-4I .50-53.3
ID# ,P. .C. . %o ffe
! 1/12.~o i CK# 1827-l-V0M1 Sf, 50,00
kc3!iawha; 1l' Sv'41'V 7
ID#
,66'a V) Elli5
11/1~7-1o I CK# 2 y4y -
,5-6,6,6
Do W6, I~g .5007
ID#
Robert G(1. C3r~~~fon
i 1/102/0 i CK# 2.27-lsfAue, Sv . 00
Clar~a r~, Ii4 ,5'05..25
ID# Donald Swanson
11/12101 CK# -2796- 2 9 o th St . 50. OD
; .IA -'-0/0 /
Ca/z
ID#
.T c k Jenk ;n s
11// ;2-/0 1 CK# toy AJortl) Aa ;r) 50, 06
Clar;an, 1-A .5052.5"
ID# Al l v%e eev ,yrn a n
,607 Tennysorl~¢ue, 1?O . v,~ ..ZSf
iV2 910 / CK# .20 .00
Sfratfo r-d; .ZA S0~ y q I 1
SUB-TOTAL 95.00
TOTAL (Nlastpage ofthis
schedule) 1$
Disclosure law requires candidate committees to disclose the relationship of any relative making a conlnWion to the
)mmittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (re4fves by
arriage) (See Page 2 of forms packet.) . If surname of contributor Is the same as candidate . but there is no Page j/ of
miial relationship. enter 'not applicable' in the relationship column . (for Schedule A)
r-ur so kzuuctions, toed oacx Ot Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN (Rev . 06/97) RECEIPTS
(fndudlng candldals's psrsaal hinds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statertlent of Organization) AMENDING FORM
D
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 6t38.32A(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 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DO/YR) AND PAC CHECK (N applicable) RAISER
NUMBER INCOME
1D# N,axel Brook
s
BoxS7
111.2-6101 CK# %D.ao
Stra tTo rd, _TA ,5-0 2,~/ 9
ID# Dool%tt/e
,Donalo(
%errace ~r .
i11.27/0I CK#
Q0y i11,
35. oa
Websier, 6%fy, ZA S5C595-306z
ID# DaL) ;d k.; eberkheeh-l-
11.2 9,0 I /.2 3 Me nfclire 4h ,
CK# .2 .5:00
,aelmcnd, Z-A 50'1.2/
ID# Bet-11 /4olrn e .5
i y~ 9~a 1 '723 D ;u,s,'cn SzL .
CK#
We bster ei
t9 , rh ,50595 - 107
.Z 0 .00
ID#
luh ;f/ey Al, Neminywav
i v.zyfo I CK# 7o 4 Luh ; to s f Dr. 20 .00
G!l'e b -~ ter e ; f-J, 1- ti 5-O5 9S"
ID#
peter) J', . /2asmusserl
///.29/01 CK# /6171 - ~zlo*h St . .z .5% 00
Cold ~~ eld~ . .ZA ,5'G~h~.Z
ID#
Aorris AJIler
li/24/o I CK# /-Z G -,5'A ,¢ u e . ~f1C . 15.0 G
C_larlon, =A 505 5
ID# E,e. Allerl
1112 9/0 1 CK# ,~5_U3--ls1 AVe, SE 1,500
Llar:orn, .,TA ,505x25 - 13 - 05
ID#
F. G'a y lov-d Wines
1I /~4/Oi CK# ,~S'e ax' l 34 , ,. O .oo
Woolsiock, .I-A 5_D,5- q9
ID#
Oerald U)A ;s%er
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
)mmittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and alfiraty (relatives by
arriage) (See Page 2 of forms packet.) . If surname of contributor Is the same as candidate. but there is no Page .
milial relationship, enter 'not applicable' in the relationship column . (for Schedule A)
rut it 1-sar ucuons, Joo CiacK of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN. -A (Rev. 06W) RECEIPTS
- (h+dudirV cendldste's penond %!rids)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
CAUTION : Section 688 .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-
(MMI)D1YR) AND PAC CHECK (if applicsible) RAISER
NUMBER INCOME
ID#
l4a rP- dock wold i'
S
11130101 CK# 2061 - .340
116-190
,Stanhope, Z A 50246
ID# ./Ylrs . EUa*n Swa ; r)
/2/0 3/01 CK# l0 N - ~l t-h Ave
.Uf, A0, 35 ,ZSoo
lea y on, ZA 50'5 -36 - 0635
ID# )--u
Ars, Eldrecal ndp"szi
/2/0 .3/6 i CK# .559 ~nkpaclufa .210.00
Sfanl,ope, ZA .02h1~a
ID#
Ars-/19 a y F_ , 7-,,/us
121,0310) CK# ZZ9-?td ~4ve . iVE . /6106
Clarlor,, _A 3z,5-2-5-
ID# Dr, Eu y en e ha / s
l d1-,9 3/o i CK# ,30 76 - //0th Sf. .25.06
$elmoncl, .Z~l SO4~2-l
ID#
1/06 /e y
12/0 -q1& I CK# 0a'-1
.231 Pjy e A ve . ,2.6-40.00
Clarion, T,9,50,525
ID#
Alvir7 Ssa k so ri
/-V6Vcr CK# 02&5 .2- .23571% Si. 20,00
Duncorrl be, =A .505"3-Z
ID# Ahon mou5- money serf Tv :rcvJa
ethics End dampwsv,,()~sc%osure, aoavY,( .
12-104101 CK# .2400
,S'ee check # 302.!0, ,fee . 0-7,2601
ID# l2uM 5h, oa(~rs
I~0~101 CK# Plb 501.ClrlT;eld dr . ,5b,60
We 65ielr- c; ~y , sA -5-6 6-9 .s-,3072
ID# 13euerly We ;dernar-Irn
1YOS`01 CK# l~5- So u A 7'ra e 9 /0.00
bows, TA .5207/
SUB-TOTAL 4/70, 616
S
L
TOTAL (iflast page of this
schedule)
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
)mmillee . Relationship must be shown to the third degree of consanguinity (blood relatives) and a" (relatives by
arriage) (See Page 2 of forms packet.) . If surname of contributor )s the same as candidate. but there is no Page /-3 of
mifial relationship, enter 'not applicable" in the relationship column . (for Schedule A)
rut to tsm ucuons, use Cfa6K of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEI, _I (Rev. 06r97) RECEIPTS
.. (Inckrdw+p canddab's pereorwl trwtdr)
Q CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
CAUTION: Section 688.32A(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-
(MM/DDfYR) AND PAC CHECK (fl applicable) RAISER
NUMBER INCOME
ID#
flec) &sevorth $
CK# ,2561 Des -lV o; n es 16-00
/~ebsfer~ C~ ; fy , Z",} ,SG~59S-30 / 9
ID#
~erfru cle
,Cenfz
l,2/i e/6 l CK# 3n Y4- 336 th St, oZ .S% o ~j
By cos, .r-# 07,10 7/ - 7,5.zh
ID#
,
L( uvell Mom a s
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE)
. LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A UST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 688 .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 .
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
)mmittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
arnage) (See Page 2 of forms packet.) . If surname of contributor Is the same as candidate, but there is no Page _ J-, of 1,6-.-
milial relationship, enter 'not applicable" in the relationship column . (for Schedule A)
I
.FOR IAIsTRucna1fS, SEE BACK OF ?M SCHEDULE
B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . OW) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES . LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS a CAMPAIGN DISCLOSURE BOARD .
Expenditures to persons/entifs 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 persordentity on behaff of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i).)
Page _ -of
of 9
FOR INSTRUCTIONS, SEE BACK OF 'QM SCHEDULE
' B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . ()9197) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS 3 CAMPAIGN DISCLOSURE BOARD.
Y , IC I I
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Oft&wswnent) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID# ~'alhou .`~C'e . .Tvurr~al Herald ,/~eUJSpoZpE'r dSLC,~SCF^ip ,~
L i oi'1
Expenditures to personstenfides providing consuldng, adverluiny" blnd-raising, pofq, meft . organizing services must also be detM fernized on
Schedule G by the amount, purpose, and date of each type of expendllure made by the personlentfty on behall of the candidate's committtee . (Refer to
Schedule G instructions and Iowa Code 56.6(3)(i).)
Page ---Z -_ _ of 9 --
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF 3M SCHEDULE
y. ~ __
%'TMlII7i~
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Alabursernent) WAS MADE
(MM/DO/YR) AND PAC
CHECK
NUMBER
ID# ~Grap h1
Iake Ci f ~j/~ sPape,-s<<b ser~ pfioh
GY/-23/0l 163 N. Cter, Po. gax
CK# l9.oG
ID# Fil~S~ar Bank serLU; ce- Char9 e_ fer
7,Z,5- ,S'hakespedvC period OVlob/ol throu3h
651a010 1 CK# ~ o5"o F/6 f 7-87
Sh ,af-ford, TJI Z-0~2 -~/ 7
Expenditures to persons/entities providing consulting, advertising. fund-raising. Poling, 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 instnictiom and lows Code 56.6(3)(1) .)
Page ._, . _ . of V
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF QM SCHEDULE
r i r7 Z I I~
PWAMW 17YT+Wr~
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED Cr applicable) (dsburswnent)WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID# ~;~s ar dank sera ;ce ahar9e-~r
7:z5~h .~kespear~ Pei-10d 06,/67/01 throu3h
0 7,190 l CK# $ 787
SfrL)f-k rcl, l 716 9/0)
ID# IDocus Aduoca4e ewspaper -ubscr,, 1o1; or)
/0-V W. F11,5worM S/,
07/2% 1 CK# 2-,? 7 l~ aG
~ou~s~ .Z"A soy ~ I
ID# 5a m's Cl ub Aaracf! e randy
67/.z% 1 CK# ed .
30,5"Air)oort ,
Gevrc e ~~s
~ .s3 Fen
E-chhorn
n SD c~~k, was-fir X30
CK# 2,? 9 SfrL) ffod,
r .rA 50~~{ 9 Set. S~heALLJe F
` ID# n
rlOs1rnaszr er PC S:~a ye
081o2/1n I CK# Z y0 720 ~'hakespearE 102 .(10
SfraIforel,=)4 tee%249
ID# Stwsfrom -1v1 dle r Pre:55 Y'rirn find 7'- l yer5 and
807 bee rer, P, 6, Box Z 7 enuelc pe5 .736 .0 /
08/6Zj01 CK# 291
tJGOne, =A ~-ZG3~,
ID# set-v , ces- earnioa ;3n
~arnie ~Tchnsen
,~~ ,~8' 1.~'ash ;n~ n oDnsultanf 1156,60
Ob~~03`0l CK#292-
Expenditures to persons/entilies providing cont:uMnq, adver", hind-raising, pollirq, mom, orgaN*q services must also be derail Itemized on
Schedule G by the amount, purpose, and date of each type ofexpenditure made by the persoNentity on behalf of the canddale's comrnittee . (Refer to
Schedule G instructions and lows Code 56.6(3)(i) .)
Page _-#-- _ of 9
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF qM SCHEDULE
B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . A9J97) EXPENDITURES
Expenditures to persons/entities providing consuWV, advertiskV, fund-raising, PO", maneg4, a0amzinp services must also be detait Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personlentity on beW of thecandidate's comndttee. (Refer to
Schedule G instructions and lows Code 56.6(3)(i) .)
Page .-I.5--- . of - 9
(for Schedule B)
I
FOR INSTRUCTIONS, SEE BACK OF `RIB SCHEDULE
Expenditures to persorWents providing consubing, adverfiang, fund-misGp, poNirp, ml . orymazing services must also be deW itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the persoNentity on Wall of the candidate's committee. (Refer to
Schedule G instructions and tows Code 56 .6(3)(1) .)
I
FOR INSTRUCTIONS, SEE BACK OF 'RM SCHEDULE
Expenditures to personslentilfes providing cmauMV, adverfting. NW-re", golfing, nlarlagbp, organizing services mwt also be detail Itemized on
Schedule G by the amount, purpose, and date of each type of experdtwe made by the persoNentity on behalf of the candidate's conwNttee. (Refer to
Schedule G instructions and Iowa Code 56.6(3)(1) .)
Page .--Z __ . of q
(for Schedule B)
I
FOR INSTRUCTIONS, SEEBACK OF AM SCHEDULE
Expenditures to persons/entitles pmvklirig consulltrV, 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 personIe" on behaM of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
Page _? -_ . of - ? __ .
FOR INSTRUCTIONS, SEE BACK OF `RM SCHEDULE
CK#
SUB-TOTAL $
Expenditures to persons/entilies pmvkkg consulting, advertisatg, (tend-relsing, Poll1IS nwIllhp, argartizinp services must also be dOW itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the persoNentily on Wall of the candidate's conwritttee . (Refer to
Schedule G instructions and Iowa Code 56.6(3)(1) .)
PART 1- MONETARY LOANS RECEIVED THIS REPORTING PERIOD PART 11- MONETARY LOAN REPAYMENTS MADEIM REPORTING PERIOD
(Original source of loan, such as a bank, must be shown it a third party is (Loans forgiven must be reported on Schedule E -- In-kind Contributions I
involved Include loans from candidate's personal funds .)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (Include Endorser's Name, If Applicable) TO CANDIDATE OF LOAN (MM/DD/YR) (Include Endorser's Name, It Applicable) TO CANDIDATE' REPAID
MMDD/YR If A )cable" If Applicable)
'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). (See Page 2 of forms
packet .) It surname of contributor Is the same as candidate, but there Is no familial
relationship, enter "not applicable" In the relationship column when It applies . Page I of
(for Schedule F)
G BREAKDOWN
OF MONETARY
THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY (Rev 02/96) EXPENDITURES
BY CONSULTANT
jLZ y b)dSA1n4~on
City J Stab Zip Code
,5~ra -~ Fr rCL
TOTAL ANTICIPATED
COMPENSATION FOR
CONTRACT PERIOD (MM/DD/YR) PERFORMANCE
From d eU Izo I
To /2L31 /o 1 $ .5 9,F, 0 U
ESTIMATES OF PERFORMANCE
$
SUB-TOTAL
&,h 6rt l fAfJ'> 0L rn e l5 q t'_ a n ry
Page
(for Schedule G)
FOR It ,TRUC77ONS, SEE BACK OF FORM SCHEDULE
IN KIND
CdUAArTTEE NAYS (Must be same as on Statanrent of Orpanizadon) LevE06/97J
. CONTRIBUTIONS
b .Cd(.u~aC Koom,refreshmen
321 f, ,doe ust Sf., rl 3rd -For 911670/ Frnba
o9/l0/0l Club fundra ;ser SW
,U es,~l0ines, IA Sa309
SUB-TOTAL
'Disclosure law ofrequires candidates to disclose the relationship of any relative making an in kind contribution to the Page / -Z
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage) . (See Page 2 of forms packet.) If sumame of contributor is the same as candidate, but there is no
familial relationship, enter 'not applicable" in the relationship column .
"FOR INSTRUCTIONS, SEE aACK OF FOAM SCHEDULE
E IN KIND
, COMMITTEE NAME (Mat be sanw as on Statnrwntof Ovanizadon) (Rev
.OB/97~ CONTRIBUTIONS
SUB-TOTAL 1 $
page of this
schedule)
'Disclosure lawof requires candidates to disclose the relationship of any relative making an in kind contribution to the Page 2
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage). (See Page 2 of forms packet.) If surname of contributor is the same as candidate, but there is no
familial relationship, enter 'not applicable' in the relationship column.
jan-c31 -02 12 :40P
~A ~day, e- ~rly
~, n'~~ I
Id'
a-I 1 !
.0
P
'e- 02
a
J
Routine Penalties Due For Late Filed Reports Range from $20 to 5800
I AM FILING A %TAnjl .z r~,I WIM I ph ~ecnm~Pr& REPORT FOR AWA (1) ELECTION 1(2)NON-ELECTION YEAR,
(report date) Indicate one
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) ........ .. . . .. ....... ... . .... . ............ ........ . ............. ........ ..... ............... .. ....... .. ..S
UNPAID BILLS (From Schedule D - Attach Schedule D) . ... .......... . . .. . .... ............ .. .......... .......... ....... ...S Q
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . S 3~
OUTSTANDING LOANS (From Schedule ;: - Attach Schedule F) . .. ...... .. ........ ........ .. ....... .. . ... .. .. ..... . .S -qe) (-A,. no