Anda di halaman 1dari 5

THE BEST YEARS Dan Vance 563 324 4120 p .

1
Oct; 18 -04 04 :45p
F_Aed~i- <D//glOIK
FOR INS rRuL, 1 ,r NS, SEE BACK OF FORM FORM
DISCLOSU RE SUMMARY PAGE DR-2 DISCLOSURE
NAME PAt be same as on tatemept p1 Prgan atiorl / (Rev . 01/2001) I REPORT

n ~~~ Gam- ~r For Office Use Onl

Comm . #
IMPORTANT : Indicate type of committee you are reporting for :
Indexed
( 1 )SIPtcw~delLPgr3I9tieC Candidate ( 2 )3ldtGwidu PAC ( 3 )State Party ( 4 )UounlyfLOCaI G3ndidate
Audited
(5 )County PAG (6 )Ballot ISSUe/Franchise Committee (7 )County/City Central Committee
( 6 )Support Slate of Candidates Computer

CANDIDATE COMMITT ES ONLY .

Candid te Party 1A -
t

Office So 9 District (i Senate or Ho e)


1~>/ 4 . I

3d6 v
SIGNAT OF TRCASURER (or perzon filing this report) TELEPHONE DATE GN

Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIO NS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:

I AM FILING A D REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR,


(report date) Indicate one

EICHECK IF AMENDMENT TO REPORT DATED Local Commdteps, enter Date of Election

(] Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees . enter County in
held which Election..
("ou rnust continue to file reports until a Notice of Dissolution is filed .)
5 Go l l

STATEMENT OF CASH 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 on hand at the end ~y ~
of the iast reporting period, or must be zero if this is first report filed .) . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . ., .$ G7" U - vc "

ADD TOTAL MONEY TAKEN IN THIS PERIOD


Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) . . . . . . . . .
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 . . . . . . $

SUBTRACT TOTAL MONEY SPENT THIS PERIOD ~7

Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below) . . . lJ _

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . . . . . . . . . . ., . . .  , .$

~UNPAIO BILLS (From Schedule D -Attach Schedule D) . . ., ., ., .  . . . . . . . . . . . . . . . . . . . . . . . . ._ . . . . . . . . ._ . . . . . . . . . . . . . . . .$ l. C? Sr?- ta7 /


`IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

"OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . .  . . . . . . . . . . . . . . . . .  . . .  . . . . . . . . . . . . . . .$

CAND IDATE COMMITTEES ONLY:


CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)


563 324 4120 p. 2
THE BEST YERRS Dan Vance
Oct 18 04 04 :45p

For Instructions, See Back of Form


SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY
(Including candidate's personal funds) (Rev . 07103) RECEIPTS

0 cl-,rCK THIS BOX IF


C TTEE NAP E/Wust be same as on Staternaril or Organization) AMENDING FORM
/AnCe- 4s~
STATE CANDIDATrs NOTE ; IF A GONTRIbUTION 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 NUMUERS IS AVAILA13LE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Suction 68H.32A(G), lows Code, prohibits the use Of infOrrnatiOn copied fiom reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory poiifical committees,

DATE PAC ID NUMBER NAMr. AND ADDRESS Or QONTRiaUi OR - RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED PUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMr;
_
ID#
CAro ~Pn+~ ~ /

t 0
CK#
0L 70 r A. Sa~O ~iS OO
ID#
pc)~ rnyr
CK#
~S a. l uteri vw-0.t 404A PI ~ o
~o
I D#
/71 i G ~,q e /,

l~~ CK# .71 Pry' 8uX t-jSi 1 .


f o 46 C? ~ -, S2 1 ~l0 ~
14, F:;~4 4%'-1--
a
ID#
;:~Aw,RS

CK# /3 ne.~ ~ed la I.,


~~ 4~v ~ sa 8J ~.
Ib# 4A3 7 A S ATF-p(c .
CK;t
/`701 3) 1 ,E,~s-errs Ir0-P,, IV &

ID#

CKIF ,

I D#

CK#

ID#

CKfR E:1

I D#

CK#

IDA

CKtf

SUB-TOTAL

TOTAL (if last page of this schedule)

' 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 consangulnlty (blood relatives) and affinity (relatives by Page ,-_L__ of
marriage) . If surname of contributor is tha tame as candidate. but thore iy no (for Schedule A)
familial relationship, enter 'not applicable" in the relationship column .
p. 3
Vanoe 563 324 4120
THE BEST YEARS Dan
Got: 18,04 04 :45p

OR iNSrRUCTIONS, SEE BACK OF FORM


SCHEDULE
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY
(Rev, U7i03) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE
CANDIOATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED
PAC CHECK NUMBER FOR EACH EXPENDITURE, A LIST OF ID NUMBERS
OR LEC.4SLATIVE
COLUMN AND THE
IS AVAILABLE FI70M THE t0WA
D CHECK THIS BOX IF
AMENDING FORM
ETHICS & CAMPAIGN DISCLO&IRE BOARD.

C ITTEE NAME Must be same o on statement Of Organisation)

'. c_ _ S ~
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIarZ TRANSACTION) t.-xPENDEO
EXPENDED (if applloahla) (OraburmarerM WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER '
!D~! 174yrJnQN 1 ke %A0qr / I rS 10/1741G ) UVr

CK# _ 17 t b W.
S~rw1 ~w+rr ln . Sl~rtS
. /D ' ~ -~ ~A. 2gf7

I 1 ~'a. ee
I b4!
17
ID#
'ta-r'-~s
CK#i
'..2 Jf
_ . ,
Ion
C `k7r GjQS " 7~v fr~
CK
f0e mod ;. d
1S
`~

~~, ~. .A y t s .,.,.~5 .

CK# ~n
/o5D Dav st - X-ok SQ ot
ID#
n in
CK# lJo ~ . So~S f

ID#

~~~,
a oc
U Li0t.Y4 s
ID#
" " 7
~ ~, min J~"
CK# /0 q 3 1has q a
~'o~.7lb
l
SUB-TOTAL $
i "5
TOTAL (if last page of this schodule) $
- d

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing tistlo or moro must A*v be inventoried on schedule H . (Refer to Schedule H Instructions .)

Expenditures to persons/entitles providing consulting . advertising . fund-4aising, polling, managing, organizN servieaS must also be detail itemized on
(Re-tar In
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 .
St~duie Q inStnrc6onS and Iowa C:rxte 681LdOZ(3)(1) .)
Page
Dan Vance 563 324 4120 p" 4
Oct 18 .0 4 04 :45p THE BEST YEARS

FOR INSTRUCTIONS, SITE BACK OF FORM


SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY


(Rev. 07/113) 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
t=THCS & CAMPAIGN DISCLOSURE BOARD.
IS AVAILABLE FROM THE IOWA AMENDING FORM

CO ITTEE N E (Must be same as on Statement of Organization)

Lam. IU
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DE5CRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM)DD(YR) AND PAC
CHECK
NUMBER '

ID# ~~-~ jlx gSy~r-


q10?g16
I57Vnes
. f~ dnCf S~

%9 _
CK# At

S~

IDA
/- 6.S- l~1-Gd S' r4in pS
CK# i© g S- Mo ~~d `~
92716, ,~'~ c 9r e cep

j -j
ID#
PC r~fz.
CK# `o VIA,-.,, 04tcr-
IO

736 F,-4--A
l o h/0 CK#
I..~I q ~ 3~ /01 x.10
ID# T

CK

IDI;

CK#

ID#

CK#

ID#

CK#

GUS-TOTAL $3
TOTAL (if last page of this schedule) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

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 personlantity on behaff of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 6BA.402(3)(i) .)

Page _-Q-L-__ of
Oct .18 A 4 04 :45p THE BEST YEARS Dan Vance 563 324 4120 p .5

FOR INSTRUCTIONS, SEE BACK OF FORM


SCHEDULE

MMI EE NAME (Mr ct he same as on Stphn,ent of Organl2Ftion)


D I INCURRED
(Hev . UB/9t3) INDEBTEDNESS

Ate. UoGQ, -ilo .r` ~ D CHECK THIS BOX


IF AMENDING
NOTL : Debts previously tupurled that remain unpaid must be Included on this
Schedule, as well as any new obligations incurred,,In this period .
FORM

An "incurred debt" is a debt for


DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD goods or services ordered or
(DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) received, but not paid for by the
end of the reporting period.,
regardless of whether an invoice
has bean received,
DATE DESCRIPTION OF GOODS OR BALANCE OWED AT
INCURRED NAME AND ADDRESS OF PERSON SERVICES PROVIDED OR' CLOSE OF
(MM/DD/YR) TU WHUM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING
PERIOD'

0 ,0

'7/o

SUBTOTAL $

/oS~ .at
TOTAL OE6TS OWED BY COMMITTED AT THE END OF THIS REPORTING PERIOD

`If actual figure is unknown, show -estimated" beside the figure . Page I of _I
(for Schedule D)

CANDIDATE COMMI I 1 LES NOTE :


'Incurred indebtedness 91so includes each persontentity with whom the candidate's committee has entered into a contract during the reporting period for fhtUre
or continuing performance . Enter the name of the consultant who provides or procures services for items such as advertising, fund-raising, polling, managing. or
organizing services .- Report on Schedule G th e nature of performance and the estimated performance reasonably expected of the consultant .

Anda mungkin juga menyukai