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DISCLOSURE SUMMARY PAGE

COMMITTEE NAME (M st be same as on Statement of Organization)

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IMPORTANT : Indicate type of committee you are reportingfor:

(

  • 1 )Statewide/Legislative Candidate 1 2 )Statewide PAC

3 )State Party

(

4 )County/Local Candidate

  • 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee

( 8 J;q pport Slate of Candidates

(

s1-3 -3 9/- y73 7

SIGNATURE OF TREASURER (or person filing this report)

TELEPHONE

DR-2

I DISCLOSURE

(Rev. 01/98)

REPORT

For Office Us2 Only

Corm . rr

  • s- 3/v2 /

Indexed

Audited

Computer

DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

I AM FILING A

(report date)

REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .

Indicate one

OCHECK IF AMENDMENT TO REPORT DATED

Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .

(You must continue to file reports until a Notice of Dissolution is filed.)

Local Committees, enter Date of Election

County 8 Local Committees, enter County in

which Election is held

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 of the last reporting period,

or must be zero N this is first report filed .)

............................................................................

$

ADD TOTAL MONEY TAKEN IN THIS PERIOD

S. O S!

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 appliesto Candidates Comm ittees Onlvl

SUB-TOTAL......S

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

.2s-

Schedule B: Expenditures total (Attach Schedule B) ...........................................................

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)

..

.

$

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)

$

'ANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?)

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

$

 

.o5-Zs

.

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0 . a0

b . 00

'0 .00

YES

, <~ NO

COMMITTEE h- .eE(Must be same as un Statement of Organization)

i,uana for 7ayor Committee

NOTE: This schedule reports money loaned to the committee which is deposited in the committee account.

TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $

25-00

SCHEDULE

F

LOANS

(Rev . 08/96)

RECEIVED

14 REPAID

O CHECK THIS BOX IF AMENDING FORM

PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD (Original source of loan, such as a bank, must be shown ita third party is involved Include loans from candidate's personal h inds .) -

DATE

RECEIVED

NAME AND ADDRESS OF LENDER (Include Endorser's Name, If Applicable)

RELATIONSHIP

TO CANDIDATE

MM/DD/YR

Applicable"

If

AMOUNT

OF LOAN

0

Luana Stoltenberg

6632 Woodland Ct

Davenport Ia 52807

3elf

25 .00 r

PART II- MONETARY LOAN REPAYMENTS MADEM REPORTING PERIOD (Loans forgiven must be reported on Schedule E -- In-kind Contributions.)

DATE PAID

(MM/DD/YR)

NAME AND ADDRESS OF LENDER (Include Endorser's Name, IfApplicable)

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RELATIONSHIP

TO CANDIDATE'

If likable

)

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AMOUNT

REPAID

$

TOTAL (PART/)

$

25 .00

TOTAL CASH REPAYMENTS (PART I/)

$ Z S as

 

From Schedule E -- TOTAL LOANS FORGIVEN

$

 

TOTAL OUTSTANDING LOANS END OF REPORT PERIOD

$

- d " 00

'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 forts packet.) It surname of contributorIs the same as candidate, but there Is no familial relationship, enter "not applicable" in the relationship column when itapplies.

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