Professional Documents
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I
FOR INSTRUCTIONS, SEE BACK OF FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev. 12/2005) REPORT
COMMITTEE NAME (Mustbe same as on Statement of Organization)
For Office Use Only
Comm . #
Logged in _
Scanned
Computer ,
di Audited
CAN
C ate Na Political Party (d applicable) File with :
u 1 Iowa Ethics and Campaign
Disclosure Board
Office Sought 510 E.12', Ste. 1A
M ' .I Des Moines, Iowa 50319
ii1"1K,la' Fax 515-281-3701
Late reports a4sljbiec to possible civil and criminal penalties . Pursuant to Iowa Code section 68B.32A(7)
the candidate, for a candidate's committee, and the chairperson, for any othertype of committee, is the
indivio"l responsible #filing timely and accurate reports.
V
TUBE OF Per& FILING REPORT TELEPHONE DATE SK94ED
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3.
(You must continue to file reports until a DR-3 is fled.) County & Local Committees, enter County in
which Election is held
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) . .................
Schedule F- Loan Repayments total (Attach SheF)_...._ ............._ ......... ..... .... .............. .___...__........
CASH ON HAND at the end of this reporting period (iffinal report balance must
be zero) (Attach DR-3)........._ . ...__............._.................._. ....__.. . ...................__............ ...._ ..........._ ............_ .$
SAID BILLS(From Schedule D - Attach Schedule D) ..............._ ....__............................... ._..___.._........... .___ ......$
'IN KIM CONTROtFIONIS (From Stele E - Attach Scied le E) ................._ ..._ ......_.. ..__ ..........._....___ ..........._._ .$
"OtnWANDBlG LOANS (From Schedule F -Attach Schedule F) .._ .........._ ...__...__........ . ..._ ._.._................__..._ .......$
CONSULTANT BREAKDOVM(Schedule G Attachedr?)
CANDIDATE co1ArTrE ONLY-
VALUE OF CAMPAIGN PROPERTY(From Schedule H - Attach Schedule H)
STATE COMMITTEES- Submit a reconciled campaign accouhtbank sw&rnerrit "wry of each year_
For Instructions, See Back of Form Reset Form SCHEDULE
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STATE CANDIDATES WOTE : IF A CONTRIBUI19FN IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN TH ESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION: Section 68B.32A(6), 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.
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
-.
ID#
CK#
ID#
CK#
SUB-TOTAL
$yoa
TOTAL (iflast page of this schedule) -- 1
$ cx~
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shownto 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 Pageof -L
familial relationship, enter "not applicable" in the relationship column. (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM 1 Reset roan SCHEDULE
, ,c
r - . CANDIDATE NAtT AND Aff-1 RE;S TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (OsWrsement) WAS MADE
(MM/DDYR) AND PAC
CHECK
NUMBER
-K M L' ~ a-A;6 ,¢ d s - .
AL M
//IA /" . er $
C3 9o
CKl c) 0
'--A,
-? .e~o-
&
c- L e~o-rr-a--a
1D#
~P /-&-U e,eAckfte- Czy 1-4, s
CK#
6
1D#
~ cK# /0 7
ID#
6,,, R e~ b U." CAN F -~,~-
F~ .fYt 11
1D# v
CK#
ID#
CK#
CK#
ID#
CK#
SUB-TOTAL $
TOTAL (ifIeStpa" of WS Sdiedule)
$ 1576
Purchases of certain campaign property costing 5500 or more must also be inventoried on Schedule H. (Refer to Sdhedde H inatrudions.)
Expenditures to personsiendties providing consutdng . advertising . fisrd-rairargl. polling . managing. cuganbing services mud also be deland Itemized on
Schedule G by the amount, purpose . and date of each type of expendbre made by the persoWenfity on behaff ofthe rw e's committee. (Refer to
Schedule G hrstrudions and Iowa Code 88A.402(3)(i).)
Page _.J- - of
(for Schedule B)