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IMPORTANT: Indicate by # type of committee you are reporting for:
( 1 )StatewidelLegislative/Judge Standing for Retention Candidate ( e PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Cand ( 7 )School Board or Other
Political Subdivision Candidate r PqC (9 )City PAC- (,10 Ichool Board or Other Political Computer
Subdivision PAC ( 11 ) Local Baibt Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name AL 1 1 UU " Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought .~.-.7,.x.-°. . .District
. (if Senate or House) penalties.
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z,i - c.o j q t) 7- H- 05
SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED
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 DR-3 is filed.)
"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) ..... ... .............. ... ._ . .......... ... .......... $
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organizpdon) 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 CHECKNUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS 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 4 IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDDfYR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
ID#
7&6 ~o El.
ID# -
El.
ID#
CK# E:1
ID#
CK# E]
ID#
CK# E:I_
CK# EJ
ID#
CK#
ID#
CK#
ID#
CK#
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Rehationship must be shown to thethird degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . tf sumame of contributor Is the same as candidate, but there Is no Page _ of
familial relationship, enter -not applicable" M the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Farm SCHEDULE
CK# U,4ro3
1ao
ID# 00
r i r r m
ID#
~ hker ~ -, ,.r . .1, aCC,k 0~Jelk.
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
1D#
CK#
SUB-TOTAL $
TOTAL (if last page of this schedUie) $
Z y5 ~
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 personslentkies 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 persoNentity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(n-)
Page __ / of _/___
(for Schedule B)