Barber George1682scanned

8/7/2019 Barber George__1682__scanned

http://slidepdf.com/reader/full/barber-george1682scanned 1/14

FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

COMMI TTEENAME ( Mu s tb e same a s o n S t a t e me n to fOr g a n i z a t i o n )

6 c r k t / - - f o _r S f ~c i e e , o .

I MPORTANT: I n d i c a t eb y # t y p eo fc o mmi t t e ey o ua r er e p o r t i n gf o r: "

( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g eS t a n d i n gf o rR e t e n t i o nCa n d i d a t e( 2 ) S t a t ePAC ( 3 ) S t a t eP a r t y( 4 ) C o u n t yC e n t r a lC o mmi t t e e( 5 ) C o u n t yC an d i d a t e( 6 ) C i t yCa n d i d a t e( 7 ) S c h o o lB o a r do rO t h e rP o l i t i c a lS u b d i v i s i o nC an d i d a t e( 8 ) C o u n t yPAC ( 9 ) C i t yPAC ( 1 0 ) S c h o o lB o a r do rOt h e rP o l i t i c a lS u b d i v i s i o nPAC( 1 1 ) L o c a lB a l l o tI s s u e

CANDI DATECOMMI TTEESONLY :Ca n d i da t eName

r ~ r

O f f i c eS o u g h t

L a t er e p o r t sa r es u b j e c tt op o s s i b l ec i v i la n dc r i m i n a lp e n a l t i e s. P u r s u a n tt o I o w aCodes e c t i o n6 8B. 3 2 A ( 7 )t h ec a n d i d a t e ,f o ra c a nd i d a t e ' sc o mmi t t e e ,a n dt h ec h a i r p e r s o n ,f o ra n yo t h e rt y p eo f c o mmi t t e e ,i st h ei n d i v i d u a lr e s p o n s i b l ef o rf i l i n gt i m e l ya n da c c u r a t er e p o r t s.

IAM F I L I N GA

P o l i t i c a lP a r t y( i fa p p l i c a b l e )1 2 , , ,6 b I ;e k . L

D i s t r i c t( i fS en a t eo rHou s e )

I AE TH, , ,-; S i tr ~ ~ ~ r ~D I OU 0 9 I Ki # f ) ~UL( r e p o r td a t e ) Q T 0 0 5

[ ] CHECKI FAMENDMENT TO REPORT DATEDFI L ED

6y/ . 1 - ) 9

TELEPHONE

1 -1

( Sc h ed u l eH a p p l i e st o Ca n d i d a t e s 'Commi t t e e sOn l y )

SUB- TOTAL.. .. .. .. .. ... $

SUBTRACT TOTALMONEY SPENTTHI S PERI OD

S c h e d u l eB: E x pe nd i t u r e st o t a l( A t t a c hS c h e d u l eB ) ( * * a l s os e e d e b t sa n d l o a nsb e l o w). . . . . . . . . . . .

S c h e d u l eF: L o a nRepay men t st o t a l( A t t a c hS c h e d u l eF ). . . . . . . . . . . . . . . .. , . . . . . . . . . . . . . . . .. . . . . . . .. . . .. ,. . . . . . . .. ,. .

CASH ON HAND a t t h ee n do ft h i sr e po r t i n g p er i o d( i ff i n a lr e p o r tb a l a n c emu s tb e z e r o )( A t t a c hDR- 3 ). . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .. .. . . . . . . . . .. . . . . . . .. . . . .. . . . . . . .. . . . . . .. . . . . . .. . .... . . . . . . . . . . . . . . . . .. .. .. $

FORM

DR- 2 DI SCLOSURE( R e v. 1 2 / 2 0 0 5 )~ REPORT

Fo rO f f i c eUs e O I

Comm. #L o g g e dI nS c a n n e dC o mp u t e rA ud i t e d

F i l ew i t h:I o w aE t h i c sa n dC a mp a i g nD i s c l o s u r eB o a r d5 1 0 E. 1 2 " ' ,S t e. 1ADe sMo i n e s ,I o w a5 0 3 1 9F a x: 5 1 5 - 2 8 1 - 3 7 0 1

ECTI ON/ ( 2 ) NON- ELECTI ONYEAR.

/ o - 7 t r -0DATE SI GNED

I n I c a t eb y#

F o c a lC ommi t t e e s. e n t e rD a t eo fE l e c t i o n

* * OUTSTANDI NGLOANS ( F r o mS c h e d u l eF - A t t a c hS c h e d u l eF ). . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . .. . . .. . . . . . . . .. , $

CONSULTANTBREAKDOWN ( S c h e d u l eG A t t a c h e d ? ) YES NO

CANDI DATECOMMI TTEESONLY:

VALUEOF CAMPAI GN PROPERTY( F r o mS c h e d u l eH - A t t a c hS c h e d u l eH) $

STATE COMMI TT EES: S u b mi ta r e c o n c i l e dc amp a i g na c c o u n tb a n ks t a t e me n ti nJ a n u a r yo fe a c hy e a r.

3SI z. GS - "

5 7

* * UNPAI DBI LLS( F r o mS c h e d u l eD - A t t a c hS c h e d u l eD). . . . . . . .. . .. . . . . . . .. . . . . . . .. . . . . . . . . .. .. . . . . . . . . .. . . . . . . . . . . .. . . . . . . .. . . .. $

* I NK I NDCONTRI BUTI ONS( F r o mS c h e d u l eE - A t t a c hS c h e d u l eE ) . . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . .. .. . . .. . . .: $ -7 Z 3

El Check i ft h i si sf i n a l( t e r mi n at i o n ) r e p o r ta n da t t a c hN o t i c eo I s( Yo umus tc o n t i n uet o f i l er e p o r t su n t i la DR- 3i sf i l e d. ) Co u n t y&L o c a lC ommi t t e e s ,e n t e rC o u n t yi n

wh i c hE l e c t i o ni sh e l d

STATEMENT OF CASHON HAND

CASH ON HANDa t t h eb e g i n n i n go ft h er e po r t i n g p er i o d. ( T o t a lo fa l lf u n d sh e l db yt h ec o mmi t t e e. T h i samou n t MUST b e t h esame a s t h ec a s h o nh a n da t t h ee n d

L 1 7 . 6o f t h el a s tr e p o r t i n gp e r i o do r mus tb e z e r oi ft h i si sf i r s tr e p o r tf i l e d. ) . . . . . . . . .. . . . .. . . . . . . . . . . .. . . . . . . . . . . . . . .. $

ADD TOTAL MONEY TAKENI NTHI S PERI ODS c h e d u l eA: CashC o n t r i b u t i o n st o t a l( A t t a c hS c h e d u l eA ) ( * a l s os e e i n - k i n db e l o w ). . . . . .. .. . . . . . . . . . . 6 - 1 - 7 3 a

S c h e d u l eF : L o a n sR e c e i v e dt o t a l( A t t a c hS c h e d u l eF ) . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . .. . . .. . .. ,. , . . . .

S c h e d u l eH : To t a lS a l e so f Campa i gnP r o p e r t y( A t t a c hS c h e d u l eH). .. . . . . . . . . . . . . .. . . . . . . . . .. .. . . . . . . .. . . . . . .



Fo r I n s t r u c t i on s ,Se e B a c k of Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s tb e s ame a s on S t a t e me n to f O r g a n i z a t i o n )

' To c ` S - Gj t V~ C A

SCHEDULE

A MONETARY( R e v. 0 7 / 0 3 )I RECEI PTS

© CHECK THI SBOX I FAMENDI NGFORM

STATE CANDI DATES NOTE: I FACONTRI BUTI ONI SRECEI VEDFROMASTATEPAC ( P O L I T I C A LACTI ONCOMMI TTEE ) ,L I S TTHEPAC I D EN TI F I C AT I ONNUMBERAND THEPACCHECKNUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVAI L A B L EFROMTHE I OWAE T HI C SANDCAMPAI GNDI SCLOSUREBOARD.

NOTE: ANY PERSON, OTHER THANAN I N DI V I D UA L ,THATCONTRI BUTESMORE THAN$ 7 5 0TOYOUR CAMPAI GN MAY HAVEF I L I N GRESPONSI BI LI TI ESANDSHOULD I MMEDI ATELYCONTACTTHEBOARD .

CAUTI ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,p r o h i b i t st h eu s e o f i n f o r ma t i o nc o p i e df r o mr e p o r t sa n d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so r f o ra n yc o mme r c i a l p ur p o s e b ya n y p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e e s.

SUB- TOTAL$

TOTAL ( i fl a s tp a g e o f t h i ss c h e d ul e )

*D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o n t ot h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es h ownt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb yma r r i a g e ). I fs u r n am eo fc o n t r i b u t o ri s t h es ame a s c a n d i d a t e ,b u tt h e r ei sn o Page o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a p p l i c a b l e "i n t h er e l a t i o n s h i pc o l u mn. ( f o rS c h e d u l eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOME

b

C K# L e o . -,

I D#AAi

G CK# t o Z G Z 1$7S Pl a ~ y 6/ . o o 0. 4 o f

I D# , ~~ ; c Ly ~ ~7 / Zy l o l o

CK# 1 9S r d h v; t ,. 0 r . ~ o 6 o , c / j /2 92 V OSCeo l 4 , 4 o f I

ID# C~ej . 3 - 1-e , - j C4 dCK# / / 7 / Yls,. A IL 5 TF

3 8 11 . d 5" 0 1 -2 30ID#

p ~I ~ I CG CK# 2 a o S. k v s s ~ , ~ {5 ~ .

17y2 D c / . 4 o i 2S=I

/ ~~G

I D# Cr / tdp l Y3&r r

CK#t o; Z

WC7 3 / o - , 1% 4 J c ," Je" , Ti 9 So Z6 y 2 5-

a- ° - "

090Z / d t ! S

ID# AJ ~ 4 4 - 1 ,CK#

t 2 y ~- y 3 0 S. T°~yl Lc 7 5 c e o l a. - ZW 5- 0 -1 -13

Zos_ o. _ -

/ l Z / OGI D# 5 + r - f - J e a ~ c r %.. ,j s

CK#f r $y 3

l 6 Gf A/.. . 1 5 - L J ' R~ -

GSc c o l a TW Sc - , t 1 3 / o oI D# iQd P A t 4 i A c Mi l l e r

CK# 2071 I Gb+n I q. - c

oSCa l s. - r Al 0 Z I Soi D#

CK# 1 3 4: 3 o 4 k wood Sf . t o oI - I Of - e r a ~$~ O



Fo r I n s t r u c t i o n s ,Se e Back o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

COMMI TTEENAME ( Mu s tb e s ame a s o nS t a t e me n to fOr g a n i z a t i o n )

2 1 & ,1- - 7 P - 1r S t c ` + e - - A I Dy d -

R e s e tF o r m SCHEDULEA I MONETARY

( R e v. 0 7 / 0 3 ) RECEI PTS

© CHECKT H I SBOXI FAMENDI NGFORM

STATECANDI DATESNOTE: I FACONTRI BUT I ONI SRECE I VEDFROMAS TAT EPAC( P O L I T I C A LACT I ONCOMMI TTEE ) ,L I S TTHEPACI D ENTI F I CAT I ONNUMBERANDTHEPAC CHECK NUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVAI LABLEFROM THEI OWAETHI C SANDCAMPA I GND I SCLOSUREBOARD.

NOTE: ANYPERSON, OTHERTHANANI NDI V I DUAL ,THATCONTRI BUTESMORETHAN$ 7 5 0TOYOURCAMPAI GNMAYHAVEF I L I N GRE SP ON SI B I L I T I E SANDSHOULDI MMEDI ATELYCONTACTTHE BOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) , p r o h i b i t st h eu s eo fi n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n s o rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h er t h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL$ 6/ 5

TOTAL( i fl a s tp a g e o f t h i ss c h e d ul e )

*D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec ommi t t e e st od i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o n t ot h ec o mmi t t e e. R e l a t i o n s h i pmus tb es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e ). I fs u r n a m eo fc o n t r i b u t o ri st h esame a s c a n d i d a t e ,b u tt h e r ei sn o P a g e Z o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn. ( f o rS c h ed u l eA )

DATE PACI DNUMBER NAME AND DRESS OF CONTRI BUTOR RELATI ONSHI PAMOUNT J I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR)ANDPACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D#

u k;. eCn. ... ~ ~ e d ~St ~ c. . . C en f ~ lCeAr ; - ~ t e

9/ 1` ) ~ ( X , CK# PO f wX ZG 3 0 - 4I 1 2 S Cr . 6 " " ': r i4 45 0 9 0 1 3 0 0

f i l l CK#7 1 9 S " l o "

r o v o J a r ~ ~1c r " s o 8 0

ID#~Uw ; n

CK#79 y0

17 ?L1 5 4

D

0 50 , 9 4

c e I t , So z l 3 Z S'.

/ 1 6 / o GI D# AAA a - ge . t i

c K#1 y a c Jo 5 c e . l ~. 0213

V/ I RI Oc oI D# S L t , i l e At n 4 o ac K# 32 9 Of . _ ~0/ , Lc. e . d 1

ySSS' Os t e o l* - Sv z f 3 I °r

/ I D#

X9 1; Ph : l l ,S Z~ : f , - yCK# 1 2 0 3 t j s s f Ad . : r

` 1 3 1 C« - ho~ f . # 4 S o v

0 1 4 1 0 6I D#

P ~ ~i d l , 3 cr h 7 a r ~ ,A0 i rc K#

Ll6 o x S

SC 2 .57C7

f wI D# J o 4 ~ . ~ ( 0 4 4 ; 3 i r d k , sCc K#

Hel l rC96C 5 -C Z 1 3

~~f t l a bI D#

J a ^ , e +CK#

2 SS*2 / r -7 1 1 0 + ` rtC .. e s ' If o j t W 5 0 f s v l ~ ` / ov s - * -

° 8~i s 1 o GI D# 5 1 e ) t + / n i c 1a l i e ~o r l a ~+

CK#J _ ~5- 3

) 7 7 8 9 3 0 1 , . 6~~ J ; . - , o l t i 0 5 - v ) z 5 '

Zv



F o rI n s t r u c t i o n s ,Se e Ba c ko f F o r m

CONTRI BUTI ONS- -MONEYTAKENI N( I n c l u d i n gc a nd i d a t e ' s p e r s o n a lf u n d s )

COMMI TT EENAME ( Mu s tb e same a s o nS t a t e me n to fOr g a n i z a t i o n )

R e s e tF or m SCHEDULE

A I MONETARY( R e v. 0 7 / 0 3 ) RECEI PTS

~L CHECKT HI SBOXI FAMENDI NGFORM

STATE CANDI DATESNOTE: I FACONTR I BUT I ONI SRECE I VEDFROM ASTATEPAC( P O L I T I C A LACT I ONCOMMI TTEE ) ,L I S TTHEPACI DENT I F I CATI ONNUMBERANDTHEPACCHECK NUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVA I LABLEFROM THEI OWAETHI C SANDCAMPA I GND I SCLOSUREBOARD.

NOTE: ANYPERSON,OTHERTHANAN I N DI V I DUAL ,THATCONTRI BUTESMORETHAN$ 7 5 0TOYOURCAMPAI GNMAY HAVEF I L I N GRE SP ON SI B I L I T I E SANDSHOULDI MMEDI ATELYCONTACTTHEBOARD.

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) , p r o h i b i t st h eu s eo f i n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n s o rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h er t h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

TOTAL( i fl a s tp a g e o f t h i ss c h e d ul e )

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec ommi t t e e st od i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c on t r i b u t i o n t ot h ec o mmi t t e e. R e l a t i o n s h i pmus tb es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e ). I fs u r n a m eo fc o n t r i b u t o ri st h esame a s c a n d i d a t e ,b u tt h e r ei sn o P a g e L lf a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA )

DATE PAC I DNUMBER EAND DRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE` RECEI VED FUND( MM/ D D/ Y R)ANDPACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOME

o l z Gj o GI D# x / ' + 5 4' r , 0 11

273oY1 . 1 3 $

CK# o` k . ~ on J3 1 0 0 0 3 Ce v : T 74 S-0 -Z

I D# AL . . . + k c ) s04 / u/ o c CK#ZSy

l o s e cQ. l ~ . 4.. ~ . p5 7o o n~ 'C 1 4 1 1 P 4 S 0 0 f

_ / 2 ~ j o GID# A- / / I J ef ) - e /CK#

C45l l N E. G . , f r . WGeo l. , - Q4 5 - c , - ? - 1 3 20

I D# 6 ; 6 yx_j ZGj o t; CK P J t o y a , t t o ,1 2 J

~ ' Zo ° °'

d t j 4 / 0 GI D#

l ~ ~r. " He c K~+a n

CK#C4$h ©939 wL e co ~ ~ o ,S ~ t 3

/ Z / ` ~G

ID#5T- . C4 1 4- ~ o . A k~ 5CK#ce 3 4 1Sog ~w l " G I f 57C700-9 5CC, 0 4 S0 Z , 3

o ~ ~ a 6 j o ~ID# w , , AYCK#C6

5h 3 1S2 G s f 5f

w no J .7~ So Z s - i o. n

o ~j a G j G

I D# . , ~q r r/ o ( f 6WQ y 0 .34 1 1

~ ' XCK #S3 S' s ~

7 3 ! 0 -4- 1 -Uc I J . 9 Sv z G Z o

o 0

$ 2G~I D# ~~ 4 . S u c l Vc r ~ t SsCK#

3~y2~ r 1 4OSCe. k

1 - 1 6 1. 4 S-L - PZ I 3 2S

I D# / /7 CK#Of l 7

y ~o w . r r t ~ Of l



Fo r I n s t r u c t i o n s ,Se e Back o f Fo r m

CONTRI BUTI ONS - -MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

COMMI TTEENAME ( Mu s t b es ame a s o nS t a t e me n to fO r g a n i z a t i o n )

Ua r ~ - F , ,r 5 4 a, + v - aZ

R e s e tFo r m SCHEDULEA I MONETARY

( Re v. 0 7 / 0 3 ) RECEI PTS

® CHECKT HI SBOX I FAMENDI NGFORM

STATECANDI DATESNOTE: I FACONTR I BUT I ONI SRECE I VEDFROM AS TAT E PA C( P O L I T I C A LACT I ONCOMMI TTEE ) ,L I S TTHEPACI D ENTI F I CAT I ONNUMBERANDTHEPACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOFI DNUMBERSI SAVAI LABLEFROMTHEI OWAETHI CSANDCAMPA I GND I SCLOSUREBOARD.

NOTE: ANYPERSON, OTHERTHANANI NDI V I DUAL ,THAT CONTRI BUTESMORETHAN$ 7 5 0TO YOURCAMPAI GNMAY HAVEF I L I N GR ES PON SI B I L I T I E SANDSHOULDI MMEDI ATELYCONTACTTHE BOARD.

CAUTI ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,p r o h i b i t s t h eu s eo fi n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n s o rf o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

5TOTAL( i fl a s tp a g e o f t h i ss c h e du l e )

SUB- r oTAL78

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec ommi t t e e st od i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o n t ot h ec ommi t t e e. R e l a t i o n s h i pmus tb es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e ). I fs umame o fc o n t r i b u t o ri st h es ame a s c a n d i d a t e ,b u tt h e r ei sn o P a g e . 5 -f a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn. ( f o rSc h ed u l e A )

DATE PACI DNUMBER NAM DADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE" RECEI VED FUND-( MMW/ YR) ANDPACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D#

Q" ol + + Ce l ~a ~ l~ ~ t l v / oG 1 0 1 4S.

d ) 0 0 1ID# Me r i 1 Jn ' 4e f

~ J t t; / v ` CK# 6 1423°H Osc Ar f Svzl 3 boa °

`

o f t / Zc %~I D#

Yt , o . 1 1"

1 e- . , FmA J r , k , , , ( c & d ,.

l 3 ~ ' 3 ) w4 ' % 1~ "

. ~ s tI D# 1 4,, ' J tCK#

ZSSS -

GI G!

o s e , , l wSoa4J ; c w / 4 r.

x , . 4 3- -oz 13

9 0 1 z cl G

I D# / 1t o r . h . 5 k ' , 1A a. -27CK#c e 2 k e, o ) a l ~ 34s c ~o 1. .. , L~. 4 S' v 2 ) Yv

' / I D#2 7 1 ' t:

c K#Cag4 , 3 f 9 z Go v s f - s fw o o r )5 v , - - , T ` 9 5 70 Z S

o~~aG~xI D# Cr y J

I l 1 3. , r '

CK#c a5

1 1 6 7

r P4 s~Z~HM/ 2

G/ o GI D#

/ b r ; d , ~ c+- 1 4yi - ~ ,e I J

c K#c e

r o s y t r e e " s PL 1 ye5 - o i ' 7

I D# ,

$~Gl O .. CK#Ca54

I t o e

0 3c ev l l < Z - . * 4 Sv Lf 3 / - - -

S~ t G/ 0 6

I D#Si r : r G , - , ' CI22 ' ~L

I xD CK# c t t r

0 S c e o h . Ti 9 c z t l 5 - - S -



Fo r I n s t r u c t i o n s ,Se e B a c k o f F o r m

CONTRI BUTI ONS- -MONEY TAKENI N( I n c l u d i n gc a nd i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me nt o fO r g a n i z a t i o n )

Rr S+ - J e - [ ~ e d

Re a d Fo r m SCHEDULE

A MONETARY( R e v. 0 7 / 0 3 )

I

RECEI PTS

® CHECK THI SBOX I FAMENDI NGFORM

STATE CANDI DATESNOTE: I FACONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( P OL I T I C ALACTI ONCOMMI TTEE ) ,L I S TTHE PACI D EN T I F I C AT I ONNUMBERAND THE PACCHECK NUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI L A B L EFROMTHEI OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

NOTE: ANY PERSON, OTHER THAN ANI N DI V I D UA L ,THATCONTRI BUTESMORE THAN$ 7 5 0TO YOUR CAMPAI GNMAY HAVEF I L I N GRESPONSI BI LI TI ESAND SHOULD I MMEDI ATELYCONTACTTHE BOARD .

CAUTI ON: S e c t i o n6 8B. 3 2 A( 6 ) , p r oh i b i t st h eu s eo f i n f o r ma t i o nc o p i e df r o mr e p o r t sa nd s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so r f o ra nyc omme r c i a l p u r p o s eb y a ny p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc ommi t t e e s.

SUB- TOTAL $I 6, 7( - /

TOTAL ( i fl a s tp a g e o f t h i ss c h e du l e )

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o n t ot h ec o m m i t t e e. R e l a t i o n s h i pm u s tb e s h o wnt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb yma r r i a g e ). I fs umameo fc o n t r i b u t o ri s t h es ame a s c a n d i d a t e ,b u tt h e r ei sn o Page o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l umn. ( f o rSc h e du l e A)

DATE PACI NUMBER E AND ADDRESSO CONTRI BUTOR RELATI ONSHI P AMOUNT I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D# G . ~ C) a - C a ~ , ( e rd ' o i e -

72 Gl 0 G CK# C45~l S2 o A Z So ' f h Ar c0 S c e v t t i. J _ A4 510"1 -3

01 / 2 9/ 0 6

I D# 4 1 a n4 / Ua - c , / &4 e S

2 0 1 5- CCK# S-~ o Gv , .

C $¢ - ~ r , 4 k v ~ )1 e so CA

q ~GCK# C o

l y Df o 1 5 0c i I

f " Ve o

r r q%

~ ` I I p l/ VLI D# s 4 n, a a . Sar a ~CK#

2 7 1 2~ t : Sev4 . ~ . I ~ r . s 'O0 0, E k + o r.

0 9 4 0 6 1 0 6I D# ~ l t ~c ~ c . 1 .L Cwr t i J o n e sCK# 3Z11 U J e o c )b r u. ( ~ L - n ,

S h y K ) e - , , , t , 4 S-o z i o / o o °~I D#

~ ~o n r a y~ .

i k q , c ~~e )o s J dy / d ~ CK#i 3 e c. o r

r OS. t - I 6 r.OF 1 5 7 0 f

0 i / 1,Z) p6I D# wX ; av t t: e &, Oj / I ta SSe r c I l eCK#

) s l X113n0+ f -h l e r ~ ' e 4 . , ~ 0 d

_ e s , . A,/t wo

I D#~a~y + . SA

CK#9 , s 7 v

2 3 0 1 3 04 ' ' A~ c-r d t i m-e -, 5 1 ~- 71

~ I / ~ z hGI D#

; ,W , / f f ' 4 9a ~e ~t / c~S~e )

CK#~~ ZZ 9 w' L ~ 1 C a ~ ns f ,°~G l i. r , C/ o Z S

/ I Z / o h' 'CK# ( 3 9 7

l t s r l & 1r ZC 7 9 c e o&_

l r - /.~C* 4 Sot I l v v



Fo r I n s t r u c t i o n s ,Se e Ba c k o f Fo r m

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEENAME ( Mu s t b es ame a s o nS t a t e me n to fO r g a n i z a t i o n )

I 6 6 i -X 4 11 41r S 4 J -c -

R e s e tFo r m SCHEDULEA I MONETARY

( Re v. 0 7 / 0 3 )I RECEI PTS

CHECKT HI SBOXI FAMENDI NGFORM

STATECANDI DATES NOTE: I FACONTRI BUT IONI SR ECE I VEDFROMASTATEPAC( P O L I T I C A LACTI ONCOMMI TTEE ) ,L I S TTHE PACI D ENTI F I CAT I ONNUMBER AND THEPACCHECKNUMBERI NTHEDES I GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVA I L ABL EFROMTHEI OWAETHI C SANDCAMPA I GND I SCLOSUREBOARD.

NOTE: ANYPERSON, OTHERTHAN ANI N DI V I DUAL ,THAT CONTRI BUTESMORETHAN$ 7 5 0TO YOURCAMPAI GNMAYHAVEF I L I N GR ES P ON SI B I L I T I E SANDSHOULDI MMEDI ATELYCONTACTTHE BOARD.

CAUTI ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,p r o h i b i t st h eu s eo f i n f o r ma t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n s o r f o ra n yc o mme r c i a l p u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

$j

TOTAL( i fl a s tp a g e o f t h i ss c h e d u l e )

SUB- TOTAL r ~~ ~

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec ommi t t e e st od i s c l o s e t h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt ot h ec ommi t t e e. R e l a t i o n s h i pmus tb es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e ). I fs u r n a m eo fc o n t r i b u t o ri st h es amea s c a n d i d a t e , b u t t h e r ei sn o Page 7 o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA )

DATE PACI DNUMBER NAM ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR)ANDPACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D# E~ " 7 s ~ fa . ( ~; n4 b; a 6 e SS C- 1 41'

CK#3 4o f

2~ J o n y ' YU. .n * J7 1 9 2 )

$Sv-

C0

0/ / 7 / 0G

ID# $ q d Z ,f 7 ( Aw k e t I p / ~ JC

POCK#I z s - 3

7Z $ '0 ~ - ~ Z* 4Sv c 2 S~

o0

0 5 / 1 7 / 0 ( -I D # / 4 , 4 4. r . I r w~ ~ T' c r c ~ n

10sCK#3 4 5 - 5- I F 501A

Ge t - n o - j " 1 4 O/ y0

C9 / 7O/ a GI D#

J a n t i G ~Qt r r ' S

CK# 7 ~I Ct C.S, n Z Z- 1 4

SO X 5 1 9/ S 00

0s / 0GI D# , 3 e , "~I +No- s k . - ~ ~f

2 7 44e^ a e. l (5fc K#~061g

0 s « 0 (o ,. 14 5 -0 Z

0 / 7 5 -1 0&

I D#4 1 - i1 - i f 4 t 1G - FV e ) ). '. ~ 7 3 , i e i ) t; I

CK# l o o) 5 v .n A # , AA- e . . 1 411 7 1. I Hc a 0n 5 7-0 rr o

0 9/ VI OGI D#

a i G POe ~e - e 5c K#

~~96) I & t o e ) a e dd 5C. c ol a . 5 - 0Z) 3 1 5 -- v

/ 0G, I D#6 / 1 A . ~ - L t

CK#2z~3

1 7 ,1S' - 1 3 0 +" 5C~r s~~, S P4 60

t r V

CK# 4~ )S~ [ 05 SV, , e *- G~ r - J c , 2 , 0` ' -

S e a . ) ~ i c t ? 0 I

1 0 11 0 1 0 ( o I D#

CK#c c ,4 , t

_

Gt s y C, - «l G- k AuA- WC .. y5Z) r SL : b .

6e5

i b e ., ,` - le e A 0 37 , 0



Fo r I n s t r u c t i o n s ,Se e Back o f F o r m

CONTRI BUTI ONS - -MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

COMMI TTEENAME ( M u s tb e s ame a s o n St a t e me nto fO r g a n i z a t i o n )

R e s e tF o r m SCHEDULE

A I MONETARY( R e v. 0 7 / 0 3 ) RECEI PTS

Wj CHECKT H I SBOXI FAMENDI NGFORM

STATE CANDI DATES NOTE: I FA CONTRI BUTI ONI SRECEI VEDFROMA STATE PAC ( P OL I T I CALACTI ON COMMI TTEE) ,L I S TTHE PAC I DENTI F I CATI ONNUMBER AND THEPAC CHECK NUMBERI NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

NOTE: ANYPERSON, OTHERTHAN ANI N DI V I DUAL ,THATCONTRI BUTESMORETHAN$ 7 5 0TOYOURCAMPAI GNMAYHAVEF I L I N GR ES PON SI B I L I T I E SANDSHOULDI MMEDI ATELYCONTACTTHEBOARD.

CAUTI ON: Se c t i o n6 8B. 3 2 A ( 6 ) ,p r o h i b i t st h eu s eo fi n f o r m a t i o nc o p i e df r o mr e p o r t sa n ds t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so r f o ra n yc o mme r c i a lp u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

$ 5 " ) 7 3 "TOTAL( i fl a s tp a g e o f t h i ss c h e d u l e )

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mm i t t e e st od i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o n t ot h ec o m m i t t e e. R e l a t i o n s h i pmu s tb es h o w nt ot h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e ). I fs u r n a m eo fc o n t r i b u t o ri st h es amea s c a n d i d a t e , b u t t h e r ei sn o Page o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn. ( f o rS c h e d ul eA )

DATE PACI NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI PAMOUNT I FFORRECEI VED ( i fa p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MMI DD / YR)ANDPACCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOME/ I D# 7, " t =77 e 7 797773

I D#

CK#G7 ol c ~ o o ~ o C7 z - l ~CX~

a c 7

ID#

CK#

I D#

CK#

CK#

ID#

CK#

ID#

CK#

I D#

CK#

I D#

CK#

I D#

CK#



THI SBOX APPLI ESTO CANDI DATES'COMMI TTEES ONLY :

P u r c h a s e so fc e r t a i nc amp a i g np r o p e r t yc o s t i n g$ 5 0 0o rmo r e mu s ta l s ob e i n v e n t o r i e do n S ch e d u l eH. ( R ef e r t oS ch e d u l eH i n s t r u c t i o n s. )

E x p e n d i t u r e st o p e r s o n s t e n t i t i e sp r o v i d i n gc on su l t i n g , a d v er t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g ,o r g an i z i n g s er v i c esmus t a l s ob e d e t a i li t e m i z e do nS c he d u l eG b y t h ea mo u n t ,p u r p o s e ,a n dd a t eo f e a c ht y p e o f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e ha l fo ft h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c he d u l eG i n s t r u c t i o n sa n d I o waCode 6 8 A. 4 0 2 ( 3 ) ( i ). )

Page - __- _ o f '3-

( f o rS ch e d u l eB)

FOR I NSTRUCTI ONS,SEE BACKOF FORM Re s d Fo r m SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENTFROM COMMI TTEEACCOUNT ( R e v. 0 7 1 0 3 ) EXPENDI TURESSTATE PAC COMMI TTEES: NOTE: FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHECANDI DATEI DENT I F I CAT IONNUMBER I NTHEDESI GNATEDCOLUMN ANDTHE ~- CHECK THI SBOX I FPAC CHECKNUMBER FOREACHEXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHEI OWA AMENDI NG FORMETHI CS$ CAMPAI GN DI SCLOSUREBOARD.

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n to f O r g a n i z a t i o n )

/ A, ~_~ _ ( ~; , S 4 J --e _CANDI DATE NAME ANDADDRESSTO WHOM PURPOSE AMOUNT

DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa p pl i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

/

2 I l i bI D#

\ k w -mQ1 ' I 'J e f f e r s c s ,S+ .

e n v z l op h 5' l~ wXesCK# 1 5 6 4 N . i d d i E. $ L4 7 - o 6

I 4 Gc n oj a. , I f l 5 z ' 1 2 - 5I D# ~ S C~ e I c LPCs t S' t a mp s

7 1 2 1 1 o 6 CK# 0 s c I I J a 1w S" v Z 1 3 / / 7 , ©a

I D# So i u 4 'o v, 5 L t; L 0 rC - Sr i 7 } u - 1Lc _7 / 2 1 / b6 CK# POB t u3

1 0 t ) c J e f i - 4 y 3N

Or. O6Ce c j a , 1 A t f-

I D# $ o j , ~ - F i o v , S ! 3 c r Co l o rC 1 _~ p / F S1 1 CK#

p t )Bo xBo x 3 6 43 6 4Pr . 6 SCec I Q , I A B( a & P1 , A i t r~ ~Y s

s ' 4 3I D# Wa [ - SI Rr f i

~ Ij x F Sr 4 ' a /

CK# j o b s 7 3 S f W, nd56 r{ ~id d 5

C5Des Mo ; n r s ,I A

I D# ^

f I o CK# d , . C a e J t1 ` f ' ( / 1 7 0 { ~ '+~ 0 ~ f ( J Os ' u J { _~ 1P ~ ~ ! %~ c t r s 4p . e x )~~ t ~ , Mu rc a Aa v4 C

I D# ~x c n i 2 c e - S+ a vwp s

CK# d 5L e0 I r ~ - T / 4 5n z l 3 - : : 3q b v

ID# wa , 1 - AAav +

I F/ I 8 ~e 6 CK# l 3 DO d l J e f ' e - 5 p, , f t .ThQ, K q 0 t , c a - r 6 ( 5 3 s ~ i S

l h dl ' a. z ? Cl a _ 5 z 1 3 S, I A E ' nVel a sSUB- TOTAL $

S7R . 0

TOTAL ( i fl a s tp a g e o f t h i ss c h e d ul e ) $1 _ _ j



THI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :

P ur c h a s e so f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o r mo r e must a l s ob e i n v e n t o r i e do n Sc h e d u l e H . ( R e f e rt o Sc h e d u l e H i n s t r u c t i o n s. )

E x pe nd i t u r e st o p er s o n s/ e nt i f e sp r o v i d i n gc o n s u l t i n g ,a d v e r t i s i n g ,f u n d - r a i s i n g ,p o l l i n g ,ma n a g i n g , o r g a ni z i n g s e r v i c e smust a l s o b ed e t a i li t e mi z e do nSc h e d u l eG b y t h eamo u n t , p u r p o s e , a n d d a t e o f e a c h t y p eo f e x pe nd i t u r emade b y t h ep e r s o n / e n t i t yo n b eh al fo f t h e c an di d at e ' sc o mmi t t e e. ( R e f e rt oSc h e d u l eG i n s t r u c t i o n sa n d I owa Code t i 8 A. 4 0 2 ( 3 ) ( i ). )

P a g e - 2- - of -- 3

--

( f o rSc h e d u l e B)

FOR I NSTRUCTI ONS,SEE BACK OF FORM Rese t Fo r a l SCHEDULE

EXPENDI TURES MONETARY- - MONEY SPENTFROM COMMI TTE EACCOUNT( Re v. 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TO STATEWI DE OR LEGI SLATI VECANDI DATES,L I STTHE CANDI DATE I DENT I F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THE CHECK THI S BOX I FPACCHECK NUMBER FOR EACH EXPENDI TURE. A L I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS& CAMPAI GN DI SCLOSUREBOARD .

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n)

- " o7 S TG3 &- -

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i fa p p l i c a b l e ) ( Di s b u r s eme n t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D# Ca5f ~ ' 5 ~~ e n e ~Q- f s - ~~ ~.

~- y s of Z ( - C- CO- $ q3 l aDS L r ? ~ l k.. ~A 5 2 < i ~3 J - k

ID#t !~Se~S 6 t n S 4 - t . n

S - t 1v , , ) , , _' f e ,CK# I I q 0 , 0EVC, 3L ,. ' 1 - c ) o o ~ L C n v c ~ +: ~ n r

~ U . DD

C) ( e 0 I mo - V0w_ +c c J SID# C r e ,,c w 'v e L e c ~ f n G, P GL l h 1CCcr d S

q 1 - lDt , CK# 1 bbl 6 f ~i Cr (-c i r ~~Cl - 6 0 0 . 0 01 3 f WeSi ` Des ~ U; I f l P

I D#Or , . e a t u a ' T e , d ,; 0 9 P r; ~ S/-I 5

9 / 5 1 0 6CK# Pp b o x 3 3 c g - D- 3dma . il ~

_, t J LG~ / o 3 - ~ 3 ~

I D#~BC- 5 ~ h S

i 2 o CK# .s.. ; s - Mo b . ~ l ~ l(. 36 6 ~ t 7 , SZ~

I D# " 4 d y e r- ~-i5 ~ - r ~ Ad i n t i L e9 I h b ~ CK# 1 1 1

~ a / 37H

o s&e o l a , /. 4

9 / i CK# ~ J S - ' r-7Vp . bU

ID#C i a t - k QC c v l r , - )P L L b l I ' s 1 ~ ~ ~ >

-I ~ ~ n Ix = p e i

CK# ( 1 5F we t s k i - h n,

/ UD

SUB- TOTAL $ 2 - ZH z g

TOTAL ( i fl a s t page o f t h i s s c h e d ul e ) $



FORI N S TRUCT I ONS ,S EEBACKOFFORM

COMMI TTEENAME ( M u s tb e s a me a s o nS t a t e m e n to fOr g a n i z a t i o n )

f o / - SAI ~ _ La .

Re s e t Fo r m

SCHEDULEE I N- KI ND

( Re v. 0 6 / 9 7 ACONTRI BUTI ONS

( p CHECK THI S BOX I FAMENDI NG FORM

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t e st od i s c l o s et h e r e l a t i o n s h i po f a n yr e l a t i v ema k i n g a ni n k i n dc o n t r i b u t i o nt o t h e P a g e o f Z

c o mmi t t e e. R e l a t i o n s h i pmu s t b es h own t o t h et h i r dd e g r e eo fc o n sa n g ui n i t y( b l o o dr e l a t i v e s )a n d a f f i n i t y( r e l a t i v e s ( f o rS c h e d u l eE)b yma r r i a g e ). ( S e eP a g e 2 o ff o r m sp a c k e t. ) I fs umame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h e r ei s n of a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a p p l i c a b l e "i n t h er e l a t i o n s h i pc o l umn.

DATE RELATI ONSHI P DESCRI PTI ON ESTI MATED 4 I FFORRECEI VED NAME ANDADDRESS TOCANDI DATE OF I NKI ND FAI RMARKET FUND- RAI SER( MM/ DDI YR) OF CONTRI BUTOR ' ( i fa p p l i c a b l e ) CONTRI BUTI ON VALUE CONTRI BUTI ON

o f / x / c G r e ? ) E a , f9 { i S~o °

~ 7vd o s FD e s -4f o t n r s . 174 S' 0 30 1

~ s f 1 v ~ ~ ~ c a. n I06+y Cr c , 4c

-L09o ~Aw E J

` s ^ , ;i e ~ 9 570309

0 J I . 1 3 l o ( o0 . , s b ); Z & - ,/ a n y of r o w 4 1

g r ~ r

F(C?I EAS+ 9 +4

' t e e . 1 I ~ SD o 1 ' ~ a: ~ l ~ s s ~i , SOUK

3 0 oG C , 1 t G~ , t ~ t ~ Os ~a ~ S 7 S 9 3e s o " . . a , 4 S0 3 c ' 5

/ a ( , Qea , , ~ hf ~ 1°w~ y c f To". x. l r i~e c }, h 4: 11 3

s o o 1 A r 0 dy~ . . ,

0 1 Vo t s R e , O4 1 , 1 a^ P a J y s - f . L O" . , q r 0 9 4. 1A o S F a y c. 4 E : : ]E a s t -5 . 4L , l S ~~. ~ s

A9 : r ~03o r ;n ~ ' wJ e a " O - k C a ~ 0 - PT o - - _ t f l , ~ e c ' f "

09

1 , 1 0 6 r. 7t

l a s t s1 416

~ ' ' ' ~y 9 5 ! y z, p 4 s 0 c lt ~~ ~ ~ r l 0 v ~ j ~ el G~ / A C t l7 y D ~ - Vir c c ~~4 . l

z t ~ - ~C - t i , ~. tF ,n EJ



- F O RI N S T RUC T I ON S ,S E EBACKOFF O RM

COMMI TTEENAME ( M u s tb e s ame a s o nS t a t e me n to fO r g a n i z a t i o n )

u / L , / - r c J 7 - t L e d ,

Re s e t Fo r m

SCHEDULEE I N- K I N D

( Re v. 0 6 / 9 7 )I

CONTRI BUTI ONS

® CHECK THI S BOX I FAMENDI NG FORM

` D i s c l o s u r el a wr e q u i r e sc a n d i d a t e st od i s c l o s et h er e l a t i o n s h i po f a n y r e l a t i v ema k i n g a ni nk i n d c on t r i b ut i o nt o t h e Page Z o f _Z-c o mmi t t e e. R e l a t i o n s h i pmu s t b eshownt o t h et h i r dd e g r e eo f c o n sa n g u i n i t y( b l o o dr e l a t i v e s )a n d a f f i n i t y( r e l a t i v e s ( f o rSc h e d u l eE )b yma r r i a g e). ( S e ePage 2 o f f o r m s p a c k e t. ) I fs u r n ameo f c o n t r i b u t o ri s t h es ame a s c a n d i d a t e ,b u tt h e r ei sn of a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i n t h er e l a t i o n s h i pc o l umn.

DATERECEI VED NAME AND ADDRESS

RELATI ONSHI PTO CANDI DATE

DESCRI PTI ONOF I NK I ND

ESTI MATEDFAI RMARKET

4 I FFORFUND- RAI SER

( MM/ DD/ YR) OF CONTRI BUTOR ' ( i fa p p l i c a b l e ) CONTRI BUTI ON VALUE CONTRI BUTI ON

1 - 9 Ak 93 Ac{ mr / ' 1 t e. ) FW]Ld p o l. - . Z " W S-o , 2 S. -

0 8 0 ~ oG0 ' %J & r v y r r e s s

l S . 2o 2 $ ' o s t i- , eS: c ) ad r Ar D~ e rI t , f a f c ' ~ -~ s FI X

e e o l t i i 9 So t 1 3 ~. . Kqt . ' 1 ~.

O~ l G/ a GAo. / Su o ~ e"

, t i as e n S, J ~ c ~; s ~ + FYNe%3V ~ i a ~s s 4 ' f i r

. K 0 4 , (

So Zl y

8 l 2 % / - t wo j ~ y S, a ~ x ,5 4 ooOSCan r . , S" o2 t 3 ~ o~ ~ + e e. /

Wr i5 / 0 A/ c , 4 "6c, 4 Z ,

r r A-7Os c e ol a . Z 7r 9 Sv t t 3

~ -- F T Ig / ZG~G 1 8 7 q

Ai e , r X

e S « o ~ E ,1 1 c , ^

. 9 0 2 I ' S~ r o l l s ` ) v=

~ Z / ~l 4 wv Jf- I J e ~ 4 , ' e _. 5 i: ,e l l. ,-,2 3 1 1 7I s 7 p l eM. ' l l y

Rd

& b r e ,6,4 . t. a ~. 1 t1 4

Y.S t ~ ' f s e f s ' 3Voiv v

0n ~ ~5 C:~. 5 ' o n G5 ' e

- 1 6 0 1 6 / 0r. 8 / ON ; ~ S f ' f ( 7 7°iOs cwk = , 4 , Swzi3

F - 1

F - 1

Barber George1682scanned

Documents

Transcript of Barber George1682scanned

Barber George__1682__scanned

Documents

Transcript of Barber George__1682__scanned

Barber George1682scanned

Transcript of Barber George1682scanned