Beltrame Marc1317scanned

8/7/2019 Beltrame Marc__1317__scanned

1/28

FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SL MARYPAGE

COMMI TTEE NAME ( Mu s t be same a s o n St a t e me n t o f Or g an i z a t i o n)Ci t i z en s f o r Be l t r ame

I MPORTANT . I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r : F i l( 1 ) S t a t e w i d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e( 8 ) S u p p o r t , S l a t e o f C a n d i d a t e s

SI GNATURE OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t )R o u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Re p o r t s Rang e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLL OWI NG SENTENCE :I AM F I L I NG A 1 2/ 3 1/ 0 1 REPORT FORAN/ A ( 1 ) E L ECTI ON / ( 2 ) NON- E L ECT I ON YEAR.

( r e p o r t d a t e )n CHECK I F AMENDMENT TO REPORT DATED

0 Ch e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t an d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Yo u mu s t c o n t i n u e t o f i l e r e p o r t s u n t i l a N o t i c e o f D i s s o l u t i o n i s f i l e d . )

STATEMENT OF CASHON HAND

I n d i c a t e o n e

CASHON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a l o f a l l mo n i e s h e l db y t h e c o mmi t t e e . T h i s amoun t MUST b e t h e same a s t h e c a s h o n h an d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d , o r must b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTALMONEY TAKEN I N T HI S PERI OD

CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l eGA t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H ) $

DR- 2 I DI SCLOSURE( Re v . 0 1 / 2 0 0 1 ) REPORTF o r O f f i c e Us e O n i v /Co mm . #I n d e x e d , 5w - 1 1 _ ( ) 7 ;

0

L o c a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y 8 < L o c a l C o mmi t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

_ X YES NO0

Sc h e d u l e A : Cas h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A ) ( * a l s o s e e i n - k i n d b e l o w ) . . . . . . . . .Sc h e d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca nd i d at e s ' Commi t t e e s On l y )

1 4, 7 90 . 0 000

SUB- TOTAL . . . . . . $ 1 4, 7 90 . 0 0SUBTRACT TOTALMONEY SPENT T HI S PERI ODSc h e d u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) ( * * a l s o s e e d e b t s an d l o a n s b e l o w ) . . . 3 , 9 26 . 0 6Sc h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

CASHON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b al a nc e mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1 0 , 8 6 3 . 9 4

* * UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d ul e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 6 19 . 0 4* I N K I ND CONTRI BUT I ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3 , 1 16 . 7 9* * OUTSTANDI NG LOANS ( F r o m Sc h e d ul e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0


2/28

F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM ASTATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CAT I ONNUMBER ANDTHE PACCHECK NUMBER I N THE DES I GNATED COL UMN. A L I S T OF I D NUMBERS I S AVA I L A BL E F ROM THE I OWA ETHI CSAND CAMPAI GNDI SCLOSURE BOARDCAUTI ON: Se c t i o n 6 8 B. 3 2 A ( 6 ) , I o wa C od e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) L$ 3 , 7 4 0 . 0 0D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b y 1 2 3ma r r i a g e ) ( S e e Pa g e 2 o f f o r m s p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa g e of _f a m i l i a l r 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 e r e l a t i o n s h i p c o l u mn ( f o r S c h e d u l e A)

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I F F ORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SENUMBER I NCOMU111 / l I p # J a s o n W2 1 Ke1 8 2 8 V i n e S t $ 1 0 0 . 0 0CK# We s t De s Mo i n e s , I A 5 0 2 6 5I D# Ga r y S a n d q u i s t8 0 0 9 He a t h e r Bo w 1 , 0 0 0 . 0 0CK# J o h n s t o n , I A 5 0 1 3 1

t Y A 1 0 I L 1 r I D# L a r r y a n I n a e t r a me1 1 1 5 Ca u l d e r F a t h e r & 2 , 0 0 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 5 Mo t h e r0 8 / 0 3 / 0 1 I D# P a t r i c i a S h o f f6 6 6 Wa l n u t , S u i t e 2 5 0 0 1 0 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 0 90 8 / 0 3 / 0 1 I D# B r i a n G a l l i g a n2 8 2 5 Gr a n d Av e 1 0 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 20 8 / 0 3 / 0 1 I D# Th er e s a Fu na r o

2 3 0 3 S . E 7 t h S t 4 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 50 8 / 0 3 / 0 1 I D# C l a y t o n Co p p l e

CK# 1 0 9 2 2 L i n c o l n Av e 1 0 0 . 0 0De s Mo i n e s , I A 5 0 3 2 50 8 / 1 0 / 0 1 I D# N i c k K u r t

CK# 1 2 4 0 7 W1 0 2 n d S t 1 0 0 . 0 0L e n e x a , KS 6 6 2 1 50 8 / 1 0 / 0 1 I D# F r e d S t i n e s

CK# 6 8 0 5 8 t h S t r e e t 1 0 0 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 50 8 / 1 0 / 0 1 I D# D a r r e n S c h l a p k o h l

CK# 2 6 3 3 F l e u r Dr . 1 0 0 . 0 0De s Mo i n e s , I A 5 0 3 2 1


3/28

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATECANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBERANDTHE PACCHECKNUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON: Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )

$ 1 , 7 2 5 . 0 0` D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b y 2 2 3m a r r i a g e ) ( S e e Pag e 2 o f f o r ms p ac k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o P a g e o ff a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn ( f o r S c h e d ul e A)

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SENUMBER I NCOM0 8 / 2 8 / 0 1 I D# B r i a n - Hook1 9 4 5 L o r r a i n e Av e $ 1 5 0 . 0 0CK# McLean , VA 2 2 1 0 10 8 / 3 0 / 0 1 I D# S e a n a n d Me l i s s a e e l e r1 3 9 2 7 B r y n Ma wr Dr 1 0 0 . 0 0CK# U r b a n d a l e , I A 5 0 3 2 30 9 / 1 / 0 1 I D# K i r s t e n a n d E r i k Bo ot h1 8 4 0 3 r d Av e S . E 1 0 0 . 0 0CK# Ceda r R a p i d s , I A 5 2 4 0 3 '0 9 / 2 1 / 0 1 I D# T h a d a nd J e a n Mu r p h y2 8 3 9 E 3 2 n d S t 2 5 0 . 0 0CK# D a v e n p o r t , I A 5 2 8 0 70 9 / 2 4 / 0 1 I D# Edwa r d B e l t r a me3 8 3 7 M u r r a y Vi e w Av e NE G r a n d f a t h e r 5 0 0 . 0 0CK# L o w e l l , MI 4 9 3 3 10 9 / 3 0 / 0 1 I D# Ma t t h e w C o u l t e r

1 1 9 3 2 H i c k o r y S p r i n g Dr 2 5 0 . 0 0CK# B r i mf i e l d , I L 6 1 5 1 70 9 / 3 0 / 0 1 I D# Ma t t a n d J e n n i f e r C r o n i n

CK# 4 0 1 1 F a g e n Dr 2 0 0 . 0 0De s Mo i n e s , I A 5 0 3 1 01 0 / 7 / 0 1 I D# T h oma s S c h l a p k o h l

CK# 5 5 0 3 9 t h S t 1 0 0 . 0 0De s Mo i n e s , I A 5 0 3 1 21 0 / 1 6 / 0 1 I D# To n y a n d Gr a c e Mo n t o g n e s e

CK# 3 0 2 5 As h wo r t h Rd 5 0 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 51 0 / 1 9 / 0 1 I D# D o r i s a n d An t h o n y B e l t r a m e

CK# 3 3 1 9 E 2 9 1 h N/ A 2 5 . 0 0De s Mo i n e s , I A 5 0 3 1 7


4/28

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I D ENT I F I CAT I ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB-TOTAL$

TOTAL ( i f l a s t page of t h i s s c h ed u l e)2 0 0 . 0 0 I - '

* Di s c l o s u r e l a w r e q ui r e s c a n di d a t e c o mmi t t e e s t o d i s c l o s e t he r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c on t r i b u t i o n t o t hec o mmi t t e e . Re l a t i o ns hi p mu s t be shown t o t h e t h i r d d e g r e e o f c o n s an gu i n i t y ( b l o od r 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 b y 3 2 3ma r r i a g e) ( S e e Page 2 o f f o r ms p a c k e t . ) . I f sur name o f c on t r i b u t o r i s t he s ame as c an d i d a t e , b ut t h er e i s n o Page o f _f a mi l i a l r e l a t i o n shi p , e n t e r " n o t a pp l i c a b l e " i n t he r e l a t i o ns hi p col umn . ( f o r Schedu l e A)

SCHEDUL EA MONETARY( R e v 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ D D / Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 0 / 2 0 / 0 1 I D# L o u i s A l f o r d4 1 1 0 N P a u l i n a $ 2 0 . 0 0 dCK# C h i c a g o , I L 6 0 6 1 31 0 / 2 0 / 0 1 I D # Be t h a ny Wi n y er d2 4 0 0 L a k ev i e w Dr A p t 1 1 1 2 2 0 . 0 0 , lCK# C h i c a g o , I L 6 0 6 1 21 0 / 2 0 / 0 1 I D# Ma t t Kr a mb e c k1 0 4 8W. Di c k e n s # 2 4 2 0 . 0 0 dCK# C h i c a g o , I L 6 0 6 1 41 0 / 2 0 / 0 1 I D# S t e v e F r a k e2 4 0 0 L ak e v i e w Dr . A p t 1 1 1 2 2 0 . 0 0CK# C h i c a g o , I L 6 0 6 1 21 0 / 2 0 / 0 1 I D # Da v e Mc D e v i t t

CK# 1 0 4 8 WDi c k e n s # 2 4 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 41 0 / 2 0 / 0 1 I D # Tom F a n t e r

CK# 3 7 2 2 S o u t h p o r t Av e # 2 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# K a v i a n B o o t s

CK# 8 5 8 WWr i g ht wo o d Av e . 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# Ma r i S w i f t

CK# 1 8 7 5 N . F r emon t 2 0 . 0 0C h i c a g o , I L 6 0 6 1 41 0 / 2 0 / 0 1 I D # Egan Du f o n

CK# 2 3 5 8 P r a i r i e 2 0 . 0 0 dE v a n s t o n , I L 6 0 2 0 11 0 / 2 0 / 0 1 I D # F a f y B o o t s

CK# 3 5 2 8 N F r emo n t 2 0 . 0 0 dC h i c a g o , I L


5/28


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

Ca r d ; r w- e - 1 6 0 i C { - ' i ; , r a l l A l " p ~ 5 SUB- TOTAL $ 4 0 0 . 0 0 `TOTAL ( i f l a s t page o f t h i s s c h e du l e )' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b yma r r i a g e ) ( S e e Pa g e 2 o f f o r ms p ac k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b ut t h e r e i s n o P a g e 4 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e du l e A)

SCHEDULEA MONETARY( Re v 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SENUMBER I NCOM1 0 / 2 0 / 0 1 I D # K a t i e L i n e h a nCK# 5 5 2 2 WL e l a n d $ 2 0 . 0 0 dC h i c a g o , I L 6 0 6 3 0

1 0 / 2 0 / 0 1 I D # Co ur t n e y Wo r r e l lCK# 5 5 2 2W. L e l a n d 2 0 . 0 0 fC h i c a g o , I L 6 0 6 3 0

1 0 / 2 0 / 0 1 I D # Mi k e D a v i sCK# 4 2 5 7 N Mo z a r t 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 8

1 0 / 2 0 / 0 1 I D # T o d d P a g e lCK# 8 1 6 WWa v e l a n d 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 3

1 0 / 2 0 / 0 1 I D # Da n B o n e r tCK# 3 3 4 3 N L e a v i t t 2 0 . 0 0 dC h i c a g o , I L 6 0 6 2 2

1 0 / 2 0 / 0 1 I D # J a s o n V e e d e rCK# 1 2 0 9 D e e r f i e l d Pkwy # 1 0 2 2 0 . 0 0B u f f o a l G r o v e , I L 6 0 0 8 9

1 0 / 2 0 / 0 1 I D # J o s h A l e s c hCK# 1 3 4 1 We s t Ad d i s o n 2 0 . 0 0 dC h i c a g o , I L

1 0 / 2 0 / 0 1 I D # Ro b e r t Wag n e rCK# C h i c a g o , I L 2 2 0 . 0 0I D #1 0 / 2 0 / 0 1 Ti m K e l s c hCK# 2 2 4 0 N H a l s t e d # 1 3 2 0 . 0 0 dC h i c a g o , I L1 D #1 0 / 2 0 / 0 1 S t e p h S a d o w s k e yCK# 2 2 4 0 N . H a l s t e d # 1 3 2 0 . 0 0 dC h i c a g o , I L


6/28

F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUT I ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( M u s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)

C i t i z e n s f o r Be l t r a me

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E PAC ( P O L I T I C A L A C T I O N C OMMI T T E E ) , L I S T T H E P A C I D EN T I F I CA T I ONNUMBER AND T HE PAC CHECKNUMBER I N T H E D E S I G N AT E D COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROMT HE I O WA E T HI C S AND C A MP A I G ND I S C L O SU R E BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m m e r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

SUB- TOTALTOTAL ( i f l a st page o f t h i s s c h e du l e ) $ 2 0 0 . 0 0 1 ' - '

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n o P a g e 5 o f 2 3f a m i l i a l r 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 e r e l a t i o n s h i p c o l u m n . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 i I i ~ ~ I l l 1 I D# J u s t i n S t e n d e r1 1 3 9 1 / 2 WWe l s t e r # 2 F $ 2 0 . 0 0 fCK# C h i c a g o , I L1 0 / 2 0 / 0 1 I D# J o h n Ku e t h e1 1 3 9 1 / 2WWe l s t e r # 2 F

2 0 . 0 0 dCK# C h i c a g o , I L1 0 / 2 0 / 0 1 I D# Mi l i s s a L i n d4 0 1 WF u l l e r t o n # 1 3 0 8 - E 2 0 . 0 0 dCK# C h i c a g o , I L1 0 / 2 0 / 0 1 I D# P h i l l i p B e n n e t t

CK# 3 2 2 9 N C l a r k 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# Ry a n S wo l l

CK# 3 8 2 2 N Wa y ne 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 31 0 / 2 0 / 0 1 I D# M e r e d i t h Bur k e

CK# 1 9 4 7 T r e v i n o 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# P h i l Bo o t s

CK# 3 5 2 8 N F r emon t 2 0 . 0 0C h i c a g o , I L1 0 / 2 0 / 0 1 I D# Andy P a t r i c k

CK# 2 2 4 0 WH o l s t e d 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# Amy J u s t i c e

CK# 1 9 2 2 N O r c h a r d 1 R 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# Ke v i n O ' D o n n e l l

CK# 1 9 0 2 B uc k i ng ha m Dr # 4 2 0 . 0 0 ,Ceda r R a p i d s , I A


7/28

Fo r I n s t r u c t i o ns , SeeBack o f Fo r mCONTRI BUTI ONS - - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t be 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)

C i t i z e n s f o r Bel t r a me

SCHEDULEA MONETARY( R ev 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NGFORM

STATECANDI DATES NOTE: I F ACONTR I BUT I ON I S RECE I VED FROMASTATE PAC( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PACI DENT I F I CATI ONNUMBERANDTHEPACCHECK NUMBER I N THEDESI GNATED COLUMN . AL I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 6 8B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o se by a n y p e r s o n ot h er t h a n s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB- TOTALTOTAL ( i f l a st page o f t h i s s c h ed u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e commi t t ees t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must be shown t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( See Pa g e 2 o f f o rms p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , bu t t h e r e i s no P a g e 6 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e du l e A)

DATE PACI D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT d I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 0 / 2 0 / 0 1 I D# Ro b Wa g ne r1 5 4 8 N . Hanover $ 2 0 . 0 0CK# C h i c a g o , I L 6 0 6 2 21 0 / 2 0 / 0 1 I D# Chad Lower1 9 4 2 N Mohawk # 2 R 2 0 . 0 0 dCK# C h i c a g o , I L 6 0 6 1 41 0 / 2 0 / 0 1 I D# R y a n P r i n c e

CK# 5 5 2 0 WL e l a n d 2 0 . 0 0 fCh i c a g o , I L1 0 / 2 0 / 0 1 I D# C a r i n F a n t e r

CK# 3 7 2 2 S o u t h p o r t Av e # 2 2 0 . 0 0 fC h i c a g o , I L1 0 / 2 0 / 0 1 I D# B r i a n Bo o t s

CK# 3 5 2 8 N Fr emont 2 0 . 0 0C h i c a g o , I L1 0 / 2 0 / 0 1 I D# L i s a Bo o t s

CK# 3 5 2 8 N Fr emont 2 0 . 0 0 dC h i c a g o , I L1 0 / 2 0 / 0 1 I D# Na t e Ol d s

CK# 2 7 2 0 N. Ma g no l i a 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 41 0 / 2 0 / 0 1 I D# A l e x Ledger

CK# R i c h f i e l d , NY 2 0 . 0 0 d1 0 / 2 0 / 0 1 I D# K y l d Ledger

CK# 2 7 2 2 N Ma g no l i a 2 0 . 0 0 dC h i c a g o , I L 6 0 6 1 4I D#1 0 / 2 0 / 0 1 A. J . A t t aCK# 3 8 2 2 N . Wa y ne 2 0 . 0 0 ,C h i c a g o , I L 6 0 6 1 3


8/28

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N


C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON: Se c t i o n 68 B . 3 2 A( 6 ) , I owa Cod e, p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me nt s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r any c ommer c i a l p ur p os e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB-TOTAL$

TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) FDi s c l o s u r e l a w r e q ui r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c on t r i b u t i o n t o t h ec o mmi t t e e . Re l a t i o n s hi p mus t b e s h o w n t o t h e t h i r d d eg r e e o f c on s an g ui n i t y ( b l o od r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( Se e Page 2 o f f o r ms p a c k e t . ) I f s umame o f c on t r i b u t o r i s t h e s ame as c an di d at e , b ut t h e r e i s no Page 7 o f 2 3f a mi l i a l r e l a t i o ns h i p , e nt e r " n o t a pp l i c ab l e " i n t h e r e l a t i o ns h i p co l umn ( f o r Sc h edu l e A)

SCHEDULEA MONETARY( R e v 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DDNR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 0 / 2 0 / 0 1 I D# U n i t e mi z e d C o n t r i b u t i o n sGa l a E v e n t $ 1 0 0 . 0 0CK# C h i c a g o , I L1 0 / 2 4 / 0 1 I D # C h a r l e s an d Sand r a C a l i g i u r i

CK#5 1 2 SE D i e h l 1 0 0 . 0 0Des Mo i n e s , I A 5 0 3 1 5

1 0 / 2 4 / 0 1 I D # R i c h a r d P a s u t t iCK# 2 1 1 3 SE 9 t h 3 0 . 0 0Des Mo i n e s , I A 5 0 3 1 5

1 0 / 2 4 / 0 1 I D# J o n Ho f f manCK# 2 8 2 5 7 7 t h S t 2 0 . 0 0U r b a n d a l e , I A 5 0 3 2 2

1 0 / 2 5 / 0 1 I D# Domi n i c & V i r g i n i a Ar me n t a r oCK# 5 2 0 Wa l l Av e . 2 5 . 0 0Des Mo i n e s , I A 5 0 3 1 5

1 0 / 2 9 / 0 1 I D # De n n i s & Ma x i n e F l a h e r t yCK# 1 8 3 4 E v e r g r e e n 2 0 . 0 0Des Mo i n e s , I A 5 0 3 2 0

1 1 / 0 1 / 0 1 I D # L a wr e n c e an d Mar y Gi n a B e l t r a meCK# 1 1 1 5 C a u l d e r F a t h e r & 1 0 0 . 0 0Des Mo i n e s , I A 5 0 3 1 5 Mo t he r

1 1 / 0 1 / 0 1 I D # J ames a n d Nancy Ga l l o wa yCK# 5 5 0 1 Wood l a n d Av e 1 0 0 . 0 0 dWes t Des Mo i n e s , I A 5 0 2 6 6

1 1 / 0 1 / 0 1 I D# Wi l l i a m an d Cynde F a n t e rCK# 3 4 1 0 SW2 4 t h S t 1 0 0 . 0 0 1Des Mo i n e s , I A 5 0 3 2 1

1 1 / 0 1 / 0 1 I D # R y a n Ga r l a n dCK# 3 2 1 7 SW 1 2 t h S t 3 5 . 0 0Des Mo i n e s , I A 5 0 3 1 5


9/28


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s on S t a t e me n t o f Or g an i z a t i o n)

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Co de , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o pi e d f r om r e p o r t s a nd s t a t e me n t s f o r s ol i c i t i n g c on t r i b ut i o ns o rf o r any c omme r c i a l p ur p os e by any pe r s on o t h e r t h a n s t a t u t o r y p o l i t i c a l commi t t e e s .

SUB-TOTAL

TOTAL ( l f l a s t p a g e o f t h i s s c h e du l e ) r $63 0 . 0 0

Di s c l o s u r e l aw r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c ont r i b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o ns a n gu i n i t y ( b l o od r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s b y 8 2 3ma r r i a ge ) ( S e e Pa g e 2 o f f o r ms p a c k e t . ) . I f su r name o f c o nt r i b u t o r i s t h e sa me as c and i d at e , b u t t h e r e i s no Page o f _f a mi l i a l r e l a t i o n s hi p , e nt e r " n o t a pp l i c ab l e " i n t h e r e l a t i o ns h i p co l umn ( f o r Sc h e d ul e A)

SCHEDUL EA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM / D D / Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / i 1 I j / L l 1 I D# Wi l l i am Fant e r6 0 8 1 1 t h S t $ 5 0 . 0 0 dCK# We s t Des Mo i n e s , I A 5 0 2 6 51 1 / 1 1 1 0 1 1 1 I D# GG and Ge o r g e u na r o2 9 0 9 So u t h e r n H i l l s C i r c l e 2 5 . 0 0 dCK# Des Mo i n e s , I A 5 0 3 2 11 1/ 0 1/ 0 1 I D# K r i s t i n e Be l t r a me2 7 0 6 Gl o v e r N/ A 1 0 0 . 0 0 dCK# Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D # J T a nd El e no r a Ga l l o wa y6 3 0 0 S c h o o l S t . , Ap t 3 1 8 5 0 . 0 0 , I rCK# Des Mo i n e s , I A 5 0 3 1 11 1 / 0 1 / 0 1 I D # L uc i a a nd A l l e n Ha l e3 8 0 5 SW1 4 t h 2 0 . 0 0CK# Des Mo i n e s , I A 5 0 3 1 51 1/ 0 1/ 0 1 I D# Ma r i o a nd Anna Fa l b o

3 9 2 5 SW2 8 t h Pl a ce 2 0 . 0 0CK# Des Mo i n e s , I A 5 0 3 2 11 1/ 0 1/ 0 1 I D# F r a nc e s a nd J o s e p h F ai n o

CK# 4 1 2 2 Au r o r a Gr e a t Un c l e 3 0 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 0 & s p o u s e1 1/ 0 1/ 0 1 I D# He l e n Go o d wi n

CK# 3 1 3 1 F l e u r D r i v e , Ap t . 6 0 3 2 5 . 0 0 fDes Mo i n e s , I A 5 0 3 2 11 1 1 0 1 / 0 1 I D # V . C . He i d ema n

CK# 3 8 3 7 SWTh o r t o n 3 0 . 0 0 dDes Mo i n e s , I A 5 0 3 2 111 / 0 1 / 0 1 I D # Von He i d ema n

CK# 3 8 3 7 SWTh o r t o n 1 0 . 0 0 dDes Mo i n e s , I A 5 0 3 2 1


10/28


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( M u s t b e same a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA TI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.

CAUTI ON : S e c t i o n 6 8 B. 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .


Di s c l o s ur e l a w r e q ui r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c on t r i b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p mus t b e s h own t o t h e t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o od r 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 b yma r r i a ge ) ( S e e Pa ge 2 o f f o r ms p a c k e t . ) . I f s u r n ame o f c on t r i b u t o r i s t h e s ame as c a nd i d a t e , b u t t h e r e i s no Page 9 o f 2 3f a m i l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

SCHEDULEA MONETARY( R e v 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG F ORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D/ Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 1 / 0 1 / 0 1 I D# J Camp b e l l H e l t o n5 8 0 8 F o r e s t $ 5 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 11 1 / 0 1 / 0 1 I D# P a u l H e r r i n4 9 0 Co u n t y L i n e Road 5 0 . 0 0 , (CK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Do r o t h y H i l l1 1 0 0 Ca u l d e r Av e 2 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Sh a r o n Ha c k b a r t h

CK# 1 4 4 6 Wi l d P r a i r i e D r i v e 1 0 0 . 0 0 , TI o wa C i t y , I A 5 2 2 4 61 1 / 0 1 / 0 1 I D# S t e v e a n d J u l i e He i d e ma n

CK# 4 2 1 9 SW 2 7 t h S t 5 0 . 0 0De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J a s on Hu i z e nga

CK# 1 6 4 3 B e a v e r Av e 1 0 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 01 1 / 0 1 / 0 1 I D# Wa r r e n a nd Su n Hu i z e n g a

CK# 4 7 2 2 Ha wt h o r n e D r i v e 5 0 . 0 0 dWe s t De s Mo i n e s , I A 5 0 2 6 51 1 / 0 1 / 0 1 I D # N i c h o l a s l a r i a

CK# 3 4 2 0 SW 1 2 t h P l a c e 1 5 . 0 0 fDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D # Mi c h a e l o r Ma r y l e e K e l l y

CK# 1 2 0 9 Edgemon t S t 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J a m e s a n d C y n t h i a K i t e

CK# 4 4 0 0 4 3 r d S t 5 0 . 0 0 fDe s Mo i n e s , I A 5 0 3 1 0


11/28

Fo r I n st r u c t i o n s, See Back o f Fo r mCONTRI BUTI ONS- - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e same as on S t a t eme n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r ameSTATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THE PACCHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S ec t i o n 68B. 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c omme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTAL $ 3 5 0 . 0 0TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d e gr e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S ee Page 2 o f f o r ms p a c k e t . ) I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s no Page 1 0 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l umn . ( f o r S ch e d ul e A)

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1/ 0 0 1 1 1 I D# B r i a n o r E m i l y B e l t r a me2 8 2 9 4 4 t h S t N/ A $ 5 5 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 01 1 / 0 1 / 0 1 I D# R o b e r t and L i n d a E r v i n4 4 0 1 Pa r k l a wn D r i v e 5 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 2 41 1 / 0 1 / 0 1 I D# J o h n and Ma r y Kay L aB on i a4 3 3 3 SW3 1 s t 2 5 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# D a v i d a n d Ma r y B e l t r a me

CK# 611 9 SW9 1 N/ A 2 5 . 0 0 1De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# A n t o n i o and Rosa Le o

CK# 3 7 2 8 SW1 2 t h 5 0 . 0 0 1De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Gu i d o Le o

CK# 2 9 0 7 S ummi t V i s t a Dr . 2 5 . 0 0 fDe s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J i m a n d J e r i Le o

CK# 2 1 3 1 SE 3 r d S t r e e t 2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J oe and L i d i a Le o

CK# 3 4 1 9 SW1 2 t h 5 0 . 0 0 1De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Mi c h a e l Le o

CK# 3 7 0 8 S . W 2 8 t h P I 2 5 . 0 0De s Mo i n e s , I A 5 0 3 2 41 1 / 0 1 / 0 1 I D# L o r e t t a Do t s o n

CK# 4 1 0 1 SE 2 2 n d S t 2 5 . 0 0 1De s Mo i n e s , I A 5 0 3 2 0


12/28

F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e same a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON: S ec t i o n 68B . 3 2A( 6 ) , I o wa Co de , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i b u t i o ns o rf o r a ny c o mme r c i a l p ur p os e by a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e e s .

SUB-TOTAL$

TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )6 5 0 . 0 0

Di s c l o s ur e l a w r e q ui r e s c a n di d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f any r e l a t i v e ma k i n g a c on t r i b u t i o n t o t h ec o mmi t t e e . Re l a t i o n s hi p mus t b e s h own t o t h e t h i r d d e gr e e o f c o ns a n gu i n i t y ( b l o od r 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 b y 1 1 2 3ma r r i a g e) ( S e e Page 2 o f f o r ms p a c k e t . ) . I f sur name o f c o nt r i b u t o r i s t h e same as c a n di d a t e , b u t t h e r e i s no Page o ff a mi l i a l r e l a t i o ns h i p , e n t e r " n ot a pp l i c a bl e " i n t h e r e l a t i o ns h i p co l umn . ( f o r Sc h e d ul e A)

SCHEDUL EA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT q I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( M M / D D/ Y R ) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 1 / 0 1 I D # G i o v a n n i L e o4 1 0 1 Wo l c o t t Av e $ 1 0 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# P e t e r L e o n e t t i2 9 2 4 SW9 t h 5 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# C h a r l e s a nd D o r i s L i g o u r i1 0 72 4 2n d S t 7 5 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 11 1 / 0 1 / 0 1 I D # An na ma r i a a nd N i c k L o i o c o mo

CK# 2 5 0 0 SE 1 8 t h ST 3 0 . 0 0De s Mo i n e s , I A 5 0 3 2 01 1 / 0 1 / 0 1 I D # An t h o ny a n d Ma r y De F i n o

CK# 5 4 0 0 S . W 2 0 t h S t 2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Ra l p h Ma r a s c o

CK# 3 0 0 9 SW2 9 t h 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J o s e p h a nd Ru t h L a k e r s

CK# 3 1 1 6 Summi t V i s t a Dr 3 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D # I s a b e l l a a nd Conn i e M a r t u r e l l o

CK# 3 6 2 0 SW9 t h 2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 5I D #1 1 / 0 1 / 0 1 M i c h a e l a n d Do r o t h y Mau r oCK# 4 3 2 5 SW 3 1 s t ST 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 11 D #1 1 / 0 1 / 0 1 Ma t t a nd J e n n y Mc Co yCK# 2 4 2 1 E L e ac h Av e 2 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 0


13/28

F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUT I ONS - - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e s a m e a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBERANDTHE PACCHECK NUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VAI L A B L E FROMTHEI OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c ont r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e d u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b y 1 2 2 3ma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a me a s c a n d i d a t e , b u t t h e r e i s no P a g e o f _f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e du l e A)



DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ I I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD1YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 01 I D# J o s e p o r Ma r y e . a z l o2 0 2 2 So u t h Un i o n $ 2 5 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# V i c Me l e1 6 2 7 E L a c o n a Av e 2 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 2 01 1 / 0 1 / 0 1 I D# V i n c e n t De An g e l i s3 12 SW 3 2 n d S t 2 0 . 0 0CK# De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# Thoma s C C a l i g i u r i1 0 F u l t o n Dr 2 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Sa r a h a nd Gene B e h r e n s1 5 2 2 SW F r a z i e r 5 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J o e o r Ro s a B a r a t t a

CK# 1 7 0 1 K e n y o n 5 0 . 0 0 fDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# C y n t h i a N a h a s

CK# 3 2 1 4 S u mmi t V i s t a D r i v e 5 0 . 0 0De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J e a n An n De B i a g g i o

CK# 3 2 8 SE Ed i s o n 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J i m a nd Yvonne Nu c a r o C - . - = - . _

CK# De s Mo i n e s , I A 5 0 3 1 5 3 0 . 0 0 d1 1 / 0 1 / 0 1 I D# Mi c h a e l a nd J u d i t y O l i v e r

CK# 5 9 2 5 EP T r u e P kwy #12 5 0 . 0 0 fWe s t De s Mo i n e s , I A 5 0 2 6 6


14/28

Fo r I n s t r u c t i o ns , See Back o f Fo r mCONTRIBUTI ONS- - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( 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)

C i t i z e n s f o r Bel t r ame

SCHEDULEA I MONETARY( R ev . 0 6 / 9 7 ) RECEI PTS


STATE CANDI DATES NOTE : I F ACONTRI BUT I ON I S RECE I VED FROMASTATE PAC( P OL I T I C AL ACTI ONCOMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBER ANDTHEPACCHECKNUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I L A BL EFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se ct i o n 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o ns o rf o r an y commer c i a l p u r p o s e by an y p e r s o n ot h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB- TOTALTOTAL ( i f l as t page o f t h i s s c h e du l e )

* D i s c l o s u r e l aw r e q u i r e s c a n d i d a t e commi t t ees t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must b e shown t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s by 1 3 2 3ma r r i a g e ) ( S e e Page 2 o f f o rms p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b ut t h e r e i s n o Page o f _f a mi l i a l r 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 e r e l a t i o n s h i p c o l umn . ( f o r Sc h e d u l e A)

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 1 / 0 1 I D# Dwi g h t and L ou Ol s o n3 3 3 9 N Av e $ 1 0 0 . 0 0 dCK# A d e l , I A 5 0 0 0 31 1 / 0 1 / 0 1 I D# Geo r g e and J o y c e P a l e t t a4 4 1 5 SW3 1 s t ST 2 5 . 0 0CK# Des Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# LaVe r a Cu n n i n g h am9 2 5 Ca u l d e r Av e 5 . 0 0 dCK# Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J o h n P a s c u z z i

CK# 4 2 0 0 SW2 7 t h 5 0 . 0 0 1Des Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# Ed a nd Yo l a nd a P a s u t t i

CK# 8 3 2 H a r t f o r d Gr e a t A u n t 3 0 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5 & s p o u s e1 1 / 0 1 / 0 1 I D# Ra l p h o r J u a n i t a Mar asco

CK# 3 0 0 9 SW2 9 t h 5 0 . 0 0 fDes Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# Ro b P a s u t t i

CK# 2 1 1 7 SW9 t h 5 0 . 0 0 1Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Ch a r l e s and Mar y B ac k s t r o m

CK# 3 6 1 7 SW4 t h 1 5 . 0 0Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J i m and Pa m P e t e r s

CK# 9 2 5 S 1 4 t h 2 0 . 0 0 1A d e l , I A 5 0 0 0 31 1 / 0 1 / 0 1 I D# F r a nc e s F a z i o

CK# 1 3 0 1 SWV i r g i n i a 1 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5


15/28


( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be s ame a s o n S t a t eme n t o f Or g a n i z a t i o n)

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THEPACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD.CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i nf o r ma t i o n c o pi e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) r $D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f any r e l a t i v e mak i ng a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p ac k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b ut t h e r e i s no Pag e 1 4 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A)

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSQ CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD / YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 1 / 0 1 I D# Da v i d a n d J u l i a Ph i p p s2 1 5 28 t h S t r e e t $ 1 0 0 . 0 0 fCK# Des Mo i ne s , I A 5 0 3 1 211 / 0 1/ 0 1 I D# Ri c ha r d Be l t r a me1 4 0 3 SW1 s t Gr ea t Unc l e 2 5 . 0 0 dCK# Des Mo i ne s , I A 5 0 3 1 711 / 0 1/ 0 1 I D # Domi n i c B e r a r d i2 9 5 9 E . L e a c h Av e . 2 0 . 0 0 , (CK# Des Mo i ne s , I A 5 0 3 2 011 / 0 1/ 0 1 I D # F r a nk o r Mar y Qu i j a no

CK# 3 2 6 E. H i l l s i d e 5 0 . 0 0 dDes Mo i ne s , I A 5 0 3 1 511 / 0 1/ 0 1 I D # Ro s e Qu i j a no

CK# 1 4 0 3 SW1 s t 1 0 0 . 0 0 1Des Mo i ne s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Ma r y Qu i n n

CK# 1 9 3 5 SE 9 t h 7 5 . 0 0 1Des Mo i ne s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Ro n al d Rab i no v i t z

CK# 5 9 3 1 Wi n d s o r Dr . 3 0 . 0 0Des Mo i ne s , I A 5 0 3 1 21 1 / 0 1 / 0 1 I D# J o A n n e C o r i g l i a n o

CK# 2 6 1 1 SE 7 t h 2 5 . 0 0 dDes Mo i ne s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D # Th omas a nd Tr a c y R i a l

CK# 111 5 1 s t S t 2 5 . 0 0 dDes Mo i ne s , I A 5 0 3 1 2I D #1 1 / 0 1 / 0 1 A I a n d Ro s e Bi s i g na noCK# 1 7 1 3 S . Un i o n 2 0 . 0 0 dDes Mo i ne s , I A 5 0 3 1 5


16/28

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r ameSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CA TI ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON: S e c t i o n 68B . 3 2A( 6 ) , I o wa Co de , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r om r e p or t s and s t a t e me n t s f o r s ol i c i t i n g c o n t r i b u t i o ns o rf o r a ny commer c i a l p u r p o s e by a ny pe r s on o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e e s .

SUB-TOTAL

TOTAL ( i f l a s t page o f t h i s s c h ed ul e )' Di s c l o s ur e l a w r e q ui r e s c a n di d at e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o ns h i p o f an y r e l a t i v e ma k i n g a c on t r i b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p mus t be shown t o t h e t h i r d d e gr e e o f c o ns an gu i n i t y ( b l o od r 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 b yma r r i a ge ) ( S ee Page 2 o f f o r ms p ac k e t . ) . I f s umame o f c on t r i b u t o r i s t h e sa me a s c a n di d at e , b u t t h er e i s no Page 15 o f 2 3f a mi l i a l r e l a t i o ns h i p , e n t e r " n o t a pp l i c ab l e " i n t h e r e l a t i o ns h i p co l umn . ( f o r Sch e d ul e A)

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS0 CHECK T HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PA C CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 1/ 0 1 I D# Do mi n i c an d Kay R i z z u t i2 1 2 SE H a r t f o r d Av e . $ 2 5 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# R o c c o an d Me l i s s a R i z z u t i4 2 1 0 SE 7 1 s t S t 5 0 . 0 0 dCK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# A n n a R u g g i e r o3 9 2 6 SW2 9 t h 1 0 . 0 0CK# Des Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# V i n c e n t an d Ka y Ru g g i e r o

CK# 3 5 0 6 SWR o s e Av e 2 5 . 0 0 , /De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# Todd Co p i c

CK# 5 1 2 C u t l e r 1 0 0 . 0 0 fDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J o e Av e r s a

CK# 3 2 6 E H a r t f o r d Av e 1 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Bo b an d L i z Co n n o r

CK# 5 4 0 0 SW 1 9 r h Gr e a t A u n t 5 0 . 0 0De s Mo i n e s , I A 5 0 3 1 5 & s p o u s e1 1 / 0 1 / 0 1 I D# Ro b e r t an d S u s a n Con n e r

CK# 3 2 1 1 SW3 9 t h 1 0 0 . 0 0 1De s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J ames an d J e n e l l e Sa r c o n e

CK# 3 1 4 2 D r u i d H i l l Dr . 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J o h n an d Na n c y S ar c o n eCK# 3 0 0 4 SW 3 9 t h S t 2 5 . 0 0 1De s Mo i n e s , I A 5 0 3 2 1


17/28

Fo r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N


Ci t i z en s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E P A C ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T T HE P AC I D EN T I F I C AT I O NNUMBER AND T HE PACCHECK NUMBER I N T H E D E S I G N AT E D COL UMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM T H E I O WA E T H I C S AND C A MP A I G ND I S C L O S UR E BOARDCAUTI ON : S e c t i o n 6 8 B. 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ 2 8 0 . 0 0

` D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e 1 6 o f 2 3f a m i l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

SCHEDUL EA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS

CHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME A ND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D / Y R ) A ND PACCHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 1 / 0 1 / 0 1 I D # V i c a n d P e n n i S c a v oCK# 2 7 0 1 SWC a u l d e r $ 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# R i c h a r d a n d R o b e r t a P e t e r sCK# 2 5 7 1 Gu t h r i e , A p t 3 0 8 - A 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 7

1 1 / 0 1 / 0 1 I D# S c o t t a n d Kemb er l y n An d e r s o nCK# 9 0 7 3 2 n d S t 5 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D # R i c h a r d a n d J o a n n a S c h me l i n gCK# 5 1 6 SE B r o a d 2 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# Do n a l d S c r i g n o l iCK# 1 2 2 6 B i r c h L a n e 2 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# L o n n i e o r A p r i l S e v e r i n oCK# 1 1 5 SWWa t r o u s 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# Ga s p e r a n d L u c i a A n a n i aCK# 7 1 4 D a v i s A v e 2 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 51 D #1 1/ 0 1/ 0 1 Mar y S i t r o n e t oCK# 2 1 H a r t f o r d A v e . 1 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5I D #1 1 / 0 1 / 0 1 T e r r y a n d Ma r i b e l S l i n d eCK# 1 5 5 7 NW1 0 7 t h S t 2 5 . 0 0 dC l i v e , I A 5 0 3 2 5I D#1 1 / 0 1 / 0 1 J o e a n d Ma r y So d aCK# 9 3 0 J a r v i s 1 5 . 0 0 dDe s Mo i n e s I A 5 0 3 1 5


18/28



C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Co de , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c omme r c i a l p u r p o s e by a ny p e r s o n o t h er t h a n s t a t u t o r y p o l i t i c a l c ommi t t e e s .

SUB-TOTAL

TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) E$ 4 3 5 . 0 0Di s c l o s u r e l a w r e q ui r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f any r e l a t i v e ma k i n g a c on t r i b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p mus t b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng ui n i t y ( b l o od r 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 b yma r r i a ge ) ( S ee Page 2 o f f o r ms p a c k e t . ) . I f s umame o f c on t r i b u t o r i s t h e s ame as c a nd i d a t e , b u t t h e r e i s no Page 17 o f 2 3f a mi l i a l r e l a t i o ns h i p , e nt e r ' n o t a p pl i c a bl e " i n t h e r e l a t i o ns h i p c o l umn . ( f o r Sch e d u l e A)


DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT V I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( M M / D D/ Y R ) AND PACCHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 1 / 0 1 / 0 1 I D # M a r i l y n S p i n a2 5 4 5 E Ov i d $ 2 0 . 0 0 dCK# Des M o i n e s , I A 5 0 3 1 71 1 / 0 1 / 0 1 I D# N i c k o r Ci nd y Sp o s a t o3 1 0 SE C r e s t o n 5 0 . 0 0 dCK# Des M o i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Roger S t e f a n i5 1 3 NE 3 r d S t 2 0 . 0 0 1CK# Ankeny , I A 5 0 0 2 11 1 / 0 1 / 0 1 I D # P h y l l i s St egman

CK# 1 8 0 9 So u t h l a wn Dr 5 . 0 0 , I rDes Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D # E s t h e r An a ni a

CK# 1 0 0 7 J a r v i s 2 0 . 0 0Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Do r een S t o k e s

CK# 3 6 0 9 Wo l c o t t 5 0 . 0 0 , /Des Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J a i mi and J as on S t o r m

CK# 2 5 E O l i n d a Av e 2 5 . 0 0Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D # An d r e w and Sa r a h Su s a n i n

CK# 5 7 0 0 Wo o dl a nd Road 1 5 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 21 1 / 0 1 / 0 1 I D # K r i s t a Tanner

CK# 5 3 0 8 Po mme l P l a c e 7 5 . 0 0 dWes t De s M o i n e s , I A 5 0 2 6 61 1 / 0 1 / 0 1 I D # I r e n e T a n t i l l o

CK# 3 1 3 1 F l e u r D r i v e , Ap t 4 0 3 2 0 . 0 0 dDes M o i n e s , I A 5 0 32 1


19/28

Fo r I n s t r u c t i o ns , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e s ame a s o n S t a t eme n t o f Or g a n i z a t i o n)

C i t i z e n s f o r Be l t r ameSTATECANDI DATES NOTE : I F A CONTRI BUT I ON I S RECE I VED FROM A STATE PAC ( P OL I T I CAL ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHE PACCHECK NUMBER I N THEDESI GNATED COL UMN . A L I S T OF I D NUMBERS I S AVA I L A BL E FROM THEI OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 688 . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c omme r c i a l p u r p o s e by an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB- TOTALTOTAL ( i f l a st page o f t h i s s c h ed u l e )

SCHEDULEA MONETARY( Re v 0 6 / 9 7 ) RECEI PTSQCHECK T HI S BOX I F

AMENDI NG FORM

$ 3 3 5 . 0 0' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e commi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e

. R e l a t i o n s h i p must b e s how n t o t h e t h i r d deg ree o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b ut t h e r e i s no P a g e I g o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l umn ( f o r Sc h e d ul e A)

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT V I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1/ 0 1/ 0 1 I D# Sonya a n d J e f f T a y l o r1 9 5 1 Wi n t e r P a r k D r $ 5 0 . 0 0CK# An k en y , I A 5 00211 1 / 0 1 / 0 1 I D# B r y a n T i edeman2 4 3 E P o r t e r

2 0 . 0 0 1CK# Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# Mi c h a e l J T o n i n i

CK# 2 1 3 5 SW9 t h 5 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# R a l p h and F r a n k i e An n Comp i a no

CK# 4 0 2 2 SW3 1 S t 2 5 . 0 0Des Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# R i c h a r d a nd Sh ar o n T u l l e r

CK# 2 9 1 4 K en da l l wo od Ci r 2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J oe Tumea

CK# 6 10 D a v i s 5 0 . 0 0 1Des Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# J oe T u r s i

CK# 3 5 1 4 SW3 7 t h S t r e e t 2 0 . 0 0 dDes Mo i n e s , I A 5 0 3 2 11 1 / 0 1 / 0 1 I D# J o e an d Mar y T u r s i

CK# 9 3 7 Ca u l d e r 5 0 . 0 0 dDes Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# P e t e and G e r t T u r s i

CK# 112 2 Wo l c o t t 2 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5I D#1 1 / 0 1 / 0 1 J o h n and H o l l y T y l e rCK # 3 17 E Ma r i o n 2 5 . 0 0 dDes Mo i n e s , I A 5 0 3 1 5


20/28

F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be same a s o n S t a t e me n t o f Or g a n i z a t i o n)

C i t i z e n s f o r Be l t r a me

SCHEDULEA I MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

CHECKT HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM ASTATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBERANDTHE PACCHECKNUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o s e by an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e du l e ) $ 2 0 5 . 0 0

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must be s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s byma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b ut t h e r e i s n o P a g e 1 9 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e du l e A)

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT q I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1 / 0 1 / 0 1 I D# C a r l Va n Ty l eCK# 3 2 1 4 Br i n k wo o d Rd

$2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 0

1 1 / 0 1 / 0 1 I D# C h a r l e s Co l o s o moCK#

8 0 6 Ma i s h Av e2 5 . 0 0De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# Th e r e s a M. C o l a s i n oCK# 1 8 1 0 SE 2 nd 1 5 . 0 0De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# L o u i s o r J u d y AmodeoCK# 7 1 2 P i o n e e r Rd 2 0 . 0 0De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D # J o h n C i v i t a t eCK# 2 2 0 0 So ut h Un i o n 1 0 . 0 0De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# B r a n do n Wa r kCK# 5 1 2 C u t l e r 2 0 . 0 0 d -De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# De nn i s a n d L i n d a Wa t e r ma nCK# 4 0 9 Ca u l d e r Av e 2 5 . 0 0De s Mo i n e s , I A 5 0 3 1 5I D #1 1 / 0 1 / 0 1 Th e r e s a Wa t t sCK# 9 0 8 E 1 7 t h A- 4 2 0 . 0 0 fN o r w a l k , I A 5 0 2 1 1I D #1 1 / 0 1 / 0 1 B a r b a r a a nd L a r r y W i l l i sCK# 3 2 0 0 SW3 1 S t S t r e e t 2 5 . 0 0 fDe s Mo i n e s I A 5 0 3 2 1I D # -1 1 / 0 1 / 0 1 De n n i s a nd Ma r y L o u Yo r kCK# 1 2 3 0 B e l l Av e 2 5 . 0 0 dc h a i r


21/28

F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be same a s o n S t a t e me n t o f O r g a n i z a t i o n )

MmeSTATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER ANDTHE PACCHECKNUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LA B LE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e by an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SUB- TOTAL $ 3 7 0 . 0 0TOTAL ( l f l a s t p a g e o f t h i s s c h e du l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , bu t t h e r e i s n o P a g e 2 0 o f 2 3f a mi l i a l r 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 e r e l a t i o n s h i p c o l u mn . ( f o r S c h e du l e A)

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSQ CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT V I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 1/ 0 1 / 0 1 I D# V i c t o r i a a n d An t h o n y C i a n c i a r u s o2 4 4 2 SW 8 t h $ 2 5 . 0 0CK# De s Mo i n e s , I A 5 0 3 1 51 1 / 0 1 / 0 1 I D# F r a n k Ch i o d o

CK#4 1 7 E Bu r n h a m Av e 5 0 . 0 0 - 1De s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# C l a i r e C e l s iCK# 7 0 4 5 t h S t r e e t 2 5 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 5

1 1 / 0 1 / 0 1 I D# Gene a n d Ma r y Ca r d amo n eCK# 3 6 0 6 Rose Av e 2 5 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 1

1 1 / 0 1 / 0 1 I D# Ra l p h o r K a t h e r i n e C a r a c c i o l oCK# 1 8 2 2 SW P o r t e r 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# T h oma s M. a n d Rosa C a l i g i u r iCK# 1 0 F u l t o n Dr . 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 1 5

1 1 / 0 1 / 0 1 I D# J o h n a nd H o l l y B o n a n n oCK# 3 2 1 6 SWWa t r o u s 2 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 1I D#1 1 / 0 1 / 0 1 Sa ndr a Ka y B e l lCK# 4 2 1 8 SW2 7 t h S t 5 0 . 0 0 dDe s Mo i n e s , I A 5 0 3 2 1I D#1 1/ 0 1 / 0 1 Ro s e ma r y Mo o d yCK# 5 2 8 5 E Oakwood D r i v e 5 0 . 0 0 fDe s Mo i n e s , I A 5 0 3 1 7I D#1 1 / 0 1 / 0 1 Pe t e L e oCK# 2 9 4 6 E . S e n e c a 2 5 . 0 0 , (De s Mo i n e s I A 5 0 3 1 7


22/28

Fo r I n s t r u c t i o n s , Se e Bac k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e same a s o n S t a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CA T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.

CAUTI ON: Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Co de , p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r om r e p o r t s a nd s t a t e me nt s f o r s ol i c i t i n g c on t r i b ut i o ns o rf o r any c omme r c i a l p ur p o se b y a ny p er s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e e s .

SUB-TOTAL

TOTAL ( I f l a s t page o f t h i s s c h e du l e )$ 1 , 2 0 0 . 0 0

' Di s c l o s ur e l a w r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o ns h i p o f any r e l a t i v e ma k i n g a c on t r i b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p mus t b e s h o w n t o t h e t h i r d d e g r e e o f c o ns a ng ui n i t y ( b l o od r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s b y 2 1 2 3ma r r i a g e) ( S e e Page 2 o f f o r ms p a c k e t . ) . I f s u r name o f c on t r i b ut o r i s t h e s ame a s c and i d a t e , b u t t h e r e i s no Page o f _f a mi l i a l r e l a t i o ns hi p , e n t e r " n o t a pp l i c ab l e " i n t h e r e l a t i o ns h i p c o l umn . ( f o r S ched u l e A)


DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM / D D / Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 1 / 0 1 / 0 1 I D# R . E . Mye r s9 Wood l a n d H e i g h t s $ 5 0 . 0 0CK# I o wa C i t y , I A 5 2 2 4 01 1 / 0 1 / 0 1 I D# U n i t e mi z e d C o n t r i b u t i o n sI z a a k Wa l t o n 2 8 0 . 0 0 dCK# De s Mo i n e s , I A1 1 / 4 / 0 1 I D # R i c h a r d and M a r g e r e t P r e y1 2 0 5 1 L i n c o l n Av e 5 0 . 0 0CK# C l i v e , I A 5 0 3 2 51 1 / 0 5 / 0 1 I D # E v e l y n e V i l l i n e s

CK# 3 3 0 0 4 9 t h S t . 2 5 . 0 0De s Mo i n e s , I A 5 0 3 1 01 1 / 0 5 / 0 1 I D # Ti m Wa l k e r

CK# 3 1 7 6 t h Av e S t e 1 2 0 0 5 0 0 . 0 0De s Mo i n e s , I A 5 0 3 0 91 1 / 8 / 0 1 I D# Thomas Re av e l y

CK# 3 1 7 6 t h Av e 1 0 0 . 0 0De s Mo i n e s , I A 5 0 3 0 91 1 / 1 2 / 0 1 I D # Gar y a nd Donna Ru n g e

CK# 3 0 2 0 SWT ho r n t o n 2 0 . 0 0De s Mo i n e s , I A 5 0 3 2 11 1 / 1 2 / 0 1 I D # P a u l Bonanno ( c a s h )

CK# 3 0 7 3 8 t h S t r e e t 5 0 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 51 1 / 1 2 / 0 1 I D# Chad and J e s s i c a E r v i n

CK# 8 0 8 1 4 t h S t 2 5 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 51 1 / 1 6 / 0 1 I D# G e r a r d Neugen t

CK# 5 0 0 0 We s t o wn PKWY 1 0 0 . 0 0We s t De s Mo i n e s , I A 5 0 2 6 6


23/28

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA S T A T E PAC ( P OL I T I C AL AC T I ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROMTHE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p ur p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b yma r r i a g e ) ( S e e Pa g e 2 o f f o r m s p a c k e t . ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa ge 2 2 o f 2 3f a m i l i a l r 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 e r e l a t i o n s h i p c o l umn . ( f o r S c h e d u l e A )

SCHEDULEA MONETARY( Re v 0 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI V ED FUND-( MM/ DD / YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SENUMBER I NCOM1 1 / 1 9 / 0 1 I D# Ma r y Be r r y1 8 1 8 P a t r i c i a Ac r e s L a n e $ 3 0 . 0 0CK# Wi n t e r s e t , I A 5 0 2 7 31 1 / 2 6 / 0 1 I D# C e c i l i a Ba ck s t r o m8 0 6 9 Cr e s t v i ew Dr . 2 0 . 0 0CK# Des Mo i n e s , I A 5 0 3 2 01 1 / 2 6/ 0 1 I D # Ra l p h a n d Nor ma Co s t a n z o1 8 0 8 SE 2 n d S t . 2 5 . 0 0CK# Des Mo i n e s , I A 5 0 3 1 51 1 / 2 6/ 0 1 I D# Ed w a r d Be l t r a me

CK# 3 8 3 7 Mu r r a y V i e w Av e . NE Gr a nd f a t h er 1 0 0 . 0 0L o w e l l , MI 4 9 3 3 11 1 / 2 8 / 0 1 I D# Bo b a n d Ann Ge r n e s

CK# 1 0 1 1 4 5t h S t . 50 . 0 0De s Mo i n e s , I A 5 0 3 1 11 2/ 1 0 / 0 1 I D # Wi l l i am a n d Ma r y McCoy

CK# 3 1 2 7 SW6 t h S t . 2 5 . 0 0Des Mo i n e s , I A 5 0 3 1 51 2/ 1 1 / 0 1 I D # Chadwyn a n d J a n e l l e Cox

CK# 2 7 4 2 T i f f a n y Ct . 2 5 . 0 0D u b u q u e , I A 5 2 0 0 11 2 / 1 5 / 0 1 I D# Wi l l i s Hami l t o n

CK# P . O . Bo x 1 8 8 5 0 . 0 0St o r m La k e , I A 5 0 5 8 81 2/ 1 5 / 0 1 I D# Tom a n d N a n c y R i l e y

CK# n o n g i v en 1 0 0 . 0 0Ced a r Ra pi d s , I A1 2/ 1 5 / 0 1 I D # Ch a r l e s a n d Pa i g e F i e d l e r

CK# 4 4 4 9 Ke ns i n g t o n C i r . 2 5 . 0 0J o h ns t o n , I A 5 0 1 3 1


24/28

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUT I ONS - MONEY TAKEN I N

( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t h e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )

C i t i z e n s f o r Be l t r a meSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ONNUMBER AND THEPACCHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t he u s e o f i n f o r ma t i o n c o pi e d f r o m r e po r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o mme r c i a l p u r p o s e by a ny p e r s o n o t h e r t ha n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .


D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must be s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r 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 b y 2 3 2 3ma r r i a g e ) ( Se e Page 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b ut t h e r e i s n o Page o f _f a mi l i a l r 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 he r e l a t i o n s h i p c o l u mn . ( f o r S c he d u l e A)



DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM1 2 / 1 8 / 0 1 I D # Ge o r g e L a Ma r c a1 3 0 0 5 0 t h S t S t e 1 0 4 $ 5 0 . 0 0CK# We s t De s M o i n e s , I A 5 0 2 6 61 2 / 1 8 / 0 1 I D # Edwa r d a n d A p r i l Po u l s e n7 6 1 0 Wi n s t o n Av e 5 0 . 0 0CK# U r b a n d a l e , I A 5 0 3 2 21 2 / 1 8 / 0 1 I D # An n T r i m b l e3 5 3 2 Hu mbo l d t Av e . S . Ap t Upp e r 1 0 0 . 0 0CK# M i n n e a p o l i s , MN 5 5 4 0 8 '1 2 / 1 8 / 0 1 I D # Ma r c H a r d i n g3 2 1 1 L i n c o l n P l a c e 5 0 . 0 0CK# De s M o i n e s , I A 5 0 3 1 21 2 / 3 1 / 0 1 I D # Wa l k e r , K n o p f , P . L . C2 0 8 N . 2 n d Av e .W 5 0 . 0 0Ne wt o n , I A 5 0 2 0 81 2 / 3 1 / 0 1 I D # Hag ema n n & G o e k e P a r t n e r s h i p1 0 0 E a s t B r eme r Av e . 1 0 0 . 0 0CK# Wa v e r l y , I A 5 0 6 7 7I D #

CK#I D #CK#I D #CK#I D #CK#


25/28

THI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY:P ur c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e nd i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c 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 n i z i n g s e r v i c e s mus t a I s o b e d e t a i l i t e mi z e d o nSc h e d u l e G b y t h e amo 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 e o f e x p e n d i t u r e ma d e b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e ( R e f e r t oSc h e d u l e G i n s t r u c t i o n s a n d I o wa Code 5 6 . 6 ( 3 ) ( i ) . )

P a g e 1 o f 2

( f o r Sc h e d u l e B)

FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECKTHI S BOXI FPACCHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI L ABLE FROMTHE I OWA AMENDI NGFORMETHI CS &CAMPAI GN DI SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )Ci t i z e n s f o r Be l t r a me

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WASMADE( MM/ DD / YR) AND PACCHECKNUMBER

8 / 2 3 / 0 1 I D # B a n k o f Ame r i c a C h e c k Or d e rCK# P . O . Bo x 7 9 8 $ 2 6 . 0 0Wi c h i t a , KS 6 7 2 0 1I D # Ca r t e r P r i n t i n g Ph o t o c o p i e s o f f l y e r s9 / 4 / 0 1 1 7 3 9 E . Gr a n d Av e . h a n d e d o u tCK# 1 0 0 1 De s Mo i n e s , I A 5 0 3 1 6 $ 1 3 7 . 8 0I D #9 / 2 0 / 0 1 B a n k o f Ame r i c a Se r v i c e Ch a r g eCK# P . O . Bo x 7 9 8Wi c h i t a , KS 6 7 2 0 1 $ 7 . 0 0I D # F r e e ma n De c o r a t i n g Vi n y l c amp a i g n b a n n e r1 0/ 2 / 0 1 2 0 0 0 Ea s t o n B l v d .CK# 1 0 0 3 De s Mo i n e s , I A 5 0 3 1 7 $ 1 7 4 . 9 0D# Po s t ma s t e r Ra t e ma i l p e r mi t1 0 / 4 / 0 1 CK# 1 0 0 4 1 1 6 S . 2 n d Av e .De s Mo i n e s , I A 5 0 3 0 1 $ 2 5 0 . 0 0

I D # Po s t ma s t e r F u n d r a i s e r i n v i t a t i o n1 0 / 1 2 / 0 1 1 1 6 S . 2 n d Av e . ma i l i n gCK# 1 0 0 5 De s Mo i n e s , I A 5 0 3 0 1 $ 1 2 6 . 1 8I D # J a s o n Ken t Mu s i c a l e n t e r t a i n me n t f o r1 1 / 1 / O1 CK# 1 0 0 6 1 0 1 5 As h wo r t h Rd . c a mp a i g n k i c k o f f e v e n tWe s t De s Mo i n e s , I A 5 0 2 6 o n No v em b e r 1 , 2 0 0 1 $ 2 0 0 . 0 0I D # Ti f f a n y Al l e n Re i mb u r s e me n t f o r l o d g i n g1 1 / 1 / O1 1 0 0 7 4 0 0 1 Adams Av e . e x p e n s e s a s s oc i a t e d wi t hCK# De s Mo i n e s , I A 5 0 3 1 0 f u nd r a i s e r i n Ch i c a g o $ 2 3 6 . 0 0

SUB- TOTAL $ 1 1 5 7 . 8 8TOTAL ( i f l a s t page o f t h i s s c h e du l e ) $

1 __j


26/28

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e m u s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H . ( R e f e r t o S c h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c 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 , m a n a g i n g , o r g a n i z i n g s e r v i c e s mu s t a ] s o b e d e t a i l i t e mi z e d o nS c h e d u l e G b y t h e a mo 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 e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o m m i t t e e . ( R e f e r t oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 5 6 . 6 ( 3 ) ( 1 ) . )

Pa ge 2 o f 2

( f o r S c h e d u l e B )

FOR I NSTRUCT I ONS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEYSPENTFROMCOMMI TTEEACCOUNT ( R e v 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I D E N T I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND THE El CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a m e a s o n St a t e me n t o f O r g a n i z a t i o n )Ci t i z e n s f o r Be l t r ame

CANDI DATE NAME ANDADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D#

1 1/ 2 / 01 Some t h i n g I t a l i a n F o o d s er v i c es f o r c a mp a i g nCK# 1 0 0 8 4 0 0 Wal nut S t r e e t k i c k o f f e v e n t on $1431 . 0 0De s Mo i n es , I A 5 03 09 Nov embe r 1 , 2 0 0 1I D# Ca r t e r Pr i n t i n g " Cowbo y " c a r d s amd t h an k1 1 / 1 0 / 0 1CK# 1 0 0 9 1 7 3 9 E . Gr a nd Av e . y o u c a r d s and en v e l o p e sDes Mo i n e s , I A 5 0 3 1 6 $ 780 . 1 6I D# I o wa Tr i a l L awy e r s Asso c . Membe r ma i l i n g l a b e l s1 1 / 1 5 / 0 1 2 1 8 6 t h Av e . , S t e . 5 2 6CK# 1 0 1 0 De s Mo i n es , I A 5 0 3 0 9 $ 50 . 0 0I D# Po l k Cou n t y Au d i t o r Da t a ba s e o f v o t e r l i s t s1 1 / 1 5 / 0 1 CK# 1 0 1 1 1 1 1 Co u r t AvenueDes Mo i n e s , I A 5 0 3 0 9 $ 33 . 0 6I D# Ca r t e r Pr i n t i n g Campa i gn s t i c k e r s a nd1 1 / 1 8 / 0 1 CK# 1 0 1 2 1 7 3 9 E . Gr a nd Av e . i n do or e v e n t s i g n sDe s Mo i n es , I A 5 0 3 1 6 $ 4 4 0 . 9 6I D# Bank o f Ame r i c a Se r v i c e Cha r ge1 1 / 3 0 / 0 1 CK# P . O . Box 7 9 8Wi c hi t a , KS 6 7 2 0 1 $ 33 . 0 0I D#CK#

I D#CK#

SUB- TOTAL $ 2 , 7 68 . 1 8TOTAL ( i f l a s t p a g e o f t h i s s c he d u l e ) $ 3 , 9 26 . 0 6


27/28

FORI NSTRUCTI ONS, SEE BACK OF FORD'

COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e m e n t o f O r g a n i z a t i o n )Ci t i z e n s f o r Be l t r a me

NOTE : D e b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p a i d m u s t b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a n y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

DEBTSI OBLI GATI ONS REMAI NI NG T HI S REPORTI NG PERI OD( DO NOT I NCLUDE L OANS - SHOWL OANS ON SCHEDULE F )

' I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i m a t e d " b e s i d e t h e f i g u r e .

SCHEDULED I NCURRED( R e v . 0 8 / 9 8 ) 1 I NDEBTEDNES0 CHECK T HI S BOXI F AMENDI NG

FORM

An " i n c u r r e d d e b t " i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f w h e t h e r a n i n v o i ch a s b e e n r e c e i v e d .

P a g e , - j`- o f 1( f o r S c h e d u l e D )CANDI DATE COMMI TT E

Beltrame Marc1317scanned

Documents

Transcript of Beltrame Marc1317scanned

Beltrame Marc__1317__scanned

Documents

Transcript of Beltrame Marc__1317__scanned

Beltrame Marc1317scanned

Transcript of Beltrame Marc1317scanned