Chambers Royd1333scanned

8/7/2019 Chambers Royd__1333__scanned

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P r i n t e d u s i n g t h e I ECDB Web R e p o r t i n g Sy s t e m o n 0 3 / 2 9 / 2 0 0 2 1 0 : 5 0 : 2 2

FORM DR- 2 : D i s c l o s u r e Summa r y P a g eS t a t u s : F i l e d

I D # 1 3 3 3

Co mmi t t e e Ch a mb e r s f o r I o wa H o u s e

CommT y p e : St a t e H o u s e

Da t e Du e : 0 1 / 1 9 / 2 0 0 2

Re p o r t Y e a r : 2 0 0 1

Tr e as u r e r : Ho wa r d T i e me n s

Pr i ma r y Ph . ( 7 1 2 ) 3 2 4 - 4 3 6 0 S e co n d a r y Ph . ( ) -

Ch a i r : R o y d E Ch amb e r s

Pr i ma r y Ph . ( 7 1 2 ) 3 2 4 - 2 6 9 4 S e co n da r y Ph . ( ) -

Co u n t y : NA

Amen ded :

S t a t e me n t o f C a s h o n Han d

A d d i t i o n a l As s e t s a n d L i a b i l i t i e s

FORM DR- 2 : Chamb e r s f o r I o wa Ho u s e

P r i n t e d u s i n g t h e I ECDB Web R e p o r t i n g Sy s t e m o n 0 3 / 2 9 / 2 00 2 1 0 : 5 0 : 2 3 P a g e 1 O f 1I OWA ETHI CS AND CAMPAI GN DI SCLOSURE BOARD 1 5 1 4 EAST LOCUST STREET, S UI T E 1 0 4 1 DES MOI NES, I A 5 0 3 0 9 ( 5 1 5 ) 2 8 1 - 4 0 2 8

Ca s h o n Hand a t S t a r t o f P e r i o d $ 0 . 0 0S c he d u l e A : Ca sh c o n t r i b u t i o n s T o t a l $ 4 , 2 2 0 . 0 0

S c he d u l e F : L o a n s Re c e i v e d T o t a l $ 0 . 0 0

S c he d u l e H : Camp a i g n P r o p e r t y Sa l e s $ 0 . 0 0

SUB- TOTAL $ 4 , 2 2 0 . 0 0

S c he d u l e B : E x p e n d i t u r e T o t a l $ 5 2 5 . 0 3

S c he d u l e F : Ca sh L o a n Re p a y me n t s

( Ca s h o n Hand A t En d o f P e r i o d 3 , 6 9 4 . 9 7

L o a n s i n P l a c e a t S t a r t o f P e r i o d $ 0 . 0 0

S c he d u l e D: Un P a i d B i l l s $ 0 . 0 0

S c he d u l e E : I n - K i n d C o n t r i b u t i o n s $ 0 . 0 0

S c he d u l e F : F o r g i v e n L o a n s

S c he d u l e F : Ou t s t a n di n g L o a n s $ 0 . 0 0

S c he d u l e G : Co n s u l t a n t Br e a k d o w n ? No

( S c h e d u l e H: Camp a i g n P r o p e r t y Va l u e $ 0 . 0 0

S t a t u t o r y Du e Da t e 0 1/ 1 9 / 2 0 0 2

A d j u s t e d Due Da t e / /

Re ce i v e d Da t e 0 1 / 2 2/ 2 00 2

Po s t ma r k Da t e 0 1 / 1 8 / 2 00 2

Amen de d / /



Fo r I n s t r u c t i o ns , See Back o f Fo r m

CONTRIBUTI 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 )

I COMMI TTEENAME( Mu s t b e s ame a s o n S t a t eme n t o f Or gam2 l

TOTAL ( i f l as t page o f t h i s s c h e du l e )

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PACI DENTI F I CATI ONNUMBER ANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN . AL I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI 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 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 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 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 es

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 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 mak i n g a c o n t r i b u t i o n t o t h e

c 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 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 } an d a f f i n i t y ( s e 4 a t i v e s b y

ma r r i a g e ) ( S e e 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 as c a n d i d a t e , b u t 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 ul e A)

SCHEDULE

A MONETARY

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

CHECK THI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT i I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE RECEI VED FUND-( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOME

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CONTRI BUTI ONS - - MONEYTAKEN I N


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

STATECANDI DATES NOTE I F A CONTRI BUT I 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 T HE PAC I DE NT I F I CA TI ONNUMBERAND T HE PAC CHECK NUMBER I N THEDESI GNATED COL UMN_ A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CSAND CAMPAI GNDI SCLOSURE BOARD.

CAUTI ON: Sec t 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 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 eme 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 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 es .

TOTAL ( i f f 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 ommi t t e es 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 e

c ommi t t e e R e l a t i o n s 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 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

ma 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 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 di d at e . b u t t h e r e i s n o

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

SUB- TOTAL

SCHEDULE

A MONETARY

( R ev 0 6 ' 9 7 ) RECEI PTS

CHECK T HI S BOX I F

AMENDI NG FORM

P a g e . . . . o f_ o f

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

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT i I F FORRECEI 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 SER

NUMBER I NCOME

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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 - - 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 )

COMMT f EE NAME ( Mu 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 )

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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 CT I O N C OMM I T T EE ) , L I S T T HE PA C I D EN T I F I C AT I O NNUMBER AND TH E P A C CHECK NUMBER I N T H E D ES I G NA T E D COL UMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM T 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 BOARD .

CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 8 ) , 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 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 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 . Re t a t i o mh i p mu s t b e s h o w n t o t h e t h l s d d e g r e e o f c o r s s a n g u t n l t y ( b l o o d r e l a t i v e s ) a n d Wmt t y ( r e l a t i v e s b Vm a 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 m e 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 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 )

SCHEDULE

A MONETARY

( Re v 0 6 / 9 7 ) RECEI PTS

CHECK THI S BOX I FAMEND I NGFORM

DATE PA C I D NUMBER NAMEAND ADDRESS OF CONTR I BUTOR REL A T I ON SH I P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-( MM/ D D/ YR) AND P A C CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I N C OME

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COMMI TTEE NAME ( Mu 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 )

a . w . ( o e r s r g v - - Lov i A j 4

S TA TE 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 AT E P AC ( P O L I T I C A L A CT I O N C OM MI T T E E ) , L I S T T HE P AC I D E NT I F I C A T I ONNUMBER AND T HE P AC CHECK NUMBER I N T HE D E S I G NA T E D COL UMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMT HE I O WA E T H I C S AND C A MP A I G N

D I S C L O SU R E BOARD .

CAUT I 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 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 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 ommi t t e es .

TOTAL ( i f f a s t p a g e 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 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 . Re 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 yma 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 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 u t t h e r e i s n of 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 .

Page__o f( f o r S c h e d u l e A ) -

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A MONETARY

( R e v . 0 6 1 9 7 ) RECEI PTS

CHECK TH I S BOX I F

AMEND I NG FORM

DA TE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR REL AT I ONSH I P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CAND I DATE ' RECEI VED FUND -( MM/ DDI YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

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STATECANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEE) , L I S T THEPACI DENT I F I CATI ONNUMBER AND THE PACCHECK NUMBER I N THEDESI 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 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 ns 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 e s .

SUB- TOTAL 1

6

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SCHEDULE

A MONETARY

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

7 / CHECK THI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT t i l I F F ORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ DDI YR) AND PA C CHECK ( i f a p p l i c a b l e ) RAI SER

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



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 )

`~1 r ` -- r , ! w, , , t 4 I 1 S~

STATECANDI DATES NOTE: I F ACONTRI BUT I ON I S RECE I VED FROM ASTATE 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 ONNUMBERAND THEPACCHECKNUMBER 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 BOARD .

CAUTI ON: Se c t 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 n f o r mat 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 an y c o mme r c i a l p u r p o s e by any p er 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

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 es 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 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 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 ) an d a f f i n i t y ( r e l a t i v e s b y ~/_ /

m a 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 a me o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b u t t h er e i s n o 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)

SCHEDULE

A MONETARY

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

CHECKT HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT t i i I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOME

a , ~ ) $1 _ 2

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A' ~ k 4 1, . , /P?7 - s c s z s s 9 4 , I V% l - a , C 2 S , a -

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CK# - 7 2 + M2 t i , r 4 - ~ t

1 1 /1 14 ~D- 02 - -s c ~ c ~ r t i . qs i z d 1

AZ, , / 0 / CK# 3 0 - 7 OVA-

S' t " , 4 / 1A. ~ l

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I D#c y - : F 47 V- 1 t h ~) o y r e e -

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THI S BOXAPPLI ES TOCANDI 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 pe 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 l 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 Gb y t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x p en d i t u r e mad e b y t h e p e r s o n / e n t i t y o n b eh a l f o f t h e c a n d i d at e ' s c o mmi t t e e . ( R e f e r t oSc h e d u l e Gi n s t r u c t i o n s a n d I o wa Cod e 5 6 . 6 ( 3 ) ( 1 ) . )

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

= ~ + a _ y c "

FOR I NSTRUCTI ONS, SEE BACK OF FORM JAN 2 2 ZOOZ SCHEDUL E

EXPENDI TURES - - MONEYSPENT FRO COMMI TTE E ACCOUN B MONETARY

" 0( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MAD 'CANDI DATES, L I ST THE CANDI DATE I D ENT I F I CATI ON NUMBER I N THE DESI G ATED COLUMNANDTHE 0CHECKTHI S BOXI FPAC CHECKNUMBER FOR EACHEXPENDI TURE A L I ST OF I D NUMBERS I S AVA I L A B L E FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCL OSURE BOARD

COM I TTEENAME ( 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 )

U~w 4~1 _ ~vI l k I - 1 1 uS, 2 _

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE( MM/ DDNR) AND PAC

CHECKNUMBER

I D # > 3 ~ 3 h" oy , 4 ~a y n yC y

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~

y

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l ~ n , y a - 5 / ?~ l e 7 n .

1 D# 1333 SL . e I i ` a 5 . f i 0 4 t z _ e _

I D# 1 3 , 3 3 PL, *Z"s" p c . 7 h , V+ -

j > 0 , 1 3 c x I Z v

l d ~~01

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ID# / 3 3 3

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l ' ~ r ~ , ~ L r l - 5i 23 / 1 1 Z ~ . v ' S S C - r i 7 S ' b l " ~ / l I h Di :

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I N

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L a

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i s s c h e du l e ) $ _____1



T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEE S ONL Y :

P u r 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 S c he d ul e H. ( R e f e r t o S c he 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 s t o p e r s o n s / e n t i c 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 l s o b e d e t a i l i t e mi z e d o nS c h ed u l e G b y t h e amou 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 pe nd i t u r e mad 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 o

S c h ed u l e G i n s t r u c t i o n s a n d I o wa C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

P a g e

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

FOR I N STRUCT I ONS , SEE BACK OF FORM SCHEDUL E

EXPENDI TURES B MONET ARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR L E GI S L A TI V ECANDI DATES , L I S T THE CANDI DATE I D EN TI F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPEND I TURE A L I ST OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA AMEND I NG FORMETHI CS &CAMPAI GN D I SC LOSURE BOARD .

COMM EE NAME ( Mu s t b e s ame a s on S t a t e me n t o f O r g a n i z a t i o n )

a s ' ' -

Z~~

~ 4 u _ I c e _

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE

( MM/ DD/ YR) AND PACCHECK

NUMBER

1 1 42 0 ,CK# ~~~ o y G S y o y G ~s " Gt ~

~~>

QscPVl ~ ~- ~az~~

1 1 p z D l 11D#D

~

~uSv l QwS ~ p s C~

CK# 1 1 18 5 1

~ - T - . , ~ s C ~ c ~ 't

~~, Sl 3 . sI D# ~ '

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/ / 3

I D# w' dv . ) F , ' w b t 'c

~ ~ I g rCK# /A

/A. k i , r r v % - ~ S7 . ? S Pw- / a , 0 - 2 1

I D # ~v , , t l e y L - 1 x " ~ s C G , . $

~ ~9 / p

1 CK#l ~ S ~ , ~

1 - , a , C l l rI D#

S~ . P. - S T 046' "

~ . 2 / l ~ l d lCK# ~/ ( v

G. a l d ~~ , . ~ 51336 S s3Lj ,

SUB- TOTAL $17~ 4 - 2 t -

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 ) $



T HI S BOX APPL I ES TOCANDI DATES ' COMMI TTEES ONLY :

Pu r 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 ul e H ( R e f e r t o S c he d u l e H i n s t r u c t i o n s . )

Ex 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 l s o b e d e t a i l i t e m i z e d o nS c he d u l e Gb y t h e amou 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 pe nd 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 di d a t e ' s c o mmi t t e e . ( R e f e r t o

Sc h e d ul 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 ) . )

( f o r Sc h e d ul e B)

FOR I NSTRUCT I ONS , SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONET ARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE T O STATEWI DE OR L EGI S L AT I V ECANDI DATES, L I ST THECANDI DATE I DE NT I F I CA TI ON NUMBER I N THEDESI GNATED COLUMN AND THE 0 CHECK T HI S BOX I FPAC CHECK NUMBER FOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI L ABLE FROM THE I OWA AMENDI NGFORME THI CS &CAMPAI GN DI SCLOSURE BOARD.

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

C~ . b C - : 3-2 0 VJA 4 VCANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE

( MM/ DDYR) AND PAC

CHECK

NUMBER

I r v i e , <

l a l 3D~

CK#/ / 7

57, 14. t: 14 5 l 2 - a l` T . ~

Y ar ^ $ / d , y e tI N We s f , N , ` I l s A f t

CK# ; ~

1 D#b

1 . 2 1 3 1c K#

/ 19

I N ? wwel pe 11 4 o - f 4- 1 1 - L

/ ; Z / 3 fCK# / I m

5kai o e_ ~ T- P S ; , 12~ f s~ yyv 0 1D

I D#

CK#

I D#

CK#

I N

CK#

I D#

CK#

SUB- TOTAL $r 3s~~

o -y

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

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