8/7/2019 Democratic Governors Association - Iowa__9658__scannecd

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C a n d i d a t e Name

I Dem. Go v e r n o r s A s s n . Fax : ' 2 02 - 7 7 25 60 2FOR I NSTPUCT10 NS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e s ame as on St a t emen t o f Or g a n i z a t i o n )Democrat i c Gover nor s' Associ at i on- I owa

I MPORTANT : I n d i c a t e b y # 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 ~I( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n Ca n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e p a r t y( 4 ) C o u n t y C e n t r a l C o mm i t t e e ( 5 ) C o u n t y , Ca n d i d a t e ( 6 ) C i t y Ca n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n Ca n d i d a t e ( 3 ) C o u n t y PAC ( 9 ) C i t y PAC . t 1 0 ; ) S g t o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TTEES ONLY :

O f f i c e So u g h t : . ; ~ r

r Ek , 2 2 0 0 5 o p t i c a l P a r t y ( i f a p p l i c a b l e )

D i s t r i c t ( i f Se n a t e o r House )

202 - 772 - 5611I r -SI GNAT14 RI 4F PERSOWF ' 1 ' L I NG REPORT TEL EPHONE

I AM F I L I N G A J a nu a r y 19 , 2005( r e p o r t d a l e )

7CHECK I F AMENDMENT TO REPORT DATEDCheck 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 and 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 Fo r m DR- 3 .( Y o 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 DR- 3 i s f i l e d . )

Feb 2 2 0 0 5 1 6 : 3 8

I n d i c a t e b y l t

FORMDR- 2( Rev . 0 7 / 2 0 0 4 )

P . 0 2

F o r O f f i c e Us e On l yComm . #L o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

L a t e r e p o r t s ar e s u b j e c t t op o s s i b l e c i v i l and c r i m i n a lp e n a l t i e s .

Fe br u a r y 1 , 2 0 0 5DATE SI GNED

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .

L o c a l Co mmi t t e e s , e n t e r Da t e o f E l e c t i o nC o u n t y & L o c a l Co 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

STATEMENT OF CASH ON HANDCASH ON 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 o t a l o f a l l f u n d s h e l d b y t h ec ommi t t e e . T h i s amou nt MUST b e t h e same a s t h e c a s h on h a n d a t t h e end 1 . 00o 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 mu s t 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 l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADDTOTAL MONEY TAKEN I N TH I S PERI OD 100 , 0 00 . 00Sc h e d u l e A : Cash 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 : Loans 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 0Sc h e d ul e H , T o t a l S a l e s o f Campa i gn P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . 0

( Sc h ed u l e H a p p l i e s t o C a n d i d a t e s ' Commi t t e e s On l lSUB- TOTAL . . . $ 1 0 0 . 0 0 1 . 0 0

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B i 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 a n d l o a n s b e l o w ) . . . . 100 , 0 00 . 00Sc h e d ul e F : L o an Re pa ymen t s t o t a l ( A t t a c h Sc h e d u l e F ) . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

CASH ON HAND a t t h e end 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 a l a n c e mu s t 1 . 00b e z e r o ) ( A t t a c h OR- 3 ) . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . I . . . $- ` UNPA I D BI L L S ( Fr o m S c h e d u l e D- A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .$" I N K I ND CONTRI BUTI ONS ( Fr om Sc h e du l e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" OUTSTANDI NG LOANS ( Fr om Sc h ed u l e F- At t ac h Sc h e d u l e F ) . . . . . . . 5CANDI DATE COMMI TTF Q ON I _ Y -CONSUL TANT BREAKDOWN ( S c h e d u l e G A 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 S c h e d u l e H ) $

DI SCLOSUREREPORT

_ 0_ 00

YES NO

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Dem . h o %, 7 e r n o r s Assn . Fa x : 2 0 2- 7 7 25 6 02 Fe b 2 2005 1 6 : 3 4 P . 03Fo r I n s t r u c t i o ns , Se e Ba c k o f F or 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 TTEENAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g a n i z a t i o n )De mo c r a t i c Go v e r n o r s ' As s o c i a t i o n - l o wa

STATE CANDI 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 THE PAC I D E NT 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 AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 68B 3 7 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 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 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 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 d o s u m 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 n l 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 ece mM75t oo Ro l a t : o n Gh l p m u s t no > . h o wn h o t h a t h i r d d07 mo o f c D- g n c ui r , ; t y ( b l o oA e ol . q 4 i , NR) a n d A f f i n i t y ( r o l a t l v s b y

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

$100, 000

ma r r i a g e ) 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 e r e i s n o p a g e . 1 o f _ 1f 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 pp l i c a bl 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 )

SCHEDULEA MONETARY( R e v , 0 7 1 0 3 ) RECEI PTS

~] CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT v I F FORECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( M I ` 1 1 1 D Di Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D# Sh e e t Me t a l Wo r k e r s I n t l A s s o c

1 0 / 2 0/ 0 4 CK# 1 7 5 0 New Yo r k Ave , NW N/ A 5 2 5 , 0 00Wa s h i n g t o n , DC 2 0 0 0 6I D# Co mmu n i c a t i o n Wo r k e r s o f Ame r i c a

0 / 2 0 / 0 4 CK# 5 01 3 r d S t r e e t , NW N/ A; 2 5 , 0 0 0

I D# Co mmu n i c a t i o n Wo r k e r s o f Ame r i c a0 / 2 0 / 0 4 CK# 5 0 1 3 r d S t r e e t ; NW N/ A $ 25 , 0 00Wash i n t on D 2 0 0 0 1I D # L a b o r e r ' s Po l i t i c a l L e a g u e0 / 2 0 / 0 4 CK# 9 0 5 16 t h St r e e t , NW N/ A $ 25 , 0 00Was h ' n DC 2I D #

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

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Dem . Go v e r n o r s As s n . Fa x : 2 0 2- 7 7 ,2 5 6 0 2 Feb 2 2 0 0 5 1 6 : 3 4 P . 0 4

FOR I NSTRUCTI ONS, SEE BACK OF FORMEXPENDI TURES - - MONEYSPENT FROM COMMI TTEE ACCOUNT

S TATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI S LAT 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 THEPAC CHECK. NUMBER FOR EACH EXPENDI TURE, A L I S T OF I D NUMBERS I S AVA I L AB LE FROM THE I OWAET ' 4 I CS & CAMPAI GN DI SCLOSURE BOARD

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

SCHEDULEB( R e v . 0 7 1 0 3 )

CHECK T HI S BOX I FAMENDI NG FORM

P u r c h a s e s o f c e r t a i n c amp a i g n p r o p e r t y c o s t i n g 5500 o r mo r e mu s 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 . )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 , 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 mu s t a l s o b e d e t a i l i t e m i 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 , and 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 l 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 s t e ' s c o mmi t t e e . ( R e f e r t oSc h e du l e G I n s t r u c t i c n s a r , d l o ws Code 6aA . 4 o 2 ( 3 ) t i ) . )

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COMMI TTEE NAME { Mu s t b e s ame a s on S t a t emen t o f O r g a n i z a t i o n )LDe mo c r a t i c Go v e r n o r s ' As s o c i a t i o n - I o waCANDI DATE NAME AND ADDRESS 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( MMI DDI YR) AND PACCHECKNUMBERI D ; 9 0 9 8 I owa De mo c r a t i c Pa r t y0 / 2 0/ 0 4 ' 1 4 0 8 L oc u s t Av e n u e Co nt r i but i o nCK# Wi r e De s MOi n es , I A 5 0 3 0 9 $ 1 0 0 , 0 00T r a ns f e rI D #CK#I D #CK#I D #CK#I D #CK#I D#C: K #I D#CK#I D#CK#

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