Independent_Insurance_Agents_of_Iowa_PAC6052scanned

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FORI NSTRUCTI ONS, SEEBACKOF FORMDISCLOSURESUMMARYPAGECOMMI 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 )I n d e p e n d e n t I n s u r a n c e A g e n t s o f I o wa PACI 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 :( 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 C a 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 Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a 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 Su bd i v i s i o n Ca n d i d a t e ( 8 ) Co u nt y PAC ( 9 ) C i t y PAC ( 1 0 ) S c h 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 :Ca n di d a t e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

O f f i c e So u g h t D i s t r i c t ( i f Se n a t e o r H o u s e )

S ' 1 5 ' . 2 2 3 - Go b 0SI GNATURE OF PERSON F I L I NG REPORT

I AM F I L I NG A( r e p o r t d a t e )

CK I F AMENDMENT TO REPORT DATED 5 / 1 9 / 2 0 0 4

TELEPHONE

F - 1 Ch e c k i f t h i s i s f i n a l ( t e r m i 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 DR- 3 i s f i l e d . )

R e s e t F o n n

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- E L ECT I ON YEAR.I n d i c a t e b y # E1

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b e gi 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 e

c o mmi t t e e . T h i s amou n t MUST b e t h e s ame a s t h e c a s h o n ha n 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 mus 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 i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc h e du 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 du 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 e du l e H a p p l i e s t o Ca nd i d at e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e d u l e B : Ex 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 ee d e bt s an d l o an s b e l o w) . . . .Sc h e d u l e F : L o a n Re pa y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

* * UNPA I 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 u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N K I ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l e G At t a ch 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) $

FORMDR-2 DI SCLOSURE

( Re v . 0 7 / 2 0 0 4) REPORTF 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 dCompu t e rA u d i t e d

L at e r e p o r t s a r e s u b j e c t t opo s s i b l e c i v i l a n d c r i mi n a lpe na l t i e s .

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

C o u n t y & L o c a l C o mm i t t e e s , e n t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

1 0 , 3 8 1 . 2 1

1 7 , 8 0 1 . 0 0

4 , 2 5 0 . 0 0

CASH ON 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 mus t 2 3 , 9 3 2 . 2 1b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

4~ . / 4-dw~DATE SI GNED

YES NO


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Fo r I n s t r u c t i o n s , Se e B a c k o f F o r 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 e me n t o f O r g a n i z a t i o n )I n d e p e n d e n t I n s u r a n c e A g e n t s o f I o wa PAC

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 )

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 PAC I DENTI F I CATI ONNUMBER AND THE PACCHECKNUMBER 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 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 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 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 .

' 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 a n 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 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 y 3 3ma r r i a g e ) 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 ut t h e r e i s n o Pa 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 umn ( f o r Sc h e d u l e A)

SCHEDUL EA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 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 PAC CHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D# Wes t Bank $ 1 . 0 04 / 1 / 2 0 0 4 CK# Wes t De s Mo i n e s I AI D#CK# E: : ] _I D #CK#I D #CK#I D#CK#D#CK#I D #CK#I D#CK#I D#CK#D#C K#


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Independent_Insurance_Agents_of_Iowa_PAC6052scanned

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Transcript of Independent_Insurance_Agents_of_Iowa_PAC__6052__scanned

Independent_Insurance_Agents_of_Iowa_PAC6052scanned

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