Professional Documents
Culture Documents
jMgCL0SURE BOARD
Political Party (if applicable) File with:
Iowa Ethics and Campaign
Disclosure Board
510 E . 12'", Ste. 1A
Des Moines, Iowa 50319
Fax: 515-281-3701
'I-ate reports are subject to possible civil and criminal penalties . Pursuant to Iowa Code section 68B.32A(7)
the cap4dnte, for a candid ntos committee, and the chairperson, for any other type of committee, is the
al responsil for fi
timely and accurate reports .
IAVFILING
GA L~ REPORT FOR (1) ELECTION 1(2)NON-ELECTION YEAR,
[7 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
County & Local Committees, enter County it
(You must continue to file reports until a DR-3 is filed .)
which Election is held
Schedule A Cash Contributions total (Attach Schedule A) ("also see in-kind below) . . . . . . . . . . . . . . . .
SUB-TOTAL . . . . . . . . . . . . . . . . .. . . . . . $
Schedule R: Expenditures total (Attach Schedule B) ("also see debts and loans below) ., . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report balance must
De zero) (Attach DR-3). . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year.
T'JL - 10-2 - n6 SON 09 ; 28 AN Security State Bank Hubb FAX NO, 16418643119
F, 02
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISC-OSURE BOARD
NOTE: ANY PERSON, OTHER THAN AN INDVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 688 .32A(6), prohibits the use of information copied from reports and statements for soliciting contributions or for any
commercial purpose by any person other than statutory political committees .
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' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee Relationsnip must be shown to the third degree of consancuinlty (blood relatives) and affinity (relat)ves by
marriage) . If surname of contributor is the same as candidate, bu'there is no Page of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
JUL-10-2r'36 NON 09 :29 AN Security
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TOTAL (if last page of this schedule) $
PJrchasez o' ce"tair , campaign property costng $500 or morr, must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to personslentities providine consulting, advertising, tund-raising, polling, managing, organizing services must also be detail itemized on
Schedule by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee. (Rete° to
Schedule G Instructions and Iowa Code 68A 402(3)(i).)
(for Schedule B)
JI!L-'C'-20"6 MON 09 :29 AM Security State Bank Hubb FAX NO, 16418643119 P, 04
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(for Scnedufe B)