You are on page 1of 2

FOR INSTRUCTIONS, SEE BACK OF FORM

I
FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 12/2005) REPORT

For Office Use_ Only


R E E L C.G. 'i' (Z % F- P E Co mvn t T-rE I_ Comm. #
IMPORTANT : Indicate by # type of committee you are reporting for: L5 Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County C 6 )City Candidate (7 )School Board or Other
Political Subdivision Candidate ( 8 )County , and or Other Political Computer
Subdivision PAC-t 11 )Local Ballot Issue
Audited
CANDIDATE COMMITTEESONLY:

File with :
Iowa Ethics and Campaign
Disclosure Board
510 E . 12'", Ste . 1A
Des Moines, Iowa 50319
Fax : 515-281-3701
Late reports are subject to possible civil and criminal penalties. Pursuant to Iowa Code section 68B.32A(7)
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is the
individual responsibjp for filing tirr ly and accurate reports .

395cf -7 33
TELEPHONE DATE!SIGNED

IAMFILING A FINAL Tr QM(WA -T(f9N REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by #

CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
'7 N oy y AA ( r, 2 le c2o 0 .
County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed.)
which Election is held

STATEMENT OF CASH ON HAND


CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the
committee. This amount MUST be the same as the cash on hand at the end
of the last reporting period or must be zero if this is first report filed .) .. . . . . . . ... . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .$ 0.00
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) (*also see in-kind below). .. . . . . . . . . . . . . .. . . . . . . . . U. O 0
Schedule F: Loans Received total (Attach Schedule F) . . . . .. . . . . . ... . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . .. . . . . . . . . 0 .00
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 0 .00
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . .. .. . . . . . ... . . . . .. .$ (? , O 0
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below). . . . . . . . . . . . . . . . . . (U. 0 0
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . C>, 00
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3). . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . .. . . . . . . ... . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . .. . .$ 0 .00
'*UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . .. . . . . . .$ 6 .00
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . .. . . . . . .. . . . . . . .$ ~P G - 0 1
'*OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . .. . . . . . . ... . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . . . . . . . . . . ..$ C),00
CONSULTANT BREAKDOWN (Schedule G Attached?) YES 9 NO
CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ (_7,00
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year.
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN-KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev- 06/97)1 CONTRIBUTIONS

-9,F's.%LQ_ C~- R
I f'~ lz C0WI111I "'('f rZL
Q CHECK THIS BOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED 4 IF FOR


RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MM/DD/YR) OF CONTRIBUTOR ' (if applicable) CONTRIBUTION VALUE CONTRIBUTION

05-17S710
. $
C'Nd ;da~e Qws~napa~ad
rricHArL RIEPOF
3dre E . WA5% (NC'-T'° Ols 57 .
1~ ~+ ~'°w9S264
c Pod5c " ug1
1FuVclt~
IJew Lo-rato.v
oUrwCI)
1916 " Z.O
F
Dews apat ~4

w"I A uo --
>ryttcmAjct Q~)Eloe C4 v+didat-e

1 -T
1 . Ptoa ~.+ 2'o ws. S2 I" Y f u "CJt s

a
F-1
F-1
F-1
F-1
F-1
71

TOTAL (if last


page of this
schedule)

'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page of
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives ( or Schedule E)
by marriage) . (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .

You might also like