Professional Documents
Culture Documents
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For Office Use Only
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IMPORTANT: Indicate by # type of committee you are reporting for : Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party
Scanned
(4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( % )School Board or Other
Political Subdivision Candidate ( 8 "County F0%1*.6,jrJty PAC ( 10 )School Beard or Other Politic-al Computer
Subdivision PAC ( 11 )Local Ballot Issue
CANDIDATE COMMITTEES ONLY. Audited
,. S6 3-3(sD -S6 VZ 16 , ) o6
E OF PERSON FILING REPORT TELEPHONE DATE SIGNED
0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County $ Local Committees, enter County in
(You must continue to file reports until a DR-31;s filed.) which Election is held
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THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:
Purchases of certain campaign property costing $500 or more must also he inventoried on Schedule H (Refer to Schedule H instructions)
Expenditures to personsientities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personlentity on behalf of the candidate's committee . (Refer to
Schedule G instructions and lows Code 68A.402(3)(i)
(_for Schedule H)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev, 07/03) RECEIPTS
(Including cand'idate's personal funds)
O CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
CAUTION: Section 68B.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 .
It PAC
(if ID nul here ILUM W-1 IF FOR
RECEIVED applicable) TOCANDDATE' ATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
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- Diaclosura law requires candidate mmmittess to die the relationship of any relative making a contribution to the
committee. Relationship must be sham to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage), If surname of contributor is the same as candidate, but there is no Page ~-of
familial relationship, enter not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form ISCHEpULEj
MONETARY
C BU-re ii v0 inv.~
v.C}IrJTRIuiY ! E ° - IM, n
viwYe Tn l1f\i'IE _~ ~E
L -"-. leYt
i1 (Rev. 07103) RECEIPTS
(Including candidate's personal funds)
0 CHECK THIS BOX IF
COMMITTEE NAME (Must be same as or. Statement of Organization) AMENDING FORM
NOTE : ANY PERSON, OTHER THAN AN INDiVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE WARD .
CAUTION : Section 6SB .3'_A6), prohibits the use of information copied from reports and statements for soliciting contributions or for any
commercial purpose by any person other than statut "ofy, political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT i v IF FOR
RFCEIVFD (if applicable) TO CANDIDATE* RECEIVED FUND}
(MM/DD1YR) AND PAC CHECK. (if applicable) RAISER
NUMBER INCOME
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Disclosure lavv rewires candidate committees to disclose the relationship of any relative making a contribution to the
com ;nittee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity ;relatives by
marriage)of If surname of contributor is the same as candidate, but there is no Page ;?,
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form
/p1 MONETARY
C0NT n
. F 168L+T11 0
-NS7 -,r..- K
-° `A0NEN . 1"V
(Rev .07i03' I RECEir7TS
(Indudwg uaadidaitt's personal funds)
CHECK THIS BOX IF
COMMITTEE NA PA E "vitust u.°- Sarno as can Statement of Organi7at on) AMENDING FORM
STATE CANDIDATES NOTE -!F-,`)I ,al- .' C,-n-w T iEF~_ Lis T ~'~. .: ._n_Fa I ~ o ^J
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NOTE - ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES-, MORE THAN $750 TO YOUR CAM-P,AIGN MAY HAVE F,L!Ncj
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD.
CAUTION: Section 6°813 .3-n,(S," , prohibits the use of information copied from reports and statornonts for soliciting Confributions or for arm
commercial purpose by any person other than statutory rd .
political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT v F FOR
RFCEIVFD (if applicable ; TO CANDIDATE" RFGF_I VFD FUND
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
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" Disclosure lava requires candidate committees to disclose the relationship of any relative making a contributien to the
cornmittee . Relalionship must be shown to the thirst degree of consanguinity (blood relatives) ,rnd affinity,reatives by
rnarnage) If surname of contributor is the same as candidate, but there is no Page ~_ of _3
familial relationship, enter "not applicable" in the relationship column . ,for Schedule A)