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IMPORTANT: Indicate by S type of committee you are reporting for: 12
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )state Party Scanned
(4 )County Contrll Committoo ( 5 )C un Cnndid to (G )City Candidato (7 )School Board or Other
Political Subdivision Candidato ( 0 ) .9t)w1F~E Pa~yC"x(,101 of Board or Othor Political Computer
Subdivision PAC (11) Local Ballot /ss Audited
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STATIC CANDIDATES NOTE : IF A CONTRIOUTION IS RrC(`IV('D FROM A STATE PAC (POLITICAL ACTION COMMITTCF), LIZ-,T THU PAC IDENTIFICATION
NUMBER AND THE PAC CHLCK NUMBER IN THE DESIONATI, .D COLUMN . A LIST OF ID NUMnrR,6 1 ;; AVAILABLE FROM I Mr, IOWA LTHICS AND CAMPAIGN
DISCLOSURE BOARD .
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statu" political Committees,
DATE PAC ID NUMBLR NAME AND ADDRESS Of CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE" RCCCIVCO FUND-
(MMIDO/YR) AND PAC CHLCK (it applicable) RAISER
NUMBER INCOME
I +1 o `I
I[7#
CS . l~ 4: tit t.a ~ { "F> v>t
CK# Zo25 N .r~~ ZO S°,a0
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ID*
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ID#
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ID#
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CK# X12 ;-L. -5
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CK# Iar Izu nf~ A,'.' o O _ D 4z;
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CK#
SUB-TOTAL
$ %7 So
TOTAL (if last page of this schodula)
- Discbaure law requires candidate Commitktltg to disclose the rolationShip of,ny mlative making a contribution to the
Comminno. Rolotionshlp munt b) anown to the third dog" of corrienfluinity (blood rolatlva)) and affinity (mlatlvns by
of 2-
marriage) . If sumamu of contributor is the some as candidate, but there IS no Page !
familial relationship, enter "not applicable" in the relationship column . (for ScheduleA)
Oct 1"9 04 11 :23a P .3
STATE CANDIDATCS NOTF : IF A CONTItI1 .iUTION IS RrCr1VF.D FROM A TATr PAC (POLITICAL ACTION COMMITTEE), LIST THC PAC IDENTIFICATION
NUMIILR AND THE PAC CHECK NUMDFR IN rHL DESIGNATED COLUMN . A LIST Or' ID NUMBERS IS AVAILADLC FROM T HI . IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION: Section 686.32A((i), Iowa Codo, prohibits the use of information copied from reports and statemonts for soliciting contributions or
for any commercial purpose by any person othor than statutory political commifos .
DATL PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RCCC..IVEO (if npplicablo) TO CANDIDATC" RFCEIVED FVND-
(MM/DDIYR) AND PAC CHECK (if applic ablo) RAISCR
NUMBER INCOME
Cn ' ~ E 1 o ~ CK#
',l l tv " ) ~k' ;'G"'.rc`", I,rw~ $ jOr
~.I1t to r~
ID# Y (,w
Z40 r1 rz<,tj
'10 co
CK#
'1Vt .l s/~ ~;~ T, G
100
Y A ~;
1 a (I2, O t1 CK# `It 13'6 ~10 ~~ ;T 2L- , 0 o
U 4_MS n/ _~ ~ ro
to ~t-1 ~ 0 1 CK# Id . ap
1D#
tot'. +o y
CK#
S ~rl r ~,^'J^ p0
ID# ,
r
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ID#
CK#
SUB-TOTAL
' Dinclonure IBW requires candidato Committee» to discloso the rolobonsup of any relative making a contribution to the
committee. Rolution,"ihp must W shown to the third dognx) or connAnguirvty (blood rolutivoo) pad affinity (miativos by
marriage) . It 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)
Oo~t 1°9 04 11 .,24a p .4
Reset Form
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
10 O\A
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, :L r .. !'A .4 V. \~ ._, Z., 223,
CK#
Go o St V4 c~'f~
ID#
CK#
ID#
CK#
I D#
CK#
SUB-TOTAL $
Purchaser; of airtmn campaign property costing $500 or more must also bo mvontonod on Schodulo H, (Rotor to Schedule H msbuCllonrc .)
Expenditures to personstentities providing consulting, advertising, fund-raising. polling, managing, organizing services must also be dotail itemized on
Schedule G by the amount, purpose, and date of each type of oxpondbture -ado by the perinfontily on behalf of the candidates committee . (Refer to
Schodulo C inutruction5 ;md Iowa Codu GAA .40Z(J)(\) .)
Page _!- of I -
(for Schedule 8)