DR-Z oiscLosure (Rev. 02796) REPORT DISCLOSURE SUMMARY PAGE RRIMTTTEE WANE GATT cp a5 Gragg OEY i SFE ACTION PAC. IMPORTANT: Incas type of comes you are reporting for aleurone (1 )inteniarLegianive Candidate (2 )tatewide PAC (3)Stte Pay (4 Court acal CandengiJL. 2 {3)couryPac {a Batt eevelraschse Communes (7 Joao Cae Conmatie td (8 Suppor Siaa of Candidates Liens ffs net see UBL 200s x TELEPHONE DATE SIGNED TURE OF Tf {ER or person filing this report) Penalties Due For Late Filed Reports Range from $10 to $400 SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE: TAM FILING A Zi REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR. {report dato) Indiate one [2] Local Committees, enter Date of Elecion (COCHECK IF AMENDMENT TO REPORT DATED uy & Local Committees, enter Coury in C1 Check i this is final (termination) report and attach Notice of Dissolution Form DR.3, | County § Local Corn salient (You must continue to file reports until a Notice of Dissolution is fled.) STATEMENT OF CASH ON HAND CASH ON HAND at the beginning of the reporting period. (This is the total of all monies held by the committee. This amount MUST be the fame asthe cash on hand at he end ofthe last reporting Berod, 236,07 ‘or must be zero if this is frst report fled.) . ADD TOTAL MONEY TAKEN IN THIS PERIOD oo Schedule A: Cash Contrbuttons total (Atach Schedule A)... 2. Schedule C: Fund-raising Events total (Attach Schedule C). ‘Schedule F: Loans Received total (Attach Schedule F). ‘Schedule H: Total Sales of Campaign Proporty (Attach Schedule H) sa les to Candidates’ Committees On 256.07 SUB-TOTAL 5 SUBTRACT TOTAL MONEY SPENT THIS PERIOD ‘Schedule B: Expenditures total (Attach Schedule 8)... Schedule F: Loan Repayments total (Attach Schedule F).. CASH ON HAND atthe end of his reporting period (fia report, balance must 7 be zero) (ataeh ORS). sas s 256, 0 UNPAID BILLS (From Schedule D - Attach Schedule D) IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E). OUTSTANDING LOANS (From Schedule F - Attach Schedule F) russes CANDIDATE COMMITTEES ONLY: CONSULTANT BREAKDOWN (Schedule G Attached?) VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)For Instructions, See Back of Form SCHEDULE A Mon CONTRIBUTIONS ~ MONEY TAKEN IN fcavtaney | ineceere (cing cana sparen! finds} D0 CHECK THis Box iF can Fedlordln 89 LAOS ELIE ACTION PAC 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 {0 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN, DISCLOSURE BOARD, ° CAUTION: Section 688.324(6), lowa Code, prohibits the use of information copied from reports and statements for solicting contributions or for any commercial purpose by any person other than statutory political committees DATE BACT NUMBER RELATIONSHIP ‘TO CANDIDATE" RECEIVED (applicable) (umpire) | AND PAC CHECK \Wapplicabe) NUMBER. SUB-TOTAL TOTAL (if last page of this schedule) “edo eaaes candle canes dct te latent tay lave making a conten te conmien Rasp ratte sows thd dye sanergurty lea evs on aly eae) 4,2. Imig) (Soe Page 2 oma paca) srare of cebu e same a cand bu ere no on eg 7 ada {amiialcelationsnip, ener ‘not applicable" inthe relaonship columa,