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DR-2 OISCLOSURE DISCLOSURE SUMMARY PAGE | tn dane | Rome . For omce use Gray SSRRRTEE HAVE Wb yao oF Sepang Oa ‘Comm. # 0 ica, Feahenalon of HT16 ACTION PAC. Indeed f pacts MPORTANT: inane of sani ou verges on (5) pena (1 )StatewiderLegisiave Candidate (2 )Statewide PAC (3 Stale Party (4 YCounty/Local Candkdate (5 }Gounty PAC (@ )Balot Issue/Franchise Commitee (7 }Couny/Cty Cenral Commitee {3 \Ssppon Sat of Candeaaton Ss (5,200 RR (or person filing this report) TELEPHONE ATE SIGNI Penalties Due For Late Filed Reports Range from $10 to $400 SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE: Y 115 1AM FILING A Lh, 206 REPORT FOR ANA (1) ELECTION /(2)NQN-ELECTION YEAR. Indleate one Z (report date) Tocal Gorimitioes, enter Date of Biecion (CICHECK IF AMENDMENT TO REPORT DATED County & Local Commins, enter County in which Election is hold Ci Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. (You must continua to fle reports until a Notice of Dissolution is filed.) ‘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 same asthe cash on hand at the end of ne last reporting perod s 47.07 Cr must be zero if this is first report filed.) ADD TOTAL MONEY TAKEN IN THIS PERIOD 20 OO ‘Schedule A: Cash Contributions total (Attach Schedule A) ~ ‘Schedule C: Fund-raising Events total (Attach Schedule C). Schedule F: Loans Received total (Attach Schedule F Schedule SUBTRACT TOTAL MONEY SPENT THIS PERIOD ‘Schedule 8: Expenditures total (Attach Schedule 6). Schedule F: Loan Repayments total (Attach Schedule F).. GASH ON HAND athe end of hie reporting pred (fal ep, belance must bbe zero) (Attach DR-3) nn —— eel UNPAID BILLS (From Schedula 0 - Attach Schedule O) ann om IN KIND CONTRIBUTIONS (From Schedule E - tach Schedule E).. OUTSTANDING LOANS (From Schedule F - Attach Schedule F) CANDIDATE COMMITTEES ONLY: CONSULTANT BREAKDOWN (Schedule G Attached?) yes __NO VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) For instructions, See Back of Form SCHEDULE A MONETARY ‘CONTRIBUTIONS — MONEY TAKEN IN (ev.c2ne) | RECEIPTS ‘Including candidate's personal funds) DD CHECK THis 80x iF AMENDING FORM COMMITTEE NAME (Must be same as on Statement of Organization) ArT ON American Federation of (acho #716 ~ PAC ‘STATE CANDIDATES NOTE: IF A CONTRIBUTION 1s KECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF 1D NUMBERS is AVAILABLE FROM THE OWA ETHICS 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 statutory poitical committees. DATE PACTO NUMBER RELATIONSHIP “AROUNT RECEIVED (fappicable) ‘TO CANDIDATE RECEIVED (wMpiyR) | AND PAC CHECK (t applicable) NUMBER. SUBTOTAL TOTAL (if fast page of this schedule) + Diedoer nw egures canna commies oat the latent o ny eave making 8 conlon oe

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