Você está na página 1de 8

FOR INSTRUCTIONS, SEE BACK OF FORM IA ETHICS & CI4fv`s :7 GN FORM

DISCLOSURE iw`,, .ASD DR-2 I DISCLOSURE

DISCLOSURE SUMMARY PAGE MAY 2 3 2006


(Rev . 01/98) REPORT

For Offlae us.Oniv

- . q~ s 2
.: i
e .: 4 :yi . Comm. #
I Indexed
Audited
IMPORTANT: Indicate type of committee you are reportingfor FZI Computer
( 1 )Statewide/L"islative Candidate ( 2 )Statewide PAC ( 73 )CountylCity
)State Party (4 )CountyJLocai Candidate
( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( Central Committee
(a )Support Slate of Candidates

SIGNATURE OF TREASURER (or person filing tbt report) TELEPHONE DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWINGSENTENCE:

1 AM FILING A m l `h, 00 {v .REPORT FOR AWA (1) ELECTION /(2)NON-ELECTION YEAR .


( date) Indicate one

OCHECK IF AMENDMENT TO REPORT DATED Local Conwlites. enter Date of Election

Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County 3 Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissokidon is tiled.)

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 as the cash on hand at the end of the last reporting period, >
or must be zero if this is fast report fited.) . . . .. ... . .. .. . . . . . . .. . . . . . . . . . .. . . .. . .. .. .. .. .. .. .. . . . . . .. .. . . . . . .. ... . .. . . . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) .. .. . . . .. .. .. .. . . . . . . . .. . . .. . .. .. .. .. . ... .. . . . .. .
Schedule F: Loans Received total (Attach Schedule F) . .. .. . . . . . . . .. .. . . . .. . . . . . . .. . . . . . . . .. .. . . .. .. .. . . . . . . O

Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . .. .. .. . . . . . .. .. . . . . . . . . . . . .. . . .


(Scheduly H snclies to ' Corrmdttaes Only)

SU13-TOTAL . . . . . $ .5 X99. -2..3


SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule 8) . . . . . .. . . . . . .. . . . . . . . .. .. .. . . . . .. . . . . . .. .. .. .. .. .. .. . . . . . . i~a .39
Schedule F : Loan Repayments total (Attach Schedule F) . . .. .. .. . . . . . . . . . .. . . .. . . . . . .. .. .. .. . . . .. . . .. .. .. . . O

CASH ON HAND at the end of this reporting period {if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . . .. .. . . .. . . . . . . . . . . . .. . . . . . . . . . .. .. $ 97 3

UNPAID BILLS (From ScheduI6 D - Attach Schedule D) . . .. . . .. .. . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . .. .. . . . . . .. . . . . . . $


IN KIND CONTRIBUTIONS (From Schedule E - Attach 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 Instructlons, See Back of Form SCHEDULE
MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 06197) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
I COMMITTEE NAME (Must be same as on Statement of Ofganfzation) AMENDING FORM
G11~ ezzl-~
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE). LISTTHE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA 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 political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# ~utiHj le en .Ca u.~
' l09o G1~~aG ~fYPe~ $
CK# 146-go Des /Y1o% nes ~r`1 S031 ~--
i- .Z 3 - pro mPrr~6,er h," (is) rnert~(arsk Is 3v. go
ID#
.Jo5 e t'. e.
bu"r"
CK#
l~.'IS Ur
ID#

cK#
Af s lZ
ID# /
lee 16"r neG "no Y7,0 c1

~- a 3- o6P / 00. p0
[DO

CK# a s-ol 9 A A~d Sire d-6


saao Or ham da (e z A s -o3a-a..
-2-.2S-o!0 is"oo
ID#
19 ccdreile, A14 s en
CK# 4e301 A,-& /570,0 1* G3d
.2. - of 8'--vG 30 Des /no ;neS 5-e,3 .71 l6. 00
Ae a eh
'r+~cva.o ""-Uhn Ggndo 2oa4L
CK#
-et8 D~ eS Mo t neS ZA 5-03rzr
ID# iy)ar9a~P~ /toss
37 ~o err e : d~e- Po.'rtt.
CK#
~-~8-0~ S`~a~l lJes mo~nes ~~ 5-o3~i l5'.~
ID#
Fmo9Pne__ LrJ% /sow
CK# 4/0
1 -a ~-olo ~ e5 /l?o~'r1Q5 y f} 50-3 1.5 . ~
ID#
wa ,i ~, Sra ~S
oZ9 oa, S car re ~
CK# ~38'
v6 _16--55-0 Z) e o ~s y 503 1 lS" C~~
s
SUB-TOTAL
$ 0?5 . o0
TOTAL (H last page of this
schedule) $
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
Committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and aflkwty (relatives by
manage) (See Page 2 of forms packet .). If surname ofeonyibLrtor is the same as candidate, but then is no Page of
familial relationship, enter 'not applicable' in the relationship column. (for Schedule A)
For Instructions, See Back of Form SCHEDULE

MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 06197) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

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 ID NUMBERS IS AVAILABLE FROM THE IOWA 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 political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

CK# X)v ~ 3 3 00 ~° ~ PS ~rrl oor- ~la a~ $ .


a-aS-o to ~U4rl'~" Des rl'lo .'~-rF s z. fi ~5o31 0 16'" 00
ID# ~BGE' a ~ -4-0
~J a.rylla.-a Si-" "
CK# 0~ q .3'70?$- tTa kS
.2 -2 o ,- .? es -~7F .5~3~ L.
~. - XT- oro ID# Cash IY1Q'r~ R,17 ~S " D d
Av(%' JA- B'
lrro(}(
"Dc
r:>
t
-bra
S:' s v3~1
3 -13-0(0 Bash Chu04-it 2e+urnect -Vo aea& X00 .00
ID#
,1_ .,, S c h rWeb-
1-
161 : n evlri
CK# "5F/
3- l 3 "D~o Cr~sell I~' ,/Q , h 50 a .-> l~:'o 0
IDS
Cmu~ai /9r~ de ,,- sv0
CK# aao -2I,d!~ C". - ele,
de_ /e ?'4- S o 3 ;) lS.oo
ID#
Cord ~y t?ort v er1 ~lvri
CK# h &ArtS
Q Od
- .
' ID# A/ eagd1 Fr l3 vu S l~~aa:
CK#
3- r3-o& /rJ " DU
ID#
f<cc yc h !P e n c< <cJ
Gl`O G3rGL . ~~r~P~
CK#
3 - 1 3-O( `~k3c~ a-es X10 : rrPS ~ .f9 S-p3~ L ~r-o . a~
IQ#
Ax alreqIx ~laaseq
CK# &A .3 vi PL1~t~= .4 v~
~r -13-GCv 7!053" ac s r7Pa,"fo5 ZA- .1,0.3-A 1 /0 -.00
ID#
Oe ~t w ~a rl 14 /h'I
CK# 6- - ~9m5- Cosh ion X ae7-e-
3-i3- o~
~~
3 -13 - ol, Sc'7''7 K ; wt 5 0- It >K a.-Lt' SUB-TOTAL W.S . o0
$ lylgw
10141 i--icol r ~v
~.t ; v Q .L A TOTAL (If last page of this
schedule) 3
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms packet .) . if sumame of conblbulor is the same as candidate, but Own is no page J-, of
familial relationship, enter'not applicable' in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 06/97) RECEIPTS
(Including candidate's personal fixods)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Otpanization) AMENDING FORM

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 ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 688.32A(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 political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DO/YR) AND PAC CHECK (if applicable) RAISER

w
NUMBER INCOME
ID# 's a ra h l7/o r7
i9 " 3 ~vst /s6 S~re.at
3-l3- &'4, CK#
13 kV it kac~c-` .Z R- SOc~.tl
ID#
eat ",y°P l; as
CK# .zot used
ID# e ~e de4 It 10'9 -0-M Al 01 eY
1

CK# 9vU 5 E .C~rr s~ .ce~ n oeu-


Nv ~a~b
co : e ~-rL~"~u1 ~d~ SO 0 .:P f o?o,a,
ID# ..~`v s e ~ 7o uy~
CK# 713-1-5
.S!- '`f- oCo c~~sh
a n ale le- ~-4
ID# /4P ; ~rt )r -
3 O r s- el 4~% -e
CK# &,s * r9 3-v3 .o
.7 i5-oo
ID# ca, ..,y~ ; ~e /boa l
33a / s ?i "yr bwiGreen A&
`E"c~-~ CK# 9a I ~-nlC~-. " y S 5'ooal 19-0 v
IDS
~,' 6bq J`C~ da !JS
_ u _ , CK* x 3 98 fop 6'C-
wn "
S16',-eet
c, G is: o 0
ID# A f' 9`! ~ai ,
CK# /Ogg' 3 .I-°! <."l Oo*
y-~-oG DIPS 5-e3lf
ID#
G ~ yP ~~zueR
~ a 4- oG CK# Woo. 00
ID#
C K#

SUB-TOTA!

TOTAL (if last page of this


schedule)
Disclosure law requires candidate committees to disclose the relationship of any relative makirV a contribution to the
committee. Relationship must be shown to the third degree of consanpuinily (blood relatives) and affinity (relatives by
mamage) (See Pageof 2 of forms packet .) . If surname of contributor is the same as candidate, but then is no Page .3
familial relationship, enter 'not applicable' in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 06/97) RECEIPTS
(including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Ofganiza0on) AMENDING FORM

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 ID NUMBERS IS AVAILABLE FROM THE IOWA 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 political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MWDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
TQ Lo A12al- '

CK# 39 .19 //V*


'29-2e aC-s 1,72O ."74's =~- .3 -o3i 3 '~. Sd
ID#
c
w lea50~') '

CK# ~0 7 a 8' A St
4/_,z4-0(. j4oia- w W-) -ZJ 4 5-o a ~.S 15 00 r/
IN bon n i e- S'¢ GI In efft
CK# S-4110 /ol ~/ .'~ ooh ~vv

IN

CK#
-a _o ~ Clash /oa .o0 1/
IN rc(--
CK# ~i,~8' o?eZ~er
f6cY~
&J c'>>» 9- A SOa& S
IN ~edara/h hP 7"sf-
CK# g';' aS sk r~ Ar-
-a ~- o(0 9a9s m sue- .s03 r- .~ ~s.oo
. IN

CK#

ID#

CK#

ID#

CK#

IN
CK#

SUB-TOTAL
$ 1h0-560
TOTAL (if last page of this
schedule) S .2,149. 17S
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
manage) (See Page 2 of forms packet.) . If sumarne 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 SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY


(Rev . 09/97) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE


CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE.' A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

L=L,~
COMMITTEE NAME (Must be same as on Statement of Organization)
&,aU AqMe~~
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# '

CK# 12,3 O X77 ..vLev ~vyt


i 9 oro /ion ,a2~, ~"v ~o3l ~a $ ao. o0
I D#

Cv f f ~~Z~ 2aC'
4. 4l.
CK#
11044- ,tom ~'lZ.a. ~ .. S`03 l,S /oO. D
1D#
~l a -Q2-c-r d 'Q7~
/ CK# /loS
`~~ldlo ~'~ r
1D#

c#
r lSDl+v ll0(A "UL~ ~~
n .S a9~~
ID#

CK#
0~ 42x, YhA 4~ pQv 4-.`2-~ v70 . a C~
ID#

CK# l1eC-
%~ ll08 yYt .a.-":- "gaso,3 300 . oo

cK#

ID#
~loq ka ZA-, w .t~ Ids

CK#
l001 '18-c~ou .L4A;0-,
'S~7vzc~-
3 r0 a &
SUB-TOTAL $ 6, S
41, 2-3
TOTAL (if last page of this schedule) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entities 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 person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(1).)

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
B MONETAR'.
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 09/97) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE


CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE.' A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

COMMITTEE NAME (Must be same as on Statement of Organization)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID#
l ADO° 3,~~ ~ftc .~
~9J A N1 9a. s-oa f~S
.3 1/016)& CK# /l(/

ID#

CK#

1D#

CK# ~io ,~ 93.1 oQ


ltJ a rr~ ~~ ~o,~,S
1D#

~/ryo(o CK#

1D#
3 / 9o i0o .tA_ "
CK#
3/~~0 6
lJ `~+503~.: X75. ~O
1D#
z F &,.J
.37i7 igo~c. Q&.ee*
CK#
3 ~a I lcy, I7a . ~
ID#

CK# rlr 7

.~ i ~0 3 ~o ,trc. CGee.d~
-caa '35 .049
SUB-TOTAL
$ ..53 (1 .Slc
TOTAL (iflast page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entities 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 person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56.6(3)(1) .)

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY


(Rev . 09197) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE


CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE.'A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

COMMITTEE NAME (Must be same as on Statement of Organization)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# s F.P 3
i9DA ~ $
CK#
Z`1~ .5-/& 39
ID#
3
~. i loC7 3/D~(,
CK#
3 11
ID#

4 CK#
//fat ,(a,,,

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $
a3~ .5'd
oZ 39
TOTAL (if last page of this schedule) $ ~~O .

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entities 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 person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(1).)

of Page _5 - 3

(for Schedule B)

Você também pode gostar