You are on page 1of 17
FOR INSTRUCTIONS, SEE BACK OF FORM FORM DISCLOSURE SUMMARY PAGE DR-2 | oisciosure MITTEE NAME (Must be samo as on of Organization) (Rev. 012001)| REPORT ia ve ate e | MPORTANT: Indicate type of committee you are reporting for: | f (1 StatovidlLeslatve Candktato (2 )Statvide PAC (2 )Stte Panty (4 )Couny/Local Candiate (5 }County PAC {6 Yast esueFranchisa Commies {7 Jocantyfoy Saal Conmatos (8 Support Sato of Candidates CANDIDATE COMMITTEES ONLY: Candidate Name Poltical Party BECKY meek pock ss DENeeLAT oo ae, Kiheeraf Metslosk Epps bop SNATURE OF TF IRER (or person filing this report) TELEPHONE DATE SIGNED Routine Penalties Due For Late Filed Reports Range from $20 to $800 EE INSTRUCTIONS ON BACK. E THE FOLLOW E: TAMFIINGA_YAY 14, FOO rePORT FOR AWA (1) ELECTION K2NONELECTION YEAR, (pon at) indicate one Lp] CICHECK iF AMENDMENT TO REPORT DATED sa Gaon oe Ome @ Eos ‘C ccheckc itis is nal termination) report and attach Notice of Dissolution Form DR-3. | Couniy Local Conmtees. era (You must continue to fie reports unt a Notice of Dissolution fs fled.) Wien Election shes STATEMENT OF CASH ON HAND. CASH ON HAND at the beginning ofthe reporting period. (This is the total of all monies held by the committee. This amount MUST be the same as the cash on hand atthe end ‘ofthe last reporting period, or must be zero if this is first rapor fled) ‘ADD TOTAL MONEY TAKEN IN THIS PERIOD Schedule A: Cash Contributions total (Attach Schedule A) (‘also see in-kind below) ‘Schedule F: Loans Received total (Attach Schedule F. ‘Schedule H: Total Sales of Campaign Property (Attach Schedule H) (Schedule oni SUB-TOTAL. SUBTRACT TOTAL MONEY SPENT THIS PERIOD Schedule 8 Expendhrs lla Mach Schedule B) (“ln see debts anders boon). 7Y29. FO _ Schedule F: Loan Repayments tl (tach Schedule F : - Sse CASH ON HAND at the end of this reporting period (if final report, balance must ‘be zero) (Attach DR) Es . s_2]0, PO __ UNPAID BILS (Tom SchoduloO -Ataoh Schedule Dy “IWKIND CONTRIBUTIONS (From Schodul E -tach Sendo ) “OUTSTANDING LOANS (From ScheculeF- tach Schedule F) CANDIDATE COMMITTEES ONLY: CONSULTANT BREAKDOWN (Schodule G Atachod?) VALUE OF CAMPAIGN PROPERTY (From Schade H- Atach Schedule H) For Instructions, See Back of Form [SCHEDULE A MONETARY CONTRIBUTIONS ~- MONEY TAKEN IN (Rev. 0697) | RECEIPTS (elu candidate's person funds) Cl cueck Tas 80x iF [COMMITTEE NAME (Must be samo as on Statement of Organization) [AMENDING FORM. EKY rotiyece pon yae KiEZER TUE | ‘STATE CANDIDATES NOTE: (FA CONTREUITION s RECEIVED FROMA STATE PAG (POLTTCAL ACTION CONMTTEE) LST THE PAC JDENTIRCATION NUMBER ANO THE PAC CHECK NUMBER INTHE OESIGNATED COLLAR. 4ST OF IO MAUBERS IS AVALABLE PROM THE OWA ETIES AND CAMPAION IE BOARD GAUTION: Section 688.32A(),lowa Code, prohibits te use of information copied from reports and statements for solitng contibutions oF for any commercial purpose by any person ther than statutory poltical commitioes. DATE PACTD NUMBER] NAME AND ADDRESS OF CONTRIBUTOR RELATIONS RECEIVED | (applicable) TOCANDIOATE* MMIDDIVR) | AND PAC CHECK (i appicabie) NUMBER ILL TAMATO 1ADY TE WVTFROD , Dt C} SUITE 27, DED Moyes, TA IW Rick Tho Soi s¢ Wil Pono, eevee 2 DE. BME, 52; ELLIE “PUCE Foo ECOG LIME PED) eae 2 LED thats A Be +S AY INPj201 SUNK Y oe fans DPPo LAY CARE A ge FHNEAS STULET ZAL_ SOUT Woo LeCusr, 54 ITE boo 2oF| ID RY $955 3S ts Z2UTW DEE nieces, "FB p22) |CELRLE re Puna ‘SUBTOTAL TOTAL (iflast page of this schedule) * Disclosure law requis candidate commits to eos the telalnshipof any rolatve making conto ‘commits. Relatenship must be shoun to the thd dear a coeanguty (ld eats) ae ted aes by ‘mamioge) (See Page 2offoms packet). i sumame of sonrbutor's the same as earn, but Cave eo Page of {aia relatonshi,e7ter "nat appicae” inthe relations cokume Tor SenculeA) For Instructions, See Back of Form CONTRIBUTIONS ~- MONEY TAKEN IN (inctng candidate's persanal funds) (COMMITTEE NAME (lust bo same as on Sialement of Organization) L, LLoc, L. [SCHEDULE A MONETARY (Rev. 08/97) | RECEIPTS check THs 80x iF AMENDING FORM. ‘CANDIDATES NOTE: IFA CONTRIBUTION Is RECEIVED FROMA STATE PAC (POLITICA ACTION CONMATTEE) LIST THE PAC DENTIACATION rhees AND THEPAC CHECK NUMBER NTHE DESIGNATED COLUNMC ALIST OF O NUMBERS IS AVALABLE PRON THE IOWA ETHICS AND CAD CAUTION: Section 688.3246), lowa Code, prohibits the use of information coped fom reports and statement fr solcting contributions ar for any commercial purpose by any person oer than statutory political commitoes, 2 seceneo | "stapmeney Tocanowate: | eceveo | ‘rowo. cmopyn | anppacertcx Cs opnlsie) eae cone oF % BAPFEY, on kao F B2AD 37a § SOLD) 2 eet TA_DB2 p¢/ox/op 0) nd DE, isn 2 Walon” Bb she DX OF Tes. GE si Sahar. 04 oro * BAM nie ‘A SUA (50. od cd TAS) Usa cit I) (atktes 2 oo: $E0.c2) oF ea ~ one Bo Hig BG TSO Ca ee DI, ie, lox/np LEE niaile sf) 12.20, 4 eee iO ser ce Ve WO) LAE Jeo. bi A ERY DB, Ik BLUE oe ge | Aer phils 2 LID AS. SD] BS LEO GLE SF lA 42) ID. SETS TOTAL (fist page ofthis schedule) eran reenter mmmnteyriemtnteenanet tates ere ppc aatonon cee ms we Cana eno vw Batok 7 For instructions, See Back of Form CONTRIBUTIONS — MONEY TAKEN IN (ctuing candidate's personal fans) ‘STATE CANDIDATES [COMMITTEE NAME (Must bo same ae on Statement of Organization) LBEKY MM Elo Fim Siz. RERESEDVH NOTE: IFA CONTRIBUTION Is RECENVED FROWA STATE PAC (POLITICAL PTME [SCHEDULE A MONETARY (Rev. 08197) | RECEIPTS CO check THis Box iF ‘AMENDING FORM. COMATTEE) LIST THE PAC IDENTIACATION [NUMBER AND THE PAC CHECK NUMBER INTHE DESIGNATED COLUNA. A LIST OF I9 NUMBERS I AVAILABLE FROM THE IOWA TMCS AND CAMPAIGN OAD. DISCLOSURE CAUTION: Section 68B.32A(6), lowa Code, prohibits the use of information copie for any comercial purpose by ary person other than statutory political commitioes jd fom reports and statoments for solcting contributions or TRE] PRCTO NEE TNE AND ADDRESS OF CONTRIBUTOR] REEATONSP] AMOUNT] TF FOR receneo | "crappie Tocanowate: | eceneo | “runs” ee aed ‘teorsto) FABER OF KATAERINE PN ELOCK omer $ coke We Hohick 5. AP a Bis Sdow OF OE oe ZTE Ae) oe SIE LEED 7 py lx, = ED ronde> F77_SD3B0 BS0D| — PD oK# ZEVELYR Nola SS Ey coeEA YUE F72 50330 Lae) — oF pe fio ead J Re | a FO. D| — oe [pap pe) o0ge SE eeA ka [ee pahies [0.0D| — = ind PEA oh ome | e 4, DED [ME FA SPA) _ J0.D a JNA /77- ag Ye doa |" LE? hPa ay BIZ Lo.00| = (08 Doyt)s SSISTOO oe BE nbs, BE. BO.|_ oF SLE # LRDIED OR | ont Bee lowe, sa) pao 0-0 — oe Pye MAze a EGF Jy} one 2ee pune’. 7 pcp) SUBTOTAL TOTAL (ilastpage ofthis schedule) tr as nts ce yoyo aig pn Eten pene a ene ‘ravage fame ape 2 ema pena), romance oattne ae aoe ene a a TrmalStets aue'na pose ie icone teheaaion For instructions, See Back of Form [SCHEDULE CONTRIBUTIONS ~ MONEY TAKEN IN ee cs sree OO check THis Box iF ST TEE RARE sre a on Sra TOO Seameal t, p OE STATE CANDIDATES NOTE: IFA CONTREUTION IS RECEWED FROM A STATE PAC (POLTIGAL ACTION COMNATTEE) LIST THE PAC DENTIACATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS Is AVALABLE PROM THE OWA ETH0CS AND CAMPAIGN DISCLOSURE BOARD. CAUTION: Section 688.32A(6), lowa Code, prohiits the use of information capac from reports and staomonts fr soliciting contributions or for any commercial purpose by any person other than statutory politcal committees PACTONONEER RELATIONSHIP] AMOUNT TOCANDIDATE* | RECEIVED (applicable) AAT. ITT h IP2Yi MW AUK LYRE AKKERY, TA) 5002) [Breath ATL) (hip 2BB) E 29IM Corse ) OF0- & FR. WIELIINGY) Fae 1S ‘SONAL LYRE 7D DES MeltdE 3, 2, DZ SHRLALY Youn BLD DEE on, CPORS, BER 3 FE 7ath STREET] 1S. Ie, 2p, 5D SEP DGGE We T, Zale ZOD Sr LE hoVtE, FZ) Dae KES, DIS Cay CLuBye CLUS JER, G04” ASHEN - Ys ‘SUBTOTAL TOTAL (if ast page of this schedule) * Disclosure law requescancdale commits to daclose to Relat lationship of ny relative making a catson othe commits. Reatonship mist be shown fo te tir dogo of consanguinity (soos relatives) and ay elaine By arog) en oge una pit)aree eco te San ean ht tee vw Poa iiss, tr na apc’ We osha eden For Instructions, See Back of Form SCHEDULE MONETARY CONTRIBUTIONS ~ MONEY TAKEN IN ‘Rev. 0807) | RECEIPTS (icing canis persona as) 1D cheek THis 80x [COMMITTEE NAME (tas bo samo a MENDING FORM BELKY RoneELec SHE ye |__| XTES_NOTE: IF A CONTRIBUTION 15 RECEIVED FROMA STATE PAC (POLITICAL ACTION COMMATTEE) LIST THE PAC DENTIRGATION NUMBER AND Te PAC SNEEK WAGER MME SOSTNATED COLLND. ALETOFIO MOWOEROIS SUARAR MOM THE DWN EPAES ANG ON DISCLOSURE BOARD, CAUTION: Section 688.32A(6), lowa Code, prohibits the use of information copied trom reperts and statements for slicing contbutons or ‘or any commercial purpose by any person other than statutory politcal committees. TAKE AND ADDRESS OF CONTRIBUTOR RELATIONSHIP] AMOUNT TOCANDIDATE® | RECEIVED (Wt apoieabio) Sea ec EP20 CANLEPTZZE Bie tae Ei Je, IP, eL, FF) 503. WA tf fe exe “Sh Dono Byeo2) “ye ieee 2 ve UE es PME SWE VLYSS) ps EE Be Galea 4 LYS Dh PLE PS ey” A 7 ep likey re Dip ponce EI Lo Li ans FIO ‘SUB-TOTAL TOTAL (iftast page of this schedule) * Disclosure lw raquites candidal commits to disclose the rlatonahip ct any eative making contbatlon to the ‘ommities, Relanship must be shown to be tw degree of consangunlty (cod telaves) and ay (lates Dy ‘mantage} (See Page 2 ot fos packet). if sumame of cortrbuto isthe same aa candidate, bt thee 5 no Page ot fami relationship, enter“notapoable" inthe eatlorship column. (er Senos) For Instructions, See Back of Form [SCHEDULE A MONETARY CONTRIBUTIONS ~ MONEY TAKEN IN (Rev. 0807) | RECEIPTS (eluding canta’ personal funds) 1 creo Tus 20x [COMMITTEE NAME (ust bo same as on Salomon of Organization) SENDING FORK BEC STATE CANDIDATES. NOTE: IFA CONTRIBUTION is RECEIVED FROMA STATE PAC (POLITICAL ACTION CONMITTEE} LIST THE PAC IDENTIRCATION NBER ANDTHE PAC CHECK NUMBER I THE DESIGNATED COLUMN, ALST FO MAIDENS 6 AVMLABLE PROM THEIOWA EIOCS AND CAMPAIGN CAUTION: ‘Section 888,32A(6), lowa Code, prohiits the use of information coped from reports and slatoments for solicting contbutions of {or any commercial purpose by any person other than statutory political commites. DATE ‘PAC TO NUWBER RAVE AND ADDRESS OF CONTRIBUTOR RELATIONS RECEIVED | (fopplcabe) ‘TO CANDIDATE [AND PAC CHECK (applicable) NUMBER 7 e713 Aeroly Lite DR. OLD [MOE 3, TF) LELS| ‘SUB-TOTAL TOTAL (iflast page of this schedule) + Disclosure lw requites cantata commitogs to sse the ritonship of any relative making a contbaton othe ‘ommiles. Reatenshp must be shown tothe hd degree of concanguy (bod eaves) an iy (rates By ‘porrano} (See Page 2afoms packet). W sumame of conor the sae as candidate but thre no von he {amillrelatonshp, enter "not appease” he relationship coun, Tar Sveduie Ay FOR INSTRUCTIONS, SEE BACK OF FORM EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT oraen STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE ‘CANDIDATES, LIST THE CANDIOATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUNN ANO THE PAC CHECK NUMBER FOR EACH EXPENDITURE, A LIST OF IO NUMBERS IS AVAILABLE FROM THE IOWA ETHICS & CAMPAIGN DISCLOSURE BOARD, (SCHEDULE MONETARY EXPENDITURES 1 CHECK THIS BOX IF AMENDING FORM, [COMMITTEE NAME (Must be same as on Statement of Organization) DATE EXPENDED (aDDrvR) “CANDIDATE IDNUMBER (applicable) ‘AND PAC CHECK NUMBER "NAME AND ADDRESS TO WHOM EXPENDITURE (Disoursement) WAS MADE MAILTECH (PC (012K PRLL DE MONE, TF LOYPUTER SERVED PURPOSE (DESCRIBE TRANSACTION) MOUNT EXPENDED ED MONEY, T79 DED ne) CPITE PAPI" | EARL EAT 1939 & GhARD LETTER HEP F EPSVELOSEDS CAATEX, fF TIL CAUWPA) ERS CANDIDS CHUTE JIU} T PE POSTERS 1 YYyQ_ SI/CIINS IDV IDERY, JAE IL9O & Coury DED Mh2iRL2 TA DI yp ee SAIOUE POPE. CANTER PUNT) YARD SIRS OFFICE MAA * FZ IS Oate SE /97R S7- 2 MY», Td LALINFUT SIM SE 14h STRET| SUBTOTAL TOTAL (if ast page of this schedule) [THis BOX APPLIES TO CANDIDATES! COMMITTEES ONLY: Purchases of cotin campaign property costing $500 of more must also be Inventoried on Schedule H. (Refer to Schedule H instructions.) Expenditures to prsonsientiies providing consulting, advertising, fund-raising, poling, managing, organizing services must also be detal tized on Schedule by the amount, purpose, and date ofeach ype of expenditure made by the persavVenty on befall f te candle’ commites (Refer Schedule G instructions and iowa Cade 8.6(310), rom Je (for Schode 8) FOR INSTRUCTIONS, SEE BACK OF FORM [SCHEDULE EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT — [STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE! ‘CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE [OWA ETHICS & CAMPAIGN DISCLOSURE BOARD. MONETARY EXPENDITURES ORLEGISLATIVE Di cueck THis Box iF AMENDING FORM, [COMMITTEE NAME (Must be same as on Statement of Organization) TANODATE | WAM AND ADORESS TO WHOM care | IONUMBER EXPENDITURE EXPENDED | (tapsabie) (@iseursament) WAS MADE tawoore) | “ano eac CHECK NUMBER Loo POST BFF IC ABO ERT Ne KIN” fo ficines, LA sex2f| PURPOSE (DESCRIBE TRANSACTION) STAMPS. AMOUNT EXPENDED CHA 2D TPT Hels) VOT S Learyjor DED M/E? T2715) Foo? F 7 EVID Ih 1P \CARI Lage CAFE ny Vee # Nop 274° EUCLID iS Gnd cA ID DIE > IZARTER PEN Fae Eur ise CAND PilprTpel 17949 & GARD IED wei TA FOF TNE FOR YANO F105 GAME. 182) aa’ Dear Lest des Mor €5,204 COMPUTER KEP IEAGE loyntapeA. Lw7eK Sees— W269 DFFLE MAA Be st "a om MILNES LA D226) Plytehe] AY FRA TOPE RE YS 297 VUES LEAL ALY 9750 Astor PRWE eS MOM ES, I D325 | 3AWLE ROTI 5 o> PETA, DE oe - Coury OED Mores, VEST Pia FR. Wt [ie SUBTOTAL TOTAL (if ast page of this schedule) 10}. Yo [| [THIS BOX APPLIES TO CANDIDATES" COMMITTEES ONLY: Schedule G nsvuctons and iowa Code 58.6(91)) Purchases of catain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer 'o Schedule H instructions.) Expenditures o prsonsientiies providing consulting, adversng, fund-raising, poling, managing, organizing services must algo be detl emized on Schecule by the amount purpose, and date ofeach ype of expencture mae bythe persarventy on beta ot te candidate's commitee, (Refer > om ht (for Scredule 8) FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE B MONETARY EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (ev.0007) | EXPENDITURES ‘STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE ‘CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 0 cHeck THis Box IF ‘BAC CHECK NUMBER FOR EACH EXPENDITURE, AIST OF ID NUMBERS IS AVAILABLE FROM THE TOWA ‘AMENDING FORM ETHICS & CAMPAIGN DISCLOSURE BOARD. (COMMITTEE NAME (Must be same as on Statement of Organization) Mk E2LO. FoR S77 “CANDIDATE | NAME AND ADDRESS TO WHOM PURPOSE ANOUNT | IONUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED EXPENDED | _(ifappeable) (Disbursement) WAS MADE | qawoorvr) | “AND PAC. CHECK NUMBER TIL Duy HD yee 8 17 7. virile eB mnie, gre TOT ne 4B OF BET Fey, or | COMPUTER WO ©’ =? spb, rie Dee MOM ES, ZH SOB RP TEL! 1b# CAAT ETC PTA | Caroye ~PLIPTS 229 £ wore? ah)al 2 Me/f23 175) iF LAVCTETC, ons WAS PDTPRS 2055 CPOE ech IDF 2 REPO 1D Te) errr LERTZA| Fun AAS (OF BRODY DRE WAL) A3 te ce a -™™™ SLL spzle3 25, (oe PMLEVS TRUS LA CN ELK) AL Ke Lbs AOCuST 57 ACLOUPT FEES pii2lo. TES POL, FA DIO} [14.00 ud PAKETS TUT CO) CHECK FEE ‘SUBTOTAL [S27 a5 | TOTAL (if last page of this schedule) [THtS BOX APPLIES TO CANDIDATES’ COMMITTEES ONLY: Purchases of certain campaign property costing $500 or more must also be lnventored on Schedule H, (Refer to Schedule H instructions.) Expenditures o personsfentiies providing consulting, advertising, fund-raising, poling, managing, orgonizng services must also be detltemized on Schecule G by the amount, pupose, and date ofeach typeof expancture mado bythe perscr/enty on bela ft candidate's commition, ort Schedule G nructone and twa Code S86(0M)) Poe Do Yf (for Schedule 8) FOR INSTRUCTIONS, SEE BACK OF FORM [ScREDULE B MONETARY EXPENDITURES -~- MONEY SPENT FROM COMMITTEE ACCOUNT foeen |foranmecs STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE (CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE DD cutee THis Box iF PAC CHECK NUMBER FOR EACH EXPENDITURE. ALIST OF IO 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 IDNUMBER EXPENDITURE (DESCRIBE TRANSACTION) (applicable) (Disbursemeri) WAS MADE 'AND PAC ‘CHECK NUMBER FACTORY UD DUTLET b3as5 se pyta ST pre Mounts LP pee ‘SUB-TOTAL ‘TOTAL (iflast page of this schedule) [THis BOX APPLIES TO CANDIDATES’ COMMITTEES ONLY: Purchases of certain campaign property costing $500 or more mus also be inventoried on Schedule . (Refer to Schedule H ietuctions.) Expenditures to personslenities providing consulting, advertising, fund-asina, pong, managing, organizing services must algo be deta tomizod on Schedule G by te amount purpose and date ofeach typeof expenditure made byte personensty on Baha of the cancdsta's commit. (afar to Schmate 6 ranuctone and iowa Cod 9580300) re on (oc Schedute 8) FOR INSTRUCTIONS, SEE BACK OF FORM [SCHEDULE D INCURRED (Rev. 08/88}] INDEBTEDNESS: Ty CHECK THIS BOX IF AMENDING NOTE: Debis previously reported that remain unpald must be included on this Schedkle, a8 well as ary new obligations incurred in this period ‘An “outed debt is a debt for DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD {004s oF services ordered or (DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) stn, at pa by regardless of whether an invoice has been recoived.. DATE DESCRIPTION OF GOODS OR INCURRED NAME AND ADDRESS OF PERSON ‘SERVICES PROVIDED OR ‘TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED. COMIN BEKY NIL 06; VOTER KEL Bole E PAUTOR AVE | PIKE FRE PK Co, AVIDTOR GEMM I + BEC Y HHAEZOK | ) WK CATMLE AMP Cornvuteie GUER CERRLD + PELICY [MeiEBL} VTP ELROD DISC. (AV2OL1 Ms Po) POLK Co. pusnfoe DisMicT ny 1x2) {ae + UBEEICY MCNEIL 2A JAB] 2 GERALDO 4 IPECCY YhefELUe| C Of EX FOU WA) ejP ) Ob e, CEMILD 4 12LiC4 Meyk20ex) PAVE TAC 24), eA 4 PECKY peteiaxe| POSTE, SUPP ‘TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD “If actual igure is unknown, show “estimated” beside the figure, Page__} _ot 4 (fer Sehedtde [EANDIDATE COMMITTEES NOTE: ncumes indebtedness also includes each personlenity with whom the canddae's committe has entered into a contract during the reporting period for future or continuing performance. Enter tho name af the consUitant who provides or procures saves for foms such ae acvorting, fd alsin, polio, managing, 2 | organizing services. Report on Schedule G the nate of performance ad the salma perfomance reasonably expected o the consultant FORINSTRUCTIONS, SEEBACK OF FORM SEDO D INCURRED COMI TEE WANE WB Sanaa on Saar oF OpaReaDO) (Rev. de}, DESTEDNESS (BEC MahkhiGe Fat sme KAUESEPIATIUE| TT CHECK THIS BOX IF AMENDING NOTE: Debs previously reported that remain unpald must be incuded on this FORM Schedule, a wellas any now oblgations cued inthis prod ‘An “noured dee dob for DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD ‘goods a srvices ordered or (DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) ‘eceived, but ot pai fer by the ‘nd ofthe reporting regardless period, ‘of whether an voke DESCRIPTION OF GOODE OR NAME AND ADDRESS OF PERSON ‘SERVICES PROVIDED OR. ‘TO WHOM DEBT OR OBLIGATION iS OWED PURCHASED CUI 1 “BECKY te oyront UE CHPlED Ft DES meiner, pa sboxn| We CLIUILD 4 IPELIC LOVE POC TONED OK , Fury? PHMIIRS LETIAS CENYLD + WPECKY (MOP ESSIOPOAL IVC EL eK, CAMPAICP wouic GENO 4 ECE Coyntu: Preps od PEE Y ae 3S/6G0S CEAND A BECKY YAM S16/0S TRONEZ OCR \CLAWLDN IPE CE Fae IRN ELL 2 osroe ‘TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD “actual fur is unknown, show “estimated” beside the gue Page. of Shea Oy [GANDIDATE COMMITTEES NOTE: eta tines en each parol wit i fh ciate’ came has ean ace he pring pia re | or continuing perfomance. Ener the name ofthe constant who poddos or proce eros for Rom euch ae averting, tun ang, pln, ane ongentng services. Repot on Schwdie G the nlreo perfomance and te erat promancs reasonably execs of the consult FOR NSTRUCTIONS, SEE BACK OF FORM SoD D INCURRED TEE WARE WB a Sr of CeaaIAT trav 00] ceSTEDNESS WDEtiy Melelax jin SIME KPIEL LYE | CREGKTHS BOX IF AMENDING NOTE: Da pepe reap mt oni Lr eds cea any nan Seton mesos ee po noua en de DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD eaten a e ore et te by (DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) ‘ond of the ret Pat no Senet ie reer cane DATE DESCRIPTION OF GOODS OR] GALANCE OWEDAT INCURRED NAME AND ADDRESS OF PERSON ‘SERVICES PROVIDED OR LOSE OF aumoprR) ‘TO WHOM DEST OR OBLIGATION IS OWED PURCHASED PERIOD" IGE. SF IPECEY BOLO F HONE DORE PORE Go Poe £ Byres Ne. es eeae /22)ADES 110/ED, TA) JOBZO Ly EWING) 9 S7S FHC Ca ipeclky natkden POs Yeo |\55 b3 3) A OID? Bete frida | COPED FUL LID)? Bey WE, ; ir ES ees THE YO [AY co oy/ of leg P0012 CEMALDY IPECKY RALZAR SE51GN yiTIAE |I DOS LérTe yo VoTeRs PSAP FR Agog SER. M2 V/TPITPIORIS: VAPEPL Fea FAVA IS BL WT VCOWIDI TORS £5 7 SUBTOTAL CRID? ete y MALLICK, LDA OV ALLY YNVGLZK. ‘TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD eee eee no nf Pia GANDIDATE COMNITTEES NOTE: ined indebiosnoss also Indudes cach personerty with whom the canto’ cammitoe has entre nto a cntac ng the repotng pra for ure ocr poreranc. te sched cows ponscre sercevonea a an Se es a ng sardoes. Report on Schedule G the nue of prfomance ane ta stnatespefonmance reasenably expacted othe consent. FORINSTRUCTIONS, SEE BACK OF FORM [SCHEDULE D INCURRED (COMMITTEE NAME (Must be same as on Statement of Organization) ‘Rev. 089] INDEBTEDNESS: EL Ty CHECK THis BOX IF AMENDING. NOTE: Debs previousty reported that remain unpald must be included on this FORM ‘Schedule, as well as any new obligations incued inthis palo. ‘An“Incutes Set ie 2 debt for DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD ‘goods oF services rcered oF 7 ‘ecaivod, but no paid for bythe {DO NOT INCLUDE LOANS ~ SHOW LOANS ON SCHEDULE F) poesia bee peat regarless of whether an invotce ha boon received. DESCRIPTION OF GOODSOR INCURRED NAME AND ADDRESS OF PERSON 'SERVICES PROVIDED OR. CLOSE OF cr) ‘TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING PERIOD. CEPALOF IBECLY WEPELEX| Eee ale Doe E FAY NUE oe bY 08 oy); E> Thepek >, 777 P2793 ly mapas GLTALOS BED SELLRK e ay oven |p Ns. 39 FEAL BECKY YWAELOCK | yeypsE Sere Cn NNO? PPERY MALL) SINS. SOO. V4.9 GEMALIO) BECEY YMA CK STAMRS 260 SOSTOTAT “Ht actual gue fs unknown, show “estimated” beside the gue. Powe. of Te schecieny ‘TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD [CANDIDATE COMMITTEES NOTE: ued indebtedness alo Includes each persone wih whom the canes comes hat entered ino contac during he repring pera for ee or canning perfomance. Ena the name of te constant who proves or procures serves or ema sch a avers fund rsing, paling, manag, 2 ergentang sericea Regt on Schocl G tho nue of partormance and ihe ealinate porerrancereasonselysxpoco of ho constant FOR INSTRUCTIONS, SEE BACK OF FORM Goes NAME (ut bo sara as on Statement of Organization) — 1 CHECK THIS BOX IF AMENDING FORM ESTIMATED |v FOR FAIR MARKET | FUND-RAISER aLue | CONTRIBUTION BATE FELATIONSHIP- | DESCRIPTION RECEIVED NAME AND ADDRESS TOCANDIDATE | "OF INKIND uM DDR) ‘OF CONTRIBUTOR, CONTRIBUTION, SOSTOTAL ‘Disclosure aw requires candles o discos the rlatonsio of any relative making an in tnd contrbuton ‘othe Page__]_of. committee. Reatonship must be shown fo the third ogre of consanguinity (hood relatives) and afin (relatives Ger Schade EV bby maiage) (See Page 2 of forme packet) If sumame of contours the same ae candidat, butter NO familial relabonship, enter “not appicabe” inte relationship cok, FOR INSTRUCTIONS, SEE BACK OF FORM [COMMITTEE NAME(Ausi bo same as on Statomont of Organization) PEcKY mog: Fat KELLE DOTUIDE NOTE: This schedule reports money loaned tothe committe which Is deposited In the committee account TOTAL UNPAID LOANS FROM LAST REPORTING PERIODS =D PART |- MONETARY LOANS RECEIVED THIS REPORTING PERIOD (Original source of oan, such as a bank, must be shown if third party is Involvod_Ineutie loans from candidate's personal funds.) DATE NAME AND ADDRESS OF LENDER] RELATIONSTIP, RECEIVED | (include Endorser's Name, I Appicable) | TO CANDIDATE (UDO) "AMOUNT OF LOAN GENALD MMELoL. Bole £ fay OES VROIRED, JA 50226 (SCHEDULE F LOANS (Rev. 08196) | RECEIVED REPAID (CO CHECK THIS BOX IF ‘AMENDING FORM PART II- MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD (Loans forgiven must be reported on Schedule E In-kind Contrbutlons.) DATE PAID] NAME AND ADDRESS OF LENDER RELATIONSHIP] AMOUNT (Include Endorser's Name, I Applicable) TOCANOIDATE® | “REPAID Applicable 3s 50. TOTAL (PART 1) "Diecosira law requires candida committees to deco the relationship of any relative making @ contibuton tothe committe. Relationship must be shown to the tid degree of [consangully (olood relatives) and afty (relatives by marrage). (See Page 2 o forms packet) If surame of contributors the same as candidate, but there Is no familia Felavorship, enter “not applicable” in the eltionship columa when it appl. ‘TOTAL CASH REPAYMENTS (PART I} s_Q s_A s50D-O From Schedule E - TOTAL LOANS FORGIVEN TOTAL OUTSTANDING LOANS END OF REPORT PERIOD rae__|_o__} TerSowier)

You might also like