berryhill mel__1691__scanned
TRANSCRIPT
-
8/7/2019 Berryhill Mel__1691__scanned
1/8
Jan 16 07 03 : 51 p
FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( Mu s t b e s a me a s o n S t a t e m e n t o f O r g r a n i z a 5 o , ! L e
~-2 ,4 / ? c , ~~I MPORTANT . I n d i c a t e b y i t t y p e o f c o mmi t t e e y ou a r e r e p o r t i n g f o r . C 7 _ J( 1 ) S t a t e w i d e l L e g i s l a t i v -. . k l u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y{ 4 ) C o u n t y C e n t r a l C ommi t t e e - ( 5 ) C o u n t y r Z a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n Ca n d i d a t e ( e ) C o u n t y P A C , ( 9 w PA C ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a l Su bd i v i s i o n PAC1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TTEES O N L Y :C a n d i d a t e Name i
O f f i c e Soug h t
L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l a n d ` i
4 ~ ~ _ERSON F I L I N RESI GNATURE OF PORTPI AM F I L I N G A
Me l He r r yhi l l
HECK I F AMENDMENT TO REPORT DATED
p e n a l t i e s .
P o l i t i c a l P a t t y ( f a p p l i c a b l e _ )
D i s t r i c t ( i f Se n a t e o r House )
TELEPHONE
REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- E LECT I ON YEAR .( r e p o r t d a t e ) I n d i c a t e b y #
[ ] C h e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n Fo r m D R- 3 -( Y o u mus t c o n t i n u e t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )
ADD TOTAL MONEY TAKEN I N T HI S PERI OD
SUBTRACT TOTAL MONEY SPENT T HI S PERI OD
STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amoun t MUST b e t h e s ame a s t h e c a s h o n h a n d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Sc h e d u l e A : Ca sh C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A) ( ` a l s o s e e i n - k i n d b e l o w ) . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e H : T o t a l S a f e s o f Camp a i g n P r o p e r t y ( A t t a c h S c h e d u l e H) . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
( Sc h e du l e H a p p l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . - . . . . $
7 1 2 - 3 3 8 - 9 7 3 3
FORMDR- 2 DI SCLOSURE( Re v . D720D4) REPORTF o r O f f i c e Us e O n l yComm .L o o n e d I nscannedC o mp u t e rA u d i t e d
L o r a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y a L o c a l C o mmi t L e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d
S c h e d u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) ( " ` a l s o s e e d e b t s a n d l o a n s b e l o w ) . . . . . . . . . . .Sc h e d u l e F : L o a n Re p a yme n t s t o t a l ( A t t a c h Sc h e d u l e F 7 . . . . . . . . . . . . . . . . . . . . . . . _ . . - . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . .
CASH ONHAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( f f i n a l r e p o r t b a l a n c e mus tb e z e r o ) ( A t t a c h D R - 3 ) . . . . . - . . . _ - _ . . . - . _ . - . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 C.A.
CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES 6 - f - I 1 0CANDI DATE COMMI TT EES ONLY :
" UNP AI D BI L LS ( F r o m S c h e d u l e D - A t t a c h S c h e d u l e D ) . _ . . . . . . . . - _ . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S' I N K I ND CONTRI BUTI ONS ( F r o m S c h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S- OUTSTANDI NGLOANS ( F r o m S c h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . - - . . . - . - - - _ - - - - - - - - . . . . . . . . . . . . . . . . . . . . - - $
p . 4
-
8/7/2019 Berryhill Mel__1691__scanned
2/8
Oc t 3 1 0 6 0 8 : 5 1 P
FOR I NSTRUCT [ ONS, SEE BACK OF FORMDI SCLOSURE SUMMARYPAGECOMMI TTEE NAME r Mu s f b e same a s e r r S t a t e me n t o f Or g a n i z a So n
I AA 4 FI L I NG A
1t JPOnoi 2 t c t r y t y p e o 1 c o mmi t t e e y o u a m r e p o r t i n g f o -( I ) S t a t e v ad e f L e g i s l a t r v r a J ud g e St a n d i n g f o r Re t L n t i o n C a n d i d a t e ( 1 ) t a t e PAC 1 3 ) S t a t e P a r t y( 4 ) C o u n t y C - - n t r a t C o mmi t t e e - ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S &o o l B o a r d o r O t h e r P o l i t i c a )S a b d i v i s i o n C a nd i d a t e ( 9 ) C o u n t y PAC ( 9 ) C i t y PAC ( 1 0 ) S r h o o [ S o a r d o r O t h e r P o l i t i c a l S u b d i v i s i o n PACi 7 ? ) L o c 2 1 B a l l o t I s s u e
CHC2 S o u g h t-L a t e r e p o r t s a r e s u b j e c t t o p o ss i b )
__ DCHECK I F A f A FNDMENT TOREPORT DATED
Me l Be r r y h i l l
REPORT FOR ( ' I ) E L E C T I O N / ( 2 ) NON - E L EC T I ON YEAR( r e p o r t d a t e ) I n d i c a t e b y #
C h e r - k i t t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n Fo r m DR- 3( Yo u must c o n t i n u e t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d )
CASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e - T h i s amou n t MUST b e t h e same a s t h e : a s h o n h a n d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r must b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . - . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDTOI AL MONEY TAKEN I N T HI S PERI ODSc h e d u l e A Cash Co n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A ) ( ' a l s o s e e i r i A i n d b e l o w ) . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F I . - - . - - - - - . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . .Sc h e d u l e H : T o t a l S a l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h ed u l e H ) . . . . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . .
S c h e d u l e H a p p l i e s t o C a n d i d a t e s ' Co mmi t t e e s On l y )
' S L I E TR A C7 TOTAL MONEY SPENT T HI S PERI OD
STATEMENTOFCASHON HAND
SUB- TOTAL . . . . . . . . . - - - - - _ $
S c h e d u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h ed u l e B ) ( a ( s c s e e d e b t s a n d l o a n s b e l o w ) , . . . . . . . . .S c he d u l e F : L o a n Repay men t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .CASH ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( r f f i n a l r e p o r t b a l a n c e must
b e z e r o ) ( A t t a c h OR- 3 ) . . . . . . . . . . . _ . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . _ . . . - - . - - . . - - . . . . . . . _ . . . . . . . . - - - - . . . - . . . . . . - . . . . . S, " UNPAI D BI L L S ( F r o m Sc h e d u l e D - At t a ch Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . - . . - . . . . . - . . . . . . - . . . . . . - . . . . S
712 - 3 3 8 - 9 7 3 3
FORMDR- 2( Re v . 0 7 r 2 0 0 4 )
Fo r Or n e e Us e Onl yComm. R _L o o p e d I nC o mp u t e rA u d i t e d
DI SCLOSUREREPORT
1 b q 1
` i N KI ND C Oi j 1 T F c 1 3 UT 1 0 NS ( F r o t h S c h e d u l e E - A t t a c 7 Sc h e d u l e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . - S" OUTSTANDI NG LOANS ( Fmm S r h e d u i e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . - - . . . . . . . . _ . . . . . . . . - . . . . . . . - . . . . . . . .CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) , ~YES _ Z NOCANDI DATE COMMI TT EES ONLY :
363 , 1 0 0C~, 0 G , -
-
8/7/2019 Berryhill Mel__1691__scanned
3/8
1 1 c t . 3 1 ( 1 R ( 1 8 : 5 1P Me l Be r r ~ j h i l 1F o r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N
( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EENAME( Mu s t b e same a s o n S t a t eme n t o f O r g a n i z a t i o n )~Omrr " 1Wee 4 " 5 1 e c ; f - I hW &Sr - ' y 4 ' 1 iSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) . L I S T THE PAC I DENTI FI CATI ONNUMBER AND THF PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .
712-338-9733
Rese t Fo r m SCHEDULEA MONETARY( Re v . 0 7 1 0 3 ) RECEI PTS0 CHECK T HI S BOX I FAMENDI NGFORMNOTE ANY PERSON, OTHER THAN AN I NDMDUAL, THAT CONTRI BUTES MORE THAN 3 7 5 0 TOYOUR CAMPAI GNMAY HAVE F I L I NGRESPONSI B I UT I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s a n d s t a l e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yComme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l Commi t t e e s .
P . ; '
J SUB- TOTALTOTAL ( i f f a s t page o f t h i s s c h ed u l e )
D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) - I f s u ma r n e o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn _ ( f o r Sc h ed u l e A)
DATE PAC I D NUMBER NAME ANDACDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SE=RNUMBER I NCOME
I D#- J v n ~ c )
CK#I D #r r / - - I er g S- 1 3 C v 5 - C . ( . ` c l
C I C I . l l L tCr Cl eY U Pe r t l/ r l 0 O
) C j6 oI D #
J 3 C - - o a ? ~ . c u
1D# ~' - - - - ~ ~ ~c s c #
y CK# s 7
-
8/7/2019 Berryhill Mel__1691__scanned
4/8
n n t 3 1 I l ( ; ( I s 5 ; 3 p M P I H p r r y h i l 1F a r I n s t r u c t i o n s , S e e B a c k o f F o r mC O N T R I B U T I O N S - - M O N E Y T A K E N I N
( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME( Mu s t be sa me a s o n St a t e me n t o f Or g a n i z a t i o n)' o n n r n ,Wee / r . / j 7 . 1 o ~ r S' enwde- ,
712-338-9733 PIRese t Fo rm SCHEDULEA( R e v . p 7 / D 3 ) MONETARYRECEI PTS0CHECK THI S BOX I FAMENDI NGFORM
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L T T I C A L ACT10N COMMI TTEE) , L I S T THEPAC I D ENT I F I C AT I ONNUMBER AND THF PAC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I O NUMBERS I S AVAI LABLE FROM TH E I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .NOTF- ANY PERSON, OTHERTHAN AN I NDNI DUAL THAT CONTRI BUTESMORE THAN $ 1 5 0 TOYOUR CAMPAI GN MAY HAVE F I L I NGRESPONSI BI UT I ES ANDSHOULD I MMEDI ATELY CONTACT THE BOARD.CAUTI ON : Sec t i o n 6 8 B . 3 2 A ( 6 ) , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r f o r a n yc omme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .
TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) I' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a b o n s t s p o f a r t y r e l a t i v e ma k h t g a c o n t r i b u t i o n t o t h emmmi t t c e R e l a t i o n s h i p m u s t be s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a mi t y ( r e l a t i v e s b y ~ma r r i a g e ) I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa g e -11ff a m i l i a l r e l a t i o n s h i p , e n t e r ' n o t a p p l i c a b l e ' i n t h e r e l a t i o n s h i p Col umn_ ( f o r Sc h e d u l eA)
DATE I PACI D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RPI ATI ONSHI P AMOUNT q I F FOR 'RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECENED FUND-( MM/ DD/ YR) ! AND PACCHECK C i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI D# 4 ~ , $CK# C ~ a Cc )S/ . 3 / ~I D# i
S- 7 3a C!
/ C C)
/ U - ~ : CK# Vc r r YtI D# / - ' - r t e 7 - CCJ~/ 0 - C/ a r , " r ~9 s%- ~ / s - ' CD# Lc 1nr C~ C~rV7 _" ' CK# / 6 ; ~%oC' c ` C . " C/ L ~C/ L- r t 7 c ~ ; 1 / 2 s S - / O V T C d
3 / - o C K #D #C K #C K #I t ? #C K #
-
8/7/2019 Berryhill Mel__1691__scanned
5/8
Oc t 3 1 0 6 0 8 : 5 2p Me l Be r r ~ j h i l l 7 12 - 3 38 - 9 73 3
FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t F or mEXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNT
STATE PAC COMMI TTEES_ NOTE : FORCONTRI BUTTONS MADE TO STATEWI DEOR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN ANDTHEPAC CHECK NUMRFR FOR EACH FXPFNDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI TT EE NAME ( Mu s t b e same a s o n St a t e me n t o f Or g a n i z a t i o n)
Z'G///e/Zer r r ~ , A , 1 / f i :- Te, 7 `4~
T HI S BOX APPLI ESTO CANDI DATES' COMMI TT EES ONLY :
SUB- TOTALs c h e d ul e ) $TOTAL ( i f l a s t page o f t h i s
( f o r Sc h e d u l e B )
p . 4
MONETARYEXPENDI TURES
SCHEDULEB( Re v . 0 7 1 0 3 )QCHECKT HI S BOX I FAMENDI NG FORM
Pu r c h a s e s o f c e r t a i n c amp a i g n p r o p e r t y c o s t i n g $ 5 0 C o r mo r e must a l s o b e i n v e n t o r i e d o n Sc h e d ul e H. ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s t e n GUe s p r o v i d i n g c o r s u l l i n g , a d v e r b s i n c , f u n d - r a i s i n g , p o l l i n g man a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o nS c h e du l e G b y t h e amoun t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o N e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c u mmi t t e e . ( R e f e r t oS c h e du l e G i n s t r u c t i o n s a nd I o wa Code 6 8A . 4 0 2 ( 3 ) ( i ) . ) _
CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI B E TRANSACTI ON) EXPENDEDEXPENDE=D ( 1 1 a p p l i c a b l e ) ( Di s b u r s e me n t ) WAS MADE( MMI DDI YR) AND PACCHECKNUMBERI D#
-X CK# 700 ~
-
8/7/2019 Berryhill Mel__1691__scanned
6/8
Oc t 31 06 08 : 53 p Mel Her r yhi l l
FOR I NSTRUCTI ONS, SEE BACK OF FORM Re s et F oc r nEXPENDI TURES - MONEYSPENT FROMCOMMI TTEE ACCOUNT
STATEPAC COMMI TTEES : NOTE: FORCONTRI BUT I ONSMADE TO STATEWI DEOR LEGI SLATFVECANDI DATES, L I S T THECAND I DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMNANDTHEPACCHECKNUMBER FOR EACH FXPFNDI TURE A L I ST OF I D NUMBERS I S A VA I L A BLE FROM THEI OWAL I HI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e sa me a s o n S t a t e me n t of Or g an i z a t i o n)
712- 338-9733
CHECK THI S BOX I FAMENDI NGFORM
THI S BOXAPPLI ESTOCANDI DATES' COMMI TTEES ONLY :
SCHEDULE
, 0( R e v , 0 7 J n 3 )
SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e du l e )
Pu r c h a s e s o f c e r t a i n c ampa i g n p r o p e r t y co s Ln g $ 5 0 0 o r mor e must a l s o be i n v e n t o r i e d on S c h ed u l e H. ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s . )
MONETARYFXPFNDr TURES I
E - x p e n d i l u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u l t i n g , ad ve r b smg , f u n d - r a i s i n g , p o l l i n g _ , manag i ng , o r g a n i z i n g s e r v i c e s must a l s o b e d e t a i l i t e m i z e d onSc h e d ul e G b y t h e amoun t , p u r p o s e , an d d a t e o f e ac h t y p e o f e x p en d i t u r e made b y t h e p e r s o N e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e ( R e f e r t oSc h e d ul e G i n s t r u c t i o n s a nd I owa Code 68A . 4 0 2 ( 3 ) ( i ) . ) - -
Page ` 'Z o f "2"( f o r S c h ed u l e B )
p .
CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER I EXPENDI TURE ( DESCR I BE TRANSACT I ON ) EXPENDEDFXPFNDFD ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) ANDPACCHECKNUMBER
~IOI L .
D# C ' ) 4 /C K#0, q $I D# l
( 0 - ? T - e w CK# . _i ~ .~~ Gc1
I D# e
I D# I ~p S 7 b / ' ~- ~ ~vuuJ
F ~ _ , l C 1 , 1- b(7 f / / vPGc I S~CK# = 3 J ~~ / t ' R- ~ u P r S' / ~ S ~. a 7O . . ~ . , ! ~ C I~~~r c ' ~ ' J r F Y 1/ y 5C , l
~O b ' b ' , r y t ~~P r o S c r / 9 c Jl 0 ' j l r ( , ( > CK# s ` Z I Y Sr r f ~~~, . , a S i 3
-
8/7/2019 Berryhill Mel__1691__scanned
7/8
C l c : t , 31 ( 1 E ; ( 1 8 : 93P
FOR I N STRI U CT I ON S . S F F RACK OF FORMCOMMI TTEE NAME ( Mu s t b e s ame z s o n S l a t - - m e n t o f O r c r a n n a t i o n )w" . f i w 4 < ' / e a t Xe l Be r i y l + , l ~ - 4 r
NOTE : De b t s p c e v i o u s t y r e o a r t e d t h a t r e ma i n u n p a i d mc s t o e i n c l u d e d o n t h i s
An i n c u r r ed d e b r i s a d e b t f o rDEB T S f OB L I GAT I ONS REMA I N I NG T HI S REPORT I NG PERI OD g o o d s o r s e r v i c e s o r d e r e d o r( DO NOT I N CLUDE LOANS - SHOW LOA NS ON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y t h t =e n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f wh e t h e r a n i n v n i c _h a s b e e n r e c e i v e dDATE
I NCURRED( v f d , J D D, y P )
/ 0_ . , 3 v _ 0~
a s : " n ! I a s an r , ?w o b l i g a t i o n s i ; e ~ n ed i n f h s p e r i o d .
CANDI DATE COMMI TTEES NOTE :
MPl Herryhi l l
NAME ANDADDRESS OF PERSONTOWHOMOEHT OR OB L I GA T I ON ' S OSVED
( , , r / e b ( , r . phI Csl o v l o w` s 4 ' P C) QoXy~~
/ ~ ' I r ~ ~ v r s , . r T; 9 4 ~3 L - 144 ' e -e. r News Sho~PrY/ 0 6 9
i ; R e s e f
712 - 338-9733
- i EDULECRev . D 8 1 9 8 ) I NCURREDI NDEBTEDNESSD CHECKTHI S BOXI F AMENDI NG
FORM
DESCRI P I I ON OF GOODS OR BALANCE OWED AISERVI CES PROVI DED OR CLOSE OrPURCHASED REPORTI NG
PERI OD 'l " Gr n PA~ ~ ~ eG rcJS
- , r , 6 1#11 7 U
/ 1 / ~ P4 I s~ r r r
S UB - T OT A I -
TOTAL DEBTS OWED BY COMMI TTEE AT THU ENOOF THI S REPORTI NGPERI OD
a7 3f . , ( ; 7. ' / S
573? / 7, 4153Y7~/ 5
- I t a c t u a l f I C L T E i s unknown, s h o w' e s i i ma t e d ' b es i d at h e ` . U , E ? a o ! ~ , o f _/ --( f o r S c he d ul e D )
- I - . . . , . " ~ ~ . " . . , . . , . , n - " n r l i d a r e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a = 1 d u r i n g t h e r e p o r t i n g p e r i o d f o r t u t J - = -
P . ( ~
-
8/7/2019 Berryhill Mel__1691__scanned
8/8
Oc t 3 1 0 6 ( 1 8 : 5 3 p Me l He r r y hi l l 7 12 - 3 3 8 - 9 73 3
FOR I NSTRUCTI ONS, SEEBACK OF FORMCOMMI TTEE NAME ( Mu s t b e same a s o n St a t eme n t o f O r g a n i z a t i o n )
Re se t Fo r m
SCHEDULEE I N- K I ND( Re v . 0 6 / 9 7 ) 1 CONTRI BUTI ONS
CHECK T H I S BOX I FAMENDI NG FORM
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e mak i n g an i n k i n d c o n t r i b u t i o n t o t h e Page / o fc o mmi t t e e . R e l a t i o n s h i p mus t b e sh ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s ( f o r Sc h e d u l e E )b y m a r r i a g e ) . ( Se e Page 2 o f f o r ms p a c k e t . ) I f s uma r n e o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn .
DATERECEI VED NAME AND ADDRESS( MM/ DD/ YR) OF CONTRI BUTORRELAT I ONSHI PTO CANDI DATE
' ( i f a p p l i c a b l e )DESCR I PT I ONOF I N K I NDCONTRI BUTI ON
ESTI MATEDF AI R MARKETVALUEA I I F FCRFUND - RAI SER
CONTRI BUTI OND t - ' c t ' S
Cc L-) C' n , r c v " A_~~Bt X~rCxi nSc : ~v y - ~ n C/ d _l OU . . o r 1- b t c C I ~ , s ~ : , y r1 9 c j 3 c l y e W-