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  • 8/7/2019 Berryhill Mel__1691__scanned

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    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

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    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 , -

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    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

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    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 #

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    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 ~

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    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 :

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