democratic governors association-iowa9658scanned

8/7/2019 Democratic Governors Association-Iowa__9658__scanned

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FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SUMMARYPAGE

COMMI 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 )Demo c r a t i c Go v e r n o r s ' As s o c i a t i o n - I o wa

I MPORTANT I n d i c a t e b y # t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r F 2_ _ 1 4; W2( 1 ) S t a t e w i d e / L e g i s l a t i v e / J 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 PA C ( 3 t a t e P a r t y( 4 ) C o u n t y C e n t r a l C o mm i 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 c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PAC ( 9 ) C i t y PAC ( 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 lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TTEES ONLY :Ca n d i d a t e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

O f f i c e S o u g h t D i s t r i c t ( i f Se n a t e o r Ho u s e )

2 0 2 - 7 72 - 5 61 1E ON PERSON ' RL I NG REPORT TELEPHONE

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I AM F I LI NG A Oc t o b e r 1 9 , 2 0 0 4( r e p o r t d a t e )

) 9CHECK I F AMENDMENT TO REPORT DATED Oc t o b e r 19 , 2 0 0 4F 1 Ch 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 F o r m DR- 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

REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR .I n d i c a t e b y #

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 e

c o mmi t t e e . T h i s amoun t MUST b e t h e same a s t h e c as 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 mus 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 : Cash 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 ) . . . . . . . . . . 2 5 1 0 0 0 . 0 0Sc h e d u l e F : L oan 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 1Sc h e d u l e H : T o t a l Sa 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 e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

( Sc he du l e H a p p l i e s t o Ca nd i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $ 2 5 , 0 01 . 00

SUBTRACT TOTAL MONEY SPENT TH I S PERI ODSc 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 ) . . . . 2 5 1 0 0 0 . 00Sc h e du l e F L oan 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

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 ( i 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 DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * UNPAI D BI L LS ( F r o m Sc h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N K I ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTAND I NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H ) $

I - 1 4 C l c \ C- I 4 JFORMDR- 2 DI SCLOSURE

( R e v . 0 7 / 2 0 0 4 )I

REPORTF o r Of f i c e Us e O n l yComm . #L o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

La t e r e p o r t s a r e s u b j e c t t op o s s i b l e c i v i l a n d c r i m i n a lp en a l t i e s .

2 - t f hDATE S I GNED

L o c 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 & L o c a l C o mmi t t e 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

1 . 00

1 . 00_ 000u YES NO


2/6

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTR I BUT I 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 EE NAME ( M u s t be s ame a s o n St a t eme nt o f Or g a n i z a t i o n)De mo c r a t i c Go v e r n o r s ' As s o c i a t i o n - I o wa

Rc sc t F o r m SCHEDULEA MONETARY( R e v 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) , L I S T TH E PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM TH E I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d 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 rf o r a ny c omme r c i a l p u r p os 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

SUB- TOTALTOTAL ( i f l a s t p a g e 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 mm i 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 mm i t t e e . R e l a t i o n s h i p m u s t b e s h own 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 r n a me 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 o Page 1 o f _1f 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 AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT q I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUN( MM/ DD/ YR) AND PA C CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# I . B . E . W .8 / 1 0 / 0 4 $ 25 , 0 00CK# 112 5 15 t h St r e e t , NW N / AWa s h i n t o n DC 20001I D#C K#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#


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4/6

De m . Go v e r n o r s A s s n . Fa x : 2 0 2 - 7 7 2 5 60 2

I A . - 5 3I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGE

COMMI TTEE NAME ( Mu s t be 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 )De mo c r a t i c Go v e r n o r s ' As s o c i a t i o n - I o wa

I MPORTANT : I n d i c a t e g Te o f c o mm i t t e e y o u e r e r e p o r t i n g f o r :( 1 ) S t a t & w l d e / L e g l s l a t l v e Ca nd i d a t e ( 2 ~ t d ~ , t ` ~ . 8 1 t t i ' Ot o( 6 ) Co u n t y PAC ( e ) b a l l o t I s s u e f F r a mh 1 8 e C r i " 0 ' 4 T , f y 1 i , 1 1 1 t r a lCANDI DA1E COMMI TT EES ONLY : C . ~C a n d i d a t e Name P o l iO f f i c e S o u g h t

i y d- NATU O TREAS o r p er s o n t i l i n g t h i s r e p o r t )

ADDTOTALMONEYTAKEN I N T HI S PERI OD

TELEPHONE

C- 1 Chec 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 F o r t h DR3 .( Y o u mu s 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 N o t i c e o f D i s s o l u t i o n i s f i l e d , )

STATEMENTOFCASHONHAND

Oc t 1 9 2 0 0 4 1138 P . 0 2

DATE SI GNEDLa t e f i l e d r e po r t s a r e s u bj e c t t o po s s i b l e c i v i l andc r i mi n al pe na l t i e s .

SEEI NSTRUCTI ONS ONBACKANDCOMPUTETHEFOLLOWI NGSENTENCE'I AM F I L I NG A REPORT FOR AI WA 1 ELECTI ON / ( 2 ) NON- ELECT I ON YEAR,

( r e p o r t d a t e ) I n d i c a t e o n e ~2[ CHECK I F AMENDMENT TOREPORT DATED

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 h i s I s t h e t o t a l o f a l l mo n i e s h e l db y t h e c o mm i t t e e . T h i s a m o u n t MUST b e t h e same 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 m u 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 . ) . , . . . . . . . . . . , . . . . . . . $ . 1 . 0 0

L o c a l C o mmi t t e e s , e n t e r D a t e o f S e c t i o nC o u n t y l 4 L o c a l C o mmi t t e e s , e n t e r c o u n t y i nw h i c h F J e c t o n i s h e l d

S c h e d u l e A: Cash C o n t r i b u t i o n s t o t a l ( A t t a c h S c 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 ) . . . , . . , . . . / _5r000.00

FORMDR- 2 DI SCLOSURE( Re v . 0 7 1 2 0 0 3 ) REPORTEa rQl AmUse On l yComm.L o g g e d I nScanne dC o mp u t e rA u d i t e d

Oc t o b e r 1 9 , 2 0 04

CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( Fr o m S c h e d u l e H - A t t a c h S c h e d u l e H) $

YES F- 1NO

R7 / 04

S c h e d u l e F : L oan s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e H: To t a l Sa l e s o f Ca mp 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 ' Commi no es On l y )

00

SUB- TOTAL . . . . . $ 2 5, 10 0 - 0 0SUBTRACT TOTAL MONEY SPENT T HI S PERI ODS 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 S c h e d u l e 8 ) ( - ' 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 ) . , . . 2 5 , 0 00 . 00S c h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . , . . . . . . 0

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 er i o d ( i f f i n a l r e p o r t , b a l a n c e mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . , . . . . _ . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . _ _ . . . . . . . . . . . . . . . . . . . . . . . . $ 1- 0 0" 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0* I N KI ND CONTRI BUT I ONS ( F r o m S c h e d u l e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . $ 0" OUTSTAND I NG LOANS ( 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 ) . . . $ 0


5/6

Dem. Go v e r n o r s As s n . Fa x : 2 0 2- 7 7 25 6 02 Oc t 1 9 2 0 0 4 1138 P . 0 3

Fo r I n s t r u c t i o n s , Se e Ba c k 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 )

I A- 5 5

COMMI TT EE NAME ( Mu s t b e same a s on St a t emen t o f O r g a n i z a t i o n )De mo c r a t i c Go v e r n o r s ' As s oc i a t i o n - I o wa

TOTAL ( i f l ost pageof l 5hi s schedul e) rD 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 mm i 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 ns N 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 omr r f f . R e l a t i o n s h i p m u s t b e 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 t a t h r e s ) a n d a f f i n i t y , ( r e l a t i v e s b yM a r t - 8 e ) . H s r w n a r n e o f oomnbu t o r i s t h e s a n e a s c a n d i d a t e , b u t t h e r e i s nof t - l l W r o f a f i e r ~ hl p , - r w, - not a pp r i a ab WI n mo r e l a go r u nI p c o l u mn .

SUBTOTAL

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I V E D FROMA STATE PAC ( P OL I T I CA L ACTI ON C OM MI T T E E ) , L I S T THEPAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r m a 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 m e 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 rf o r a n y c o mme r c i a l p u r p o s e b y any 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 e s .

$25, 000

1 Of 1( f o r S d t e d u l e A )

7 / 0 4SCHEDULEA MONETARY( R e v - 0 7 1 0 3 ) RECEI P T SD CHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE - RECEI VED FUND-( MM1DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D #/ 1 0 / 0 4 i , B . E, W, / A $ 25 , 0 0 0CK# 1 1 2 5 1 5 t h St r e t0 6 0 5NWWa s h i n t o n DCI D #CK#I D #CK#1 Q#

.CK #I D ! #CK #I D#CK #1 D#CK#I D# wCK#I D0CK #I D t #CK #


6/6

Dem . Go v e r n o r s As s n . Fa x : 2 0 2- 7 7 25 6 02 Oc t 1 9 2 0 0 4 1 1 : 3 8 P . 0 4

I A- 5 7 7 / 0 4

T HI S BOX APPUI ES TO CANDI DATES ' COMMI TT EES ONLY :P u r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ S 0 0 o r mo r e mu s t a l s o b e I n v e n t o r i e d o n S c h e d u l e H ( R e f e r t o S c 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 l t u r e s t o p e r a o n a / e n t i f i e s p r o v i d i n g o o n s u l f i n g , a d v e r t i s i n g , f u n d - r a i s i n g . p o l l i n g , ma n a g i n g , o r g an i z i n g s e r v i c e s mu s t a l s o b e d e t a i l I t e mme d a nS c h e d u l e G b y t h e amount p u r p o s e . and 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 J 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 wmmi t l e e . ( R e f e r t oSc hed u l e G i n s t r u c t i o n s a n d I o w a Co de 1 5 M. 4 0 2 ( 0 . )

( f o r S c h e d u l e B)

FOR I NSTRUCT I ONS, SEE SACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TOSTATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I ON NUMBER I N THE DESI GNATED COLUMN AND THE L J CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMET HI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e s ame a s on S t a t emen t o f Or g a n i z a t i o n )Democrat i c Governor s' Associ at i on- I owa

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i t 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" ) AND PACCHECKNUMBERI D# 9098 I owa Democrat i c Pa r t ,

/ 10/ 04 CK# 100 1408 Locust Avenue Cont r i but i on $25, 000De s Moi nes, I A 50309I D4CK#I D#CK#I b #CK#I D#CK#I b #CK#I D#CK#I D#

L CK# SUB77a_ $ 25, 000TOTAL ( i f l a s t p a ge o f t h i s S c h ed u l e ) $

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democratic governors association-iowa9658scanned