radig keith__1557__scanned
TRANSCRIPT
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FOR I NSTRUCTI ONS, SEE BACKOF FORM
DI SCLOSURE SUMMARY PAGE
COMMI TTEE NAME ( t i f u
b e s a
s o
S t a t e
t o f Or g a n i z a t i o n ) .
b a e b 4 e
r
C. r
VI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :
( t
a t e w i d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e
( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e Co mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e( 6 ) S u p p o r t y5 l a j e o f C a n d i d a t e s
SI GNA UR
TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t )
I AM F I L I NG A
( r e p o r t d a t e )
FI CHECK I F AMENDMENT TO REPORT DATED
_. s3- zE77
TELEPHONE
Ro u t i n e Pe na l t i e s Du e Fo r L a t e F i l e d Re p o r t s Rang e f r o m $ 2 0 t
SEE I NSTRUCTI ONS ON BACKAND COMPLETE THE FOL LOWI NG SENTENCE :
REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) N
)
( ] C h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h No t i c e o f D i s s o l u t i o n F o r m DR- 3 .
( Yo u mus t c on t i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )
ST ATEMENT OF CASH ON HAND
I n d i c a t e o n e
CASH ON HAND a t t h e b eg i n ni 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 d b y t h e c o mmi t t e e . T h i s am o u n t MUST b e t h e
s ame a s t h e c a sh o n h a n d a t t h e e n d o 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
FORM
DR- 2( Re v . 0 1 / 9 8 )
DI SCLOSURE
REPORT
F o r O f f i c e Us e On l y
Comm . a _
I n d e x
A u d i t e d
Compu t e r
As C~
NOV
4 2 0 0 4
QMI d 2&;
I ON YEAR .
L o c a l C o mmi t t e e s , e n t e r Da t e o f E l e c t i o n
/ UOJ
Z 4 z o o
Co u n t y & L o c a l C o mmi t t e e s , e n t e r Co u n t y i n
wh i c h E l e c t i o n i s h e l d
7 - 7 SS
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Fo r I n s t r u c t i o n s , See Back o f Fo r m
CONTRI BUTI ONS - - MONEYTAKEN 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 ( M u s t b e s ame a s o n S t a t e m n t o f O r g a n i z a t i o n )
STATE CANDI DATES - N O T E : I F A C ON T R I B U T I O N I S R E C E I V E D FROMA S T A T E P A C ( P O L I T I C A L A C T I O N C OMMI T T E E) , L I S T T H E P A C I D E NT I F I C A T I O NNUMBER A N D T H E P A C CHECK NUMBER I N T H E D E S I G N A T E D COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I O WA E T H I C S A ND C A MP A I G ND I S C L O SU R E BOARD
CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o 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 a n d 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 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 e s .
SCHEDULE
A MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS
CHECK T H I S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AN D ADDRESS OF CONTRI BUTOR R EL A T I ON SH I 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-
( MM/ D D / Y R ) AN D PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME
I D#I 0
CK# z FC J J ` T - e 4 - - t , " I To - e - c { Ap 4 - Z f 5$
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Fo r I n s t r u c t i o ns , See Back o f Fo r m
CONTRI 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 EE NAME ( M u s t be s ame a s o n St a t g n j e n t o f Or g a n i z a t i o n)
STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER ANDTHE PACCHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E F ROM T HE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa C o d e , 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 op i e d f r o m r e por t s a n d s t a t e me nt 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 an y c omme r c i a l p ur p o s e b y an 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 e s .
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI 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/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
I D# `
/09 CK# = 3 , f ' 35 Fo . . wr ~ t e P ~OLJv
S , l s t t o ~I D#
CK#l o t s - 00
CA A ' S 1 I C'
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FOR I NSTRUCTI ONS, SEEBACK OF FORM R e s e t F o r m SCHEDULE
EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT
( Re v . 0 9 / 9 7 ) EXPENDI TURES
STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI V ECANDI DATES, L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHE 0 CHECK THI S BOXI FPAC CHECKNUMBER FOR EACH EXPENDI TURE A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA AMENDI NG FORMETHI CS &CAMPAI GN DI SCLOSURE BOARD.
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )
, / CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED
EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE
( MM/ DD/ YR) AND PAC
CHECK
NUMBER
I D # 7-7. t o 3 , 7 s b , w a , + ^ Zz , n r b , ; :
E"-, e I - I , OCK# j p
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CK# ~LGo S , ' u 3u = ' ^ 1 7 u v C- b
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FOR I NSTRUCTI ONS, SEE BACK OF FORM
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e m
t o f O r g a n i z a t i o n )
11 1 e
SCHEDULE
E
I N K I ND
( Re v . 0 6 1 9 7 )
CONTRI BUTI ONS
CHECK THI S BOX I FAMENDI NG FORM
DATE
RECEI VED
( MMI DDI YR)NAME ANDADDRESS
OF CONTRI BUTOR
RELATI ONSHI P
TO CANDI DATE
* ( i f a p p l i c a b l e )
DESCRI PTI ON
OF I N K I ND
CONTRI BUTI ON
ESTI MATED
FAI R MARKET
VALUE
~ I F FOR
FUND- RAI SER
CONTRI BUTI ON
/
/ O~ 1
s Auc ; r e 5o2w" i3 COG, t i p F
< i C - 4 - 4 , i Oi y Ci L 1 r 3Z - ( E e t t l -
z s I L Co - 7 f KJ / / q 502o3 0 c ~ 1 0 , c ) U F7
F 7
F7
7 1
F7F 7
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FORI N S T RU CT I ON S , SEEBACK OF FORM
T HI S FORMI S USED BY CANDI DATES' COMMI TTEES ONLY
COMMI TT EE NAME( Mus t b e s a me a s o n St a t e me n t o f O r g a n i z a t i o n )
PART I I - I T EMI Z ED BREAKDOWNOF UNREI MBURSED EXPENSES P AI D BY CONSULTANT
TO OTHERS I N PERFORMI NG SERVI CES OF CONTRACT ( T h es e e x p e n s e s s h ou l d NOT be
PART I - NAME AND ADDRESS OF CONSULT ANT
r e p o r t e d o n Sc h e d u l e B, as t h e y ar e d i r e c t p a y me n t f r o m t h e c o n s ul t a n t . )
Name o f Co n s u l t a n t
J_acvhMa i l i n g Ad d r e s s
' 0c i t y
ESTI MATES OF PERFORMANCE
St a t e
Zi p C o d e
TOTAL A NT I C I P A T ED
COMPENSAT I ON FOR
CONTRACT PERI OD ( MMI D DI Y R)
PERFORMANCE
P a g e o f
( f o r S c h ed u l e G)
SCHEDULE
G BREAKDOWN
OF MONETARY( Re v . 0 2 / 9 6 ) EXPENDI TURES
BY CONSULT ANT
QCHECKTHI SBOXI F
AMENDINGFORM
r S L ' ,UU-~CJ
- 4 e 1 2 ' °e _ o e
DATE
EXPENDED( MMI DD/ YR
NAME AND ADDRESS TOWHOMEXPENDI TURE
Di s b u r s e me n t ) WASMADE PURPOSE
AMOUNT
EXPENDED
s
SUB- TOTAL
TOTAL ( I f l a s t p a g e o f t h i s s c h ed u l e ) $