van patten nick__1632__scanned
TRANSCRIPT
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FOR I NSTRUCTI ONS, SEE BACK OF FORM
DISCLOSURESUMMARYPAGE
COMMI TT EE NAME ( Mu s t b e same a s o n S t a t e me nt o f Or g a n i z a t i o n
I MPORTANT : I n d i c a t e b y # 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 : I
I
( 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 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 Co 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
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 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 PA C
1
) 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
S 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
v r , " - -
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 )
~ e - r GCt n
i s t r i c t ( i f Se n a t e o r H o u s e )
3 1
CANDI DATE COMMI TT EES
k , Va r lr
1a
ON %DI SC~Oca
Ca n d +Ce Name
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 c r i m i n a l p e n a l t i e s . P u r s u a n t t o I o w a Code s e c t i o n 6 8 B . 3 2 A ( 7 )
t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mmi t t e e , a n d t h e c h a i r p e r s o n , f o r a n y o t h e r t y p e o f c o mmi t t e e , i s t h e
i n d i v i u a l r e s p o n s i b l e f o f i l i n g t i m e l y a n d a c c u r a t e r e p o r t s
~ t 1
AM F I L I N G A
SI GNATURE ( k t ERSON F I L I N G REPORT
5 ) 1 5 1p
t, - 5~31 I Db
REPORT FOR ( 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 b y # ID
MCHECK I F AMENDMENT TO REPORT DATED
Chec 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 N o t i c e o f D i s s o l u t i o n Fo r m DR- 3 .
( Y o 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 . )
STATEMENT OF CASH ON HAND
R e s e t Fo r m
( 5 1 5 ~~ 85 - 6 9 0 1
S ~ 3 1 I O ( ,
TELEPHONE
DATE SI GNED
CASHON 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 nd 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
FORM
DR-2
( R e v . 1 2 / 2 0 0 5 )
F o r O f f i c e Us e On l y
DI SCLOSURE
REPORT
Comm . #
L o g g e d , 6 1 1 1 2S c a n n e dCompu t e r
A u d i t e d
F i l e w i t h :
I o wa E t h i c s a n d Campa i g n
D i s c l o s u r e B oa r d5 1 0 E . 1 2 " , S t e . 1 A
Des Mo i n e s , I o wa 5 0 3 19
F a x : 5 1 5 - 2 8 1 - 3 7 0 1
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 n
Co un t y & L o c a l C ommi t t e e s , e n t e r Co u n t y i n
w h i c h E l e c t i o n i s h e l d
I , ~ , 3 L + . i 3
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Fo r I n s t r u c t i o n s , Se e Ba c k o f F o 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 ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
N( - - k UUnPa-~n- For 1~vva
- 5- - n- +e
STATE CANDI DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D F R OM A S T A T E PAC ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T T HE P AC I D EN T I F I C AT I O NNUMBER AND T HE P A C CHECK NUMBER I N T HE D E S I G N AT E D COLUMN . A L I S T O F I D NUMBERS I S A V AI L A B L E FROM T H E I O WA E T H I C S AND 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 7 / 0 3 ) RECEI PTS
Q CHECK THI S BOX I F
AMENDI NG FORM
DATERECEI VED
PAC I D NUMBER( i f a p p l i c a b l e )
NAME AN D ADDRESS OF CONTR I BUTOR RELAT I ONSH I PTO CANDI DATE*
AMOUNT
RECEI VEDI F FORFUND-
( MM/ DD I YR ) AND PAC CHECK
NUMBER
( i f a p p l i c a b l e ) RA I SER
I NCOME
5 i S ~ a b
I D# i 1 __ , :.
r ) ~
CK# a 6 5 y - l 5 0 51 5 6
I D# Eve r e f f ~, h e r5 1 5 Ob CK# 1 8 g ~ 5 8 g ~ 7 5 N i b 1 K L i + y Dr pd
So b - , A3
5 1 1- 6 1 0 6
l D# C h o i . D hq~
a h a rCK# 3 4 6 - 7 ~5r Wn a sI D# f u r o l e c h a r c H -
5 CK# 1 6 6 5 1 - 7 - 7 t - . , NW 1 3 0 - + h 5 f 5 6C e 5 o a 5
. ~ I I ~ I b b
1 D#
c K# L%3
1 3 6 t r b o r C t t _ . - i
45 Ri r r nh =~r ~ ~
e , , 0 x 7 3 Co u s i n a , 56hG l e o 3
5 1 B ~ o b
I D#
N r e ' y ~ i ~ P o x 4 a o v0c K# SRba ~ 3 5r r 1 h a m V i 1 1 e - : CA 5 0 5 3 3
, - ,
Ch r 1 5 - I - i n e Ml i I e r
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Fo r I n s t r u c t i on 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 ( Mu s t be s ame a s on S t a t e me n t o f Or g a n i z a t i on )
h ! ( C . KVanP&+en - ( ~ r Iowa5
: 1
-e Senate
STATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECE I VED FROM A STATE PAC ( P O L I T I C A L ACT I ON C O MMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .
CAU T I ON : S e c t i o n 6 8 B . 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 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 by 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 .
SCHEDULE
A MONETARY
( R e v . 0 7 / 0 3 ) RECEI PTS
QCHECK T HI S B OX I F
AMENDI NG FORM
DATERECEI VED
PAC I D NUMBER( i f a p p l i c a b l e )
NAME AND ADDRESS O F CO NT R I B U TO R RELAT I O NSH I PT O CANDI DATE '
AMOUNTRECE I VED
J I F FO RFUND-
( MMI DD/ YR) AND PAC CHECK
NUMBER
( i f a p p l i c a b l e ) RAI SER
I NCOME
I D# N e w t a n
' 5 i D i n c e 5 , r - 503I D#
Wj j G t m, ~ VV ni 8 b b c K# 43oa a
C ~ - x 5 t __
D n e s TA . 5 ~3 1 a - 1~ " o 00
~ 1 ~Ob
I D#( ' ( r I C A Wood
b S I 5 - 1 - r ' t r e a , n~CK # 1 x , 0 1 5 4 1 1 c i n - l e t SA 5 o . 3 ~ a a Cv~ t 5 I r ) 1
~o ~ Ob
I D #0 - . / 37j si la-hD
o I t , c c - F r y ~phnml - r -
o
CK # O' ~0 1 L - p e - - , r r 1 - , W ~a S U , ie ~d0
UD
. T: .
5 ~~bK# 1633 M11 I
5D 0
SA503I
5 ~~bb
I D#
CK# 1143
4nn u - i r e.
I t p39 r ed ~' Q
D r 566aa
I D#r n i ( : e 13a l c . - f - a r t
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F o 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 m
C ON T R I B U T I O N S - - 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 )
C OMM I T T E E NAME ( M u s t b e s a m e a s o n S t a t e m e n t o f O r g a n i z a t i o n )
_
f i e~ l I , - ? < Van
~r ' J ' oWa SWe
S T A T E C A N D I D A T E S NOTE I F A C O N T R I B U T I O N I S R E C E I V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T I O N C O M M I T T E E ) , L I S T T H E P A C I D E N T I F I C A T I O NN U M B E R A N D T H E P A C C H E C K N U M B E R I N T H E D E S I G N A T E D C O L U M N A L I S T O F I D N U M B E R S I S A V A I L A B L E F ROM T H E I O W A E T H I C S A N D C A M P A I G ND I S C L O S U R E B O A R D
C A UT I 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 m m e 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 m m i t t e e s
SCHEDULE
A MONETARY
( R e v . 0 7 / 0 3 ) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATERECE I VED
PA C I D NUMBER( i f a p p l i c a b l e )
NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI PT O CANDI DATE`
AMOUNTRECE I VED
V I F FORFUND-
( MM/ DD/ YR) A ND P AC CHECKNUMBER
( i f a p p l i c a b l e ) RAI SERI NCOME
~ - O b
I D#
CK# y -5
h i r e e r '6A - T b e ~ - I n e - Or $ ) o De s ` f - ~ r n o f f l e ~ f 1 5 a ~ b 5
5 j ~ ` t ~ Ob
I D#
c K # - 7 C) AaCh ar l e s Lo z l e r3 3 0 - J - ~ ) n a wa n d cC Dr - 35a s A 1 o i r n e5 5o3t a
D# h n Br a s We
5 1 , 3 L + J O b CK# ~a 1 9 4 D O 0 s . W, 19A " o 0~ e 5 "D I r ~ ~! 5 0 3 1 5
l a d l o b
I D#
CK# Y ° y a a - t - ~ 'e ' t ~s u ~ ~565
I D#1 / V e b s - l - e r L - e - - h m n n J . r ,
05 ` F ' b b c o 440 1 l n l e s ~ awn V%S 1 C l ~o0e 5 f i n2 wom
I D#
D o r o +bV1 h I 1 I i ~5Ob C . ~' S6R q f i v e -hC ; ar 1 ~5 CI T. E a' ~
I D #Ronal d j an c ~ ~
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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 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 me n t o f O r g a n i z a t i o n )
N i c K f a n P a t f e t ' )- fO f '
T a n / c t 6 + o - + eSTATECANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHE PAC CHECKNUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I LAB LEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCL OSURE BOARD .
CAUTI ON : Se ct i o n 68B . 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 mat i o n c o p i e d f r o m r e p o r t s an 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 an 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 er t h an 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 .
SCHEDUL E
A MONETARY( R e v . 0 7 / 0 3 ) RECEI PTS
a CHECK T H I S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL ATI ONSHI P AMOUNT J I F F ORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D I Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOMEI D# J u l i e , E v a r l 5
5 1 3 1 ( O b CK# I d a 3 a o o P u r l s / A j e n u e$ ` D
1 0 .7- MA N , 16e5
5 ~ 3 ( ( Y ,I D#
CK#a463
Ma- - ~ - n
s ~ ~ ` ~ ' sewS t " v
1 7 e 6 I V l o f e i e 5 ~A 5 0 3 , 4 1I D # Mcmel eo e f o r t - e 5 ~ 'CK# ` 1 ~ J 1 b 0 3 b - r e r r a c e Dr .
hn 5 f v n 5 0 1 3 1 - 1 55 PI D #
CK#
I D #
CK#
I D #
CK#
I D#
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FOR I NSTRUCT I ONS, SEE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI T T EE ACCOUNT
STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE T O STATEWI DE OR L EGI 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 O N NUMBER I N THE DESI GNATED COL UMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM T HE I OWATHCS & CAMPAI GN DI SCLOSURE BOARD
SCHEDULE
B MONETARY
( R e v . 0 7 / 0 3 )
IEXPENDI TURES
CHECK T HI S BOX I FAMENDI NG FORM
COMMI TT EE NAME ( M u s t b e same a s o n S t a t e me n t o f Or g a n i z a t i o n )
N l i c K v a n Pa - I - 1 6 n - F D r _ - rDv i a - 5 * f e Se r a t e
Sk i d 1 0 6
5 1 3 0 1 A t ,
S 1 3 1 I a >
5 1 3 1 l o b
CK# j b d 8
CK# i p a q
CK# 1 0 3 6
CK# 1 0 3
(
n ' ' a me n ( 3 i s h o p
3 5 ~ 0 , ~ 5 , w i A f A P l a c eD: - , 5 M 1 > o e 5 ) TA 5 o 3 1 5
amen i 3 i s h o o ~3 5 0 S , W , ) A + h p l a c
G e t , Mo f n e 5 , S / f 50315
/ I ~ c l c d o r o l d L e - H e ' Seme p ) r o , h u r e0 h r o
De. 5 mo i n o , V 5034
No - f i o n - w i d e 6 I d r 5 r h c .' 7 0 b E , r ) r i d tDe s Mo i n e 5 , J 3 1 i 5 0 3 0 9
PURPOSE( DESCRI BE TRANSACTI ON)
CDI ' I Si . t ~ l t ~ ' ) J C. ' J e l r v t ~ Ce S
Co ~ ' ~ 5 c ~ f i n3 c Se - , w' Ce5
U h ( i t i e s
~ '
~n1 ( a - i ro n 0 - ~
AMOUNT
EXPENDED
$ 6 L f 5 . 0 0
5 q6 , v v
M, 0 9
b 0 . 5 r 3
D# Naha-w4 e BI d6T~e , Ren t ~br c =s pa - i qn
~ 3 0 0 , 0 0CK#1o3a10e I _ a s t
DesMol nes, T f 3 50 3 09 0 - ~ - 3 , . - r n e
I D # J ' l r l e z z CJ F u r - - ~ J r G, i 5 e ( -~) o a r 1 4
CANDI DATE NAME AND ADDRESS T OWHOMDATE I D NUMBER EXPENDI TURE
EXPENDED ( i f a n n l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) A f : D PAC
CHECKN 1 ' , 9 B E R
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FOR I NSTRUCT I ONS , SEE BACKOFFORM
I COMMI TT EE NAME( Mus t b e s ame a s o n S t a t e me n t o f O r g a ni z a t i o n )
1 A ) C 1
NOTE T h i s s c h e d u l e r e p o r t s money l o a n e d t o t h e c o mmi t t e e wh i c h i s d e p o s i t e d i n t h e c o mmi t t e e a c c o u n t
TOTAL UNPA I D LOANS FROM L A S T REPORT I NG PER I OD $
O
C ) o
1 - MONETARY LOANS RECEI VED T HI S REPORT I NGPER I OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , must b e s h o wn i f a t h i r d p a r t y i s
i n v o l v e d I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )
TOTAL ( P ART/ )
* 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 e c o mmi t t e e R e l a t i o n s h i p mu s t b e s h o wn t o t h e t h i r d d e g r e e o fc o n s a ng 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 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 st 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 f 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 wh e n i t a p p l i e s
TOTAL CASH REPAYMENTS ( P ART 1 1 )
F r o m S c h e d u l e E - TOTAL LOANS FORGI VEN
$
TOTAL OUTSTANDI NG LOANS END OF REPORT PER I OD
Page
PART 1 1 - MONETARY LOAN REPAYMENTS MADE T HI S REPORT I NGPERI OD( L o a n s f o r g i v e n must b e r e p o r t e d o n S c he d u l e E - I n - k i n d C o n t r i b u t i o n s . )
( f o r S c h e d u l e F )
SCHEDULE
F LOANS
( R e v 0 7 / 0 3 ) RECEI VED& REPA I D
CHECK T H I S BOX I F
AMENDI NG FORM
DATERECEI VEDMM/ DDNR
NAME AND ADDRESS OF LENDER( I n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e )
RELA T I ONSH I PTO CANDI DATE
I f A p p l i c a b l e * )
AMOUNT
OF L OA NDATE PAI D
( MM/ DD/ YR)
NAME ANDADDRESS OF LENDER
( I n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e )RELAT I ONSH I PT O CANDI DATE*
I f A p p l i c a b l e )
AMOUNT
REPA I D
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FOR I NSTRUCT I ONS , SEE BACK OF FORM
COMMI TT EE NAME( Mus t b e same a s o n S t a t e me n t o f O f g a n i z a t i o n )
~ c . a n & L - Ee
r
PART i l - I TEMI ZED BREAKDOWN OF UNREI MBURSED EXPENSES PAI D BYCONSULT ANTTO OTHERS I N PERFORMI NG SERVI CES OF CONTRACT ( T h e s e e x p e n s e s s h o ul d NOT b e
PART 1 - NAME AND ADDRES S OF CONSULTANT
r e p o r t e d o n S c h e du l e B , a s t h e y a r e d i r e c t p a ym e n t f r o m t h e c o n s u l t a n t . )
Name o f Co n s u l t a n t
ame n a s hM a i l i n g - A d d r e s s
TOTAL ANT I C I PATEDCOMPENSATI ON FOR
CONTRACT PER I OD ( MM/ DD/ YR)
PERFORMANCE
T o 5 J - 3 ! D
ESTI MATES OF PERFORMANCE
$ 1 1 8 . 5 ' "
( ! amp&q j l n A/ k ~ - Oa ~
Page( f o r S c h ed u l e G)
SCHEDULE
G BREAKDOWN
OF MONETARY( R e v . 0 2 / 9 6 ) EXPENDI TURES
BY CONSULT ANT
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T HI S FORM I S USED BY CANDI DATES ' COMMI TT EES ONLY
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