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8/7/2019 Winnebago Republican Women_6940_scanned

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FOR I NSTRUCTI ONS,SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

COMMI TT EENAME ( Mu s t b e s ame a s o n St a t eme n t o fOr g a n i z a t i o n )Wl nnebago Rer : u o l i . c an Wo r s e n

I MPORTANT : . i n d i c a t et y p eo fc o m m i t t e ey ou a r er e p or t i n gf o r:

( 1 ) S t a t e w i d e l L e g i s l a t i v eC a n d i d a t e(2 ) S t a t e w i d ePAC(3 ) S t a t eP a r t y( 4 ) C o u n t y / L o c a lC a n d i d a t e

( 5 ) C o u n t yPAC ,( 8 - ) B a l l o tI s s u e / F r a n c h i s eC ommi t t e e(7 ) C ou n t y / C i t y C e n t r a lCo mmi t t e e

8 ) S u p p o r tS l a t eo fCa n d i d a t e s- -

FORMR- 2 DI SCLOSURE

~R e v. 0 1 / 9 8 ) REPORT

o rO f f i c eUs eOn l yomm. #

I n d e x e dA u d i t e dC o m p u t e r

SI GWATUREOF TREASURER( o rp e r s o n f i l i n gt h i s r e p o r t ) TEL EPHONE

6 1 1 1; q 5 5 2 6 0

Ro u t i n ePe na l t i e sDu e Fo r L a t eF i l e dRe p or t sR a n g e f r o m$ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPL ETE THE FOL LOWI NG SENTENCE :

I AM F I L I N GA l i l f b 1 1 1 V _ a 'D 6 REPORT FORAN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR.( r e p o r td a t e )

OCHECK I FAMENDMENTTO REPORT DATED

C]Che c ki ft h i si sf i n a l( t e r m i n a t i o n )r e p o r ta n da t t a c hN o t i c eo f D i s s o l u t i o nF o r mDR - 3.( Yo u mu t tc o n t i n u et of i l er e p o r t su n t i la N o t i c eo fD i s s o l u t i o ni sf i l e d. )

STATEMENT OF CASH ON HAND

I n d i c a t eo n e

CASHON HAND a t t h eb e g i n n i n go f t h er e p o r t i n gp e r i o d. ( T h i si st h et o t a lo fa l lmo n i e sh e l db yt h ec o mmi t t e e. T h i samoun tMUST b e t h es ame a s t h ec a s ho n h a n d a t t h ee n do f t h el a s tr e p o r t i n gp e r i o d ,o rm u s tb e z e r oi ft h i s i sf i r s tr e p o r tf i l e d. ) . .. ... . ... .. . . . . .. . ... .. .. . . .. . .. .. .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . . .. .. . .. . $

ADD TOTALMONEY TAKENI NTHI SPERI ODS c h e d u l eA: Cash C o n t r i b u t i o n st o t a l( A t t a c hS c h e d u l e A ). .. . ... .. ... .. .. .. . . .. .. .. .. .. . . . . .. .. . .. .. .. .. ..S c h e d u l eF : L o a n sR e c e i v e dt o t a l( A t t a c hS c h e d u l eF ).. .. .. .. . . ... .. ... .. .. .. . . .. .. .. .. .. .. . . . . . . .. . . ... .. ..S c h e d u l eH: To t a lS a l e so fCampa i gnP r o p e r t y( A t t a c hS c h e d u l eH) .. . . .. .. .. .. .. .. .. .. .. .. . . ... .. ..

( Sc h ed u l eH a p p l i e st o C a n d i d a t e s 'Commi t t e e sOn l y )

S c h e d u l eF: Lo a nRepay men t s t o t a l( A t t a c hSc h e d u l eF ) . .. .. .. . .. .. . . . .. .. .. .. .. .. .. .. .. .. .. . . .. .. .. .. . . ..

CASH ON HAND a t t h ee n do f t h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a n c em u s tb ez e r o )( A t t a c hD R - 3 ). .. .. ... . .. . .. ... .. .. .. . . . . .. .. .. ... .. .. .. .. .. .. .. .. .. .. .. .. .. .. ... . . . .. . .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .. . .. . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. $

0

L o c a lC ommi t t e e s ,e n t e rD a t eo f E l e c t i o

C o u n t y&L o c a lC ommi t t e e s ,e n t e rC o u n t yi nw h i c hE l e c t i o ni sh e l d

1 S- - &~DATESI GNED

1 0 0 3 . P1

1 99 , 0 0

SUB- TOTAL.. . .. $ 1202 . 8 1SUBTRACTTOTALMONEY SPENTTHI SPERI OD ,S c h e d u l eB: E x p e n d i t u r e st o t a l( A t t a c hS c h e d u l eB ) . .. .. . . . . . . . .. .. . . . .. . . . . . . .. . .. .. . .. .. .. . .. . ... .. .. . . .. .. . 6 7 0- 0 0

5 3 2 . Pl

UNPAI DBI L L S( F r o mS c h e d u l eD - A t t a c hS c h e d u l eD ). . . . . .. .. . . . . . . . . .. .. .. .. ... .. . .. . ... .. . . . . .. . . . . . . . . .. .. .. .. .. .. . . $I NKI NDCONTRI BUTI ONS( F r o mS c h e d u l eE - A t t a c hSc h e d u l eE). . . . . .. .. . .. .. .. . . .. . . .. .. .. .. . . .. . . . . .. . . . . . . . .. $OUTSTANDI NG L OANS( F r o mS c h e d u l eF - A t t a c hSc h e d u l eF ) .. .. .. . . . . . .. . .. .. .. . . .. .. .. .. .. .. .. .. .. .. .. . . . . . . . .. $CANDI DATECOMMI TT EESONLY:CONSUL TANTBREAKDOWN ( S c h e d u l eG A t t a c h e d ? ) YES NOVAL UE OF CAMPAI GNPROPERTY( F r o mS c h e d u l eH -A t t a c hS c h e d u l eH) $


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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- MONEY TAKEN I N( I n c l u d r qc a nd d e t e ' sp e r s o n a l t o u c h )

COMMI TTEENAME ( M u s tb e s ame a s o nS t a t e me n to fO r g aW r s g o n )

': 7 i. n r: e ~ b ~ _: r r o Rep ,~b l i c an ' r ~ o t l e n

TATECANDI DATES NOTE: I FACONTRI BUTI ONI SRECEI VEDFROMA STATEPAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DE NT I F I C AT I O N

NUMBER ANDTHE PAC CHECKNUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSANDCAMPAI GN

DI SCLOSUREBOARD.

AUTI ON : Se c t i o n6 8B. 3 2 A ( 6 ). I o wa Code , p r o h i b i t st h e u s e o f i n f o r m a t i o nc o p i e d f r o mr e p o r t sa nd s t a t e me nt s f o rs o l i c i t i n gc o n t r i b u t i o n so r

o ra ny c o mme r c i a l p u r p o s eby a ny p e r s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

TOTAL ( i fl a s t p a g e o f t h i ss c h ed u l e )

' l i s c l o s u r el awr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s et h er e l a t i o n s h i p o fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt o t h e:,mmi f l e e. R e l a t i o n s h i pmu s tb e s h ow nt o t h et h i r dd e g r e eo fc o n s an gu i n i t y( b l o o dr 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 sb yma r r i a g e)( S e ePage 2 o ff o r ms p ac k e t) . I fs u r n ame o f c o n t r i b u t o rI s t h es ame a s c a n d i d a t e , b u tt h e r ei s n o Page o f

1

a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e 'i n t h er e l a t i o n s h i pc o l umn. ( f o rSc h e d ul eA)

SCHEDULE

A MONETARY( Re v. 0 6 1 9 7 ) RECEI PTS

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NUMBER I NCOME

1 / g / Q6I D#

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SBOX APPL I ESTOCANDI DATES'COMMI TT EES ONLY:

c h a s e so f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0o rm o r emus ta l s ob e i n v e n t o r i e do n S c h e d u l eH. ( R e f e rt oS c h e d u l eH i n s t r u c t i o n s. )

e n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d v o r t 1 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 esmus ta l s ob e d e t a i li t e m i z e do ne d u l eG b y t h ea mo u n t ,p u r p o s e ,a n dd a t eo f e a c ht y p e o fe x pe nd i t u r emade b y t h ep e r s o n / e n l f l yo nb e h al fo ft h e c an d i d a t e ' sc o mmi t t e e. ( R e f e rt oe d u l eG in s t r u c t i o n sa n dI o w aCode5 6. 8 ( 3 ) ( 1 ). )

Page 1_

- o f

( f o rS c he d u l eB )

FOR I NSTRUCTI ONS,SEEBACK OF FORM SCHEDULE

EXPENDI T URES B MONETARY- -MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. Os i s 7 ) EXPENDI TURESTATEPAC COMMI T TEES: NOTE: FORCONTRI BUTI ONSMADETOSTATEWI DEORL E GI S L AT I V E 0 CHECK T HI SANDI DATES,L I S TTHE CANDI DATEI D EN TI F I CAT I O NNUMBERI NTHEDESI GNATEDCOLUMNANDTHE BOX I FCCHECK NUMBERFOREACHEXPENDI TURE. AL I S TOF 1 0NUMBERSI SAVAI LABLEFROMTHEI OWA AMENDI NG FORM

THI CS3 CAMPAI GNDI SCLOSUREBOARD.

OMMI TTEE NAME ( Mu s tb e s am e a s o n St a t e me n to fO r g a n i z a t i o n )

Wi n n e b a g oRe p u b l i c a n Wo r n e n

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

XPENDED ( i fa p p l i c a b l e ) ( Di s b u r s e me n t )WAS MADEMM/ DDNR) AND PAC

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TOTAL ( Nl a s tp a g e o f t h i ss c he d u l e ) $ 67p. 00

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