Allison Chuck5118scanned

8/7/2019 Allison Chuck__5118__scanned

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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI 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 )I CMTTEENAME ( Mu s t b e same 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 )

1 1STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROM A STATE PAC ( P O L I T I C A L ACTI ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE 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 SAND CAMPAI GNDI SCLOSURE BOARD .CAUT 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 ny c omme r c i a l p ur p o s e b y a n y p e r s o n o t h e r 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 .

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

0 1 10 wl 6 6 1 D # 5 ' C . o oCK# 1 4 3 1 I ' L o " -, PA SO31I D # 11N. ~ - 1 ( R ( o t o m {o t / 1 1 10G CK# 1160 7 I ' a L v , 000; , t , y4t o A. ~ sO / ! 3 / 0 6

1 D # 0 L ( y r 1 n . j ~ 1. t ' o , w [ . G c ~ .~ v t 4 ' 2 -kw ~ `i t + s T~ 1 l CSs , ` c mr t i c oCK#_ A J

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1 4 1 . k ; i k e -L 1 ' 7 s + , ^ ~ '18 2 0I A 0 x" 0 0o o q ~ , - A ( ~~

I D # H . 1 9 1 I ( ~ 5 ~ ~b 1 1 3 / 0 1 6 c o 1 1 1 3 1 6 1 - 0 1 L 1 5 , , , o os o " l ~ - z y TA . 5 - 0 3 1 7I D # - 7 5 4% ' n l 5 ( , , ) t + +d o t ;CK# 300 1 k . ) - c 5 4 - O W1 1eI D # ( i l l { ' S ' e b ~ t i


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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 mCONTRI 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 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 )1} 1k

- r0i se-"ac"

SCHEDULEa( R e v 0 7 / 0 3 ) MONETARYRECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P O L I T I C AL AC T I O N C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD.C AU T I ON : S e c t i o n 6 8 B . 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 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 n y c o mme r c i a l p u r p o s e b y a ny 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 .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONT RI B U T OR RELAT I ONSH I P AMOUNT v ' I F F ORRECEI VED ( i f a p p l i c a b l e ) T O CANDI DATE` RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#0 3/ o $r o b CK# , ~ _ C 1 - 7 ~J. h L l ~ l k c y , ~ , ~ a 5 - CO

03 / 1 3 / 4I D# V4 - - ~ t6 , t , ~ " ~ e ~ r . x , 5 0 , I r k0c , ~ , 7 c ) 3 2 -e - ' sI D# ' n ~Vm . ~

0 3 / / 3 / 0 ( , CK# 6 o ~ C 7G ( ~3 p 5o u ( I t Ht I 1 S f l 1 ' - CVtC 3 1 2 , ` 4 / C6

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K~ e V I A t f k V . uk Ia 0~s PW1 l ~ - 0 N00.~ ? ? L( f - o v L ~ 1 7 A 5 - 1 1 adoI D #~ - . s ~0 L ( / o 5 1 0 CK # ~ I d -

I D # C; i n , u ~ } 1 1 ; S t r n l


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FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t Fo r m SCHEDULEB MONETARYEXPENDI TURES - MONEY SPENT FROM COMMI T T EE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURESSTATE PAC COMMI TT EES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VE CHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC 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 FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mus t b e s a m e 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 )RR6 0 k t F o ( 5 e _ C { ej * r , ( f f l 0 4 - ) l y - _ - + e -

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( 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 PA CCHECKNUMBERI D# TodS I 1 e ( Sa r in ' e " 't wo o d 1 - . , $ ~( I C0 0 , 0 0

4I D#

0~ . ~ I / o f f CK# 6 , 0 1 51 E ) # 6 0CK# L I F f i

c~iCOYono.~ a ih 4 e ~. K~oLl C ~ j L ~ d3, - PfI D# r s . ~ ~ ~ ( o v - c % 3 I . c ) Oo 3 / i 3 / o 6 CK# U r - TI D# Kw; KS0 ~yr , SS3/ I 3 p 6 c K# Ft &5


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FOR I NSTRUCTI ONS, SEE BACK OF FORM Re s e t F o r m~ SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

S TA TE PAC COMMI TT EES : NOT E : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V E CHECK T HI S BOX I FCANDI DATES, L I S T T HE CANDI DATE I D E NT I F I C A T I ON NUMBER I N THE DES I GNATED COLUMN AND T HEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLETROMT HE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a me 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 )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MWDDI YR) AND PACCHECKNUMBER

03 / z ~~b CK# . ~ T $ 7&0

03 / - l % CK# / 0/ / r i b 4 A 1 , . . a. , 00040I D #CK#I D #CK#I D #CK#I D # D/ CCJ 8_101 - , .CK# MAY


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FORWSTRUCTI ONS, SE E 6 A C J C OF FORMCOMMI TT EE k A i E ( A f u s J b e a f s n 8 a s o n S t a f a r n s k n t o f O r y e r r i z a t k n )

NOTE : T h i s s c h e d u i s r e p o r t s m o n e y l o a n e d b Me o a m r d t f e much i s d e p o s i t e d t o t h e o c r n m M e s a o r r K : O LTOTAL uwAD Laws FROMLWR5' PORTWd PERI OD tPART 1 - MONET ARY LOANS RECE I VEDDoREPORTI NG PERI OD( Of V r Wmums o f b a n , s u c h a s a b a r k , m u s h b e a h o k c r N a d u r r 1 p a r t y ma w < * M o t k r d t s 7 k l o a n s f r o m c a n C k d r t o ' s p e r s o n a e l + a n d s )

TOTAL ( P A R T / ) b g

' A t s d o s r t m l a w r e q u i r e s c a n d i d a t e c o mmi ! e e s t o f d os e t h e r %Wo n a h f q o f a n y r e t a t h er n a # n g a o o n A i b u i l a n b t h e c o m v n b e e . R e l e t l o r w h i p mu s t b e s h o w n t o t h e t t * d d e g r e e o fc o n s a n g u i n i t y ( b l o o d m l a t f v v s ) a n d a n n k y ( r e Wt k e s b y r r s u , i e g e ) , 3 wuneme o 4 c o n a f t u w I st h e s a T v e s c a r r d i d a t s , WI t h e r e r e n o f a r m e d r NWi o r ~ , s r A w ' n o t e p p i a s b l e ' I n t h er o t a t i o n s * c a t u m n w t , e n r a p p i s s

PART I l - WOWTARY L OI N REPAYYE I TS WI DEM, R10 r ORTMPt y( L o a n s I b r g i v w m r u s 9 b e r e p o r t e d o n S r h e d r * E - M4kd C o v r b i b r B a n a )

TOTAL CASH REPAYMENTS ( P A RT 1 1 )F r o r n S d Te d u l e E - TOTAL LOANS FORGI VEN

TOTAL OUTSTANDNG LOA NS END OF REPORT PERI 0 0

P s g e( f c r S c f * i d r l e F )

$ - - 0-$ d b 's F 1 0 ~

SCHEDULEF Laws( R e v . 0 7 ( 0 3 ) RECE I V EDs R E P A I DWCHECK T HI S BOX I FAMEND I NG FORM

OATSC r r ! V E O4 ) D I Y RNAME ANDADDRESS OF L ENDER( k r c l W d e E n d o r a a r a N w n e , n A Mp a mb l e ) RELAT I ONSK! PTO C A N ( 3 1 D A T En

AMOUNTOF LOAN DATE P A I D( W031YR ) NAME AN D ADORESS OF LENDERo n d u d e E n d a r s e e a d a m s , t f A p p b c e b l a ) RELA T I OWVPT O CANOWATE't f l aAMOUNTR E P A I D

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Allison Chuck__5118__scanned

Allison Chuck5118scanned