Iowa Sierra Club Political Committee __9735__scanned

Embed Size (px)

Citation preview

  • 8/7/2019 Iowa Sierra Club Political Committee __9735__scanned

    1/3

    FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( 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 )I o wa S i e r r a Cl u b P o l i t i c a l Commi t t e e # 9 7 3 5I 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 :0( 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 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 l

    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 mi 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 C o d e 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 s c o mmi t t e e , 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 ei n d i v i d u a l r e s p o r l s 0 e , J o r t i me f * a n d r a t e r e p o r t s . 2 2 - 2 ? i ' ~S I GNATURE OF P q Fi ONGT&ORT TELEPHONE

    I AMRUNG A _ Ma 1 6 t h - J u l y 1 4 t h , 2 0 0 6( r e p o r t d a t e ) I n d i c a t e b y #

    [ 1 CHECK I F AMENDMENT TO REPORT DATEDChe 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 mDR- 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 . )

    REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR.

    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 ec o mmi t t e e . T h i s a m o u n t MI DST 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 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 must 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    " 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $' I N K I ND CONTRI BUTI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" OUTSTANDI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    FORMDR- 2 DI SCLOSURE( R e v . 1 2 / 2 0 0 5 ) REPORTF o r O f f i c e Us e O n l yComm. # 6 ? ' 7 0L o g g e d I nSc a n n e dCompu t e rA 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 nD i s c l o s u r e B o a r d5 1 0 E . 1 2 ' , S t e . 1 ADe s Mo i n e s , I o w a 5 0 3 1 9Fa x : 5 1 5 - 2 8 1 - 3 7 0 1

    7 1 9 - - 6DATE S I GNED

    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

    C 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 , 9 4 5 . 0 0ADD TOTAL MONEY TAKEN I N THI S PERI ODS 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 ) . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e F : L o a n 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 : T o t a l S a l e s o f Campa 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    , ( , S c h e d u l e H a p p l i e s t o Ca n di d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $ 2 , 1 4 5 . 0 0

    SUBTRACT TOTAL MONEY SPENT T HI 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 S c 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 ) . . . . . . . . . . . . . . . . . 9 4 7 . 1 0S 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 S c h e d u l e 0 . 0 0

    2 0 0 . 0 00 . 0 00 . 0 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 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 m u s t 1 , 1 9 7 . 9 0b e z e r o ) ( A t t a c h DR-3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    NOCONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) _ YESCANDI DATE COMMI TT EES ONLY:VALUE OF CAMPAI GN PROPERTY ( F r 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 ) $STATE COMMI TT EES : S u b mi t a r e c o n c i l e d c a mp a i g n a c c o u n t b a n k s t a t e m e n t i n J a n u a r y o f e a c h y e a r .

  • 8/7/2019 Iowa Sierra Club Political Committee __9735__scanned

    2/3

    Fo r I n s t r u c t i o n s , Se e Ba c k o f F o 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 on 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 )I o wa S i e r r a Cl u b P o l i t i c a l Commi t t e e # 9 7 3 5

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I ST TH PAC I DENT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.NOTE : ANYPERSON, OTHER THAN AN I N D I V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAYHAVE F I L I N GRESPONSI B I L I T I ES ANDSHOULD I MMEDI ATELY CONTACT THE BOARD.CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 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 r f o r a n ycommer c i a l p u r p o s e b y a n y p er 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 ommi t t e es .

    SUB- TOTAL $ 2 0 0TOTAL ( i f l a s t p a g e o f t h i s s c hed u l e ) ' $ 2 0 0

    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 ec o mmi t t e e . R e l a t i o n s h i p m u s t b e s h o i i v 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 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 mame o f c o n t r i b u t o r i s t 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 Pagef 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 .1 o f I( f o r S c h e d u l eA)

    SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

    DATE PA C I D NUMBER u T - 1 1 I T, , m-11 "_ a s 9 . .i r 7 a v r - 1 I WOUi r CE R LA I I P A I T I ~ NT - 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( f f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D# Ro n a l d S . B l a z e $ 2 50 5/ 1 2 / 0 6 CK# 6 0 9 S . 3 r d S t r e e tF a i r f i e l d , I o wa 5 2 5 5 6I D#

    Mi c h a e l E . De l a ne y a n d De l l R a d c l i f f e $ 1 0 0OS/ 1 0 / 0 6 CK# 1 1 1 2 - 4 5 t h S t r e e t0 1I D#

    Ba r b a r a Wr i g h t Heck $ 2 50 5/ 0 6/ 0 6 CK# 1 0 1 7 Ar b o r Ri d g e C i r c l eCo u n c i l B l u f f s , I o waRo b e r t P . Br ammer $ 2 50 5/ 1 6/ 0 6 1 7 1 7 Mar E l l a T r a i l

    , o 1 . I . - . f i WiL i n d a L . a n d Ro b e r t D . S c a r t h $ 2 50 5/ 1 5 / 0 6 CK# 1 6 3 0 Wi l d wo o d Dr i v e NECe d a r Ra i d s I o wa 5 2 4 0 2

    I D#CK#I D#CK#I D#CK#I D#CK#

    I D#CK#

  • 8/7/2019 Iowa Sierra Club Political Committee __9735__scanned

    3/3

    THI S BOXAPPLI ES TOCANDI DATES' COMMI TTEES ONLY :P ur 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 $ 5 0 0 o r mo r e must a l s o b e i n v e n t o r i e d o n Sc h e d ul e H. ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s . )E x pe n di t u r e s t o p e r s o n s t e n t i t i e s p r o v i d i n g c o n s u l t 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 a n i z i n g s e r v i c e s must a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e Gb y t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x pe nd i t u r e mad e b y t h e p e r s o n / 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 c o mmi t t e e . ( R e f e r t o

    ~ Sc h e d u l e G i n s t r u c t i o n s a n d I o wa Code 68A . 4 0 2 ( 3 ) ( i ) . )

    ( f o r Sc h e d u l e B)

    FOR I NSTRUCTI ONS, SEE BACK OF FORM I Rue, Fo r m SCHEDULEEXPENDI TURES B MONETARY-MONEYSPENT FROMCOMMI TTE E ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

    STATEPACCOMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI V ECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATEDCOLUMN ANDTHE CHECKTHI S BOXI FPAC CHECKNUMBER FOREACH EXPENDI TURE . A L I STOF I D NUMBERS I S AVAI L ABL E FROMTHE I OWA AMENDI NGFORMETHI CS&CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e sa me a s on St a t e me n t o f Or g a n i z a t i o n)I o wa S i e r r a Cl u b P o l i t i c a l Co mmi t t t e e # 9 7 3 5

    CANDI DATE NAME AND ADDRESSTOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI 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 PACCHECKNUMBERI N Commun i t y S t a t e Ban k Ba n k i n g S e r v i c e s0 6 / 3 0 / 0 6 CK# 3 5 4 0 E . 3 3 r d S t r e e t $ 4 7 . 1 0De s Mo i n e s , I o wa 5 03 1 7I N 1 5 0 4 Bo b K r e s s i g f o r I o wa House D i s t . 1 9 C o n t r i b u t i o n0 7 / 1 0 / 0 6 CK# 1 0 0 1 $ 3 0 0I N 1 3 9 5 Ma r k D a v i t t f o r I o wa House C o n t r i b u t i o n0 7 / 1 0 / 0 6 $ 3 0 0CK# 1 0 0 2I N 1 3 9 2 Dono v a n Ol s o n f o r S t a t e Re p . Comm . C o n t r i b u t i o n0 7 / 1 0 / 0 6 CK# $ 3 0 01 0 0 3I NCK#I D#CK#I D#CK#I NCK#

    SUB- TOTAL $ 9 4 7 . 1 0TOTAL ( i f l a s t page o f t h i s s c h e du l e ) $ 9 4 7 . 1 0