8/7/2019 Republican Women of Madison Co__9551__scanned

1/4

FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PACECOMMI TT EE NAME ( M u 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 )

REPUBLI CAN WOMEN OF MADI SON COUNTY

I MPORTANT : I n d i c a t e 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 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 C o 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( 8 ) S u p p o r t S l a t e o f C a n d i d a t e sSI GNATURE OF T SU ER ( o r p e r s o n f i l i n g t h i s r e p o r t )

[ ] CHECK I F AMENDMENT TO REPORT DATED

P e n a l t i e s Du e F o r L a t e F i l e d Re p o r t s Range f r o m $ 1 0 t o $ 4 0 0SEE I NSTRUCTI ONS ON BACK ANDCOMPLETE THE FOLL OWI NG SENTENCE :AM F I L I N G A J a n 0 1 - Ma y 1 4 , 2 0 0 6 REPORT FOR A N N A ( 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 o n e

0 Che 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 N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Y o u m u s t 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 N o t i c e o f D i s s o l u t i o n i s f i l e d . )STATEMENT OF CASH ON HAND

CASH 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 h i s i s t h e t o t a lo f a l l mo n i e s h e l d b y t h e c o mm i t t e e . T h i s a m o u n t MUST b e t h esame 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 , 5 8 0 . 0 1o 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 C a n d i d a t e s ' Commi t t e e s O n l y )SUB- TOTAL . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODS c 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e F L o a n Repa y men t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND 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 tb e z e r o ) ( A t t a c h D R - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $UNPAI D B I L L S ( 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES ONLYCONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )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 ) $

Fo r O f f i c e Us e On l yComm sI n d e x e d -A u d i t e dC o mp u t e r

1 5 , 5 1FORM

0 5 - 1 5 - . 0 6DATE SI GNED

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 nC 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

4 4 8 . 0 0

1 0 2 8 . 0 15 3 7 . 9 6

4 9 0 . 0 5

n o n en o n en o n e

YES _ X NO

8/7/2019 Republican Women of Madison Co__9551__scanned

2/4

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 TTEE NAME ( Mu s t b e s ame as o n S t a t eme n t o f O r g a n i z a t i o n )EPUBL I CAN WOMEN OF MADI SON COUNTY

mwmr. 1 ART( Re v . 0 6 / 9 7 ) l RECE I PTSQCHECK T HI S BOX I F

AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON C Ot I MU 1 T T E E) , L I S T THE PAC I D EN T I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co 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 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 an 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 o mmi t t e e s .

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 mu s t b e s h o w 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 ) ( S ee Pa ge 2 o f f o r m s p a c k e t . ) . I f s u r n ame 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 Page o f _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 . ( f o r S c h ed u l e A )

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAiNUMBER I NCO1 D#

3 - 1 5 - 0 6 CK# 7 d u e s p ai d @ $ 1 5 . 0 0 e a c h 1 0 5 . 0 0D#3 - 1 5 - 0 6 Do na t i o n s r e c e i v e d a tCK# Co u n t y Co n v e n t i o n 2 3 . 0 0I D #

3 - 2 0 - 0 6 1 1 d u e s p ai d p l u s $ 1 0 . 0 0 d on at i o n 1 7 5 . 0 0CK#I D #

3 - 3 0 - 0 6 CK# 6 d u e s p ai d p l u s $ 1 0 . d o n at i o n 1 0 0 . 0 0I D #

5 - 1 - 0 6 CK# 3 d u e s p ai d 4 5 . 0 0I D #CK#I D #CK#I D #CK#I D #CK#I D #CK#

SUB - TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h e du l e ) $ 4 4 8 . 0 0

8/7/2019 Republican Women of Madison Co__9551__scanned

3/4

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY:Pu r 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 mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i f 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 mu s t 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 G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e m a d 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 oI 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 Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

Pag e

, s . , - c . - 1 . . - A , d e Q%

FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUT I ONS MADE TO STATEWI DEORLEGI SLATI VE 0 CHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBERFOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n)REPUBLI CAN WOMEN OF MADI SON COUNTY

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI 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 ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D# I o wa F e d e r a t i o n Re p u b l i c a nWo me n , Ka r e n Mc Al l i s t e r 1 1 d u e s p a i d $ 1 0 . 0 0 1 1 0 . 0 00 1 - 1 2 - 0 6 CK #1 2 3 7 3 7 1 7 - 1 9 0 t h St .

.

$I D # Aar y El l e n Ma u l s b y0 1 - 1 2 - 0 6 2 6 9 5 DHa r r i s t A v e n u e u r e rCK# 1 2 3 g 1 1 d u e s @ . 5 0 5 . 5 0Ro c k we l l Ci t y , I a 5 1 6 3 9I D # Ma r y El l e n Ma u l s b y

2 5 9 5 DH a r r i s t A v e n u e u r e r Se r v i c e F e e 3 0 . 0 01 - 1 2 - 0 6 CK # 1 2 3 9 Ro c k we l l Ci t y , I a 5 1 6 3 9I D #

3 - 0 2 - 0 6 CKJ24 0 Po s t ma s t e r p o s t a g e f o r n e ws l e t t e r 3 9 . 0 0I D#

3 - 0 2 - 0 6 CK#1 2 4 1 C a s e y s , Wi n t e r s e t Do n u t s f o r Co . Co n v e n t i o n 1 9 . 9 6I D# I o wa F e d e r a t i o n Re p u b l i c a nM~ 1 n - ' ~ ~ hAl l i s t e r 2 4 d u e s p a i d @ $ 1 0 . 0 0 2 4 0 . 0 00 4 - 1 0 - 0 6 CK#1 24 2 F a r r a g u t , I a 5 1 6 3 9I D# R~Dps r i c a r e a s u r e r0 4 - 1 0 - 0 6 1 2 4 3CK # 2 4 0 4 K i n g s l e y Av e . 2 4 d u e s @ . 5 0 1 2 . 0 0Ro c k we l l Ci t y , I a 5 0 5 7 9

0 4 - 1 0 - 0 6 I D # Wi n t e r s e t Pu b l i c L i b r a r y REs e r v a t i o n s p a i d i nCK # Wi n t e r s e t , I o wa A d v a n c e Ma y & D e c e m b e r 5 0 . 0 0Me e t i n g s $ 2 5 . e a c h

SUB- TOTAL $ 5 0 6 . 4 6TOTAL ( I f l a s t p a g e o f t h i s s c h e du l e ) $

8/7/2019 Republican Women of Madison Co__9551__scanned

4/4

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY:Pu r 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 mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / 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 mu s t 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 G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made 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 oSc 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 Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

P a g e

FOR I NSTRUCT I ONS, SEEBACKOF FORM SCHEDULEEXPENDI T URES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T T HE CANDI DATE I DENT I F I CAT I ON NUMBER I N T HE DESI GNATED COLUMN AND T HE EJ CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROMT HE I OWA AMENDI NG FORMETH I CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a m e 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 )REPUBLI CAN WOMEN OF MADI SON COUNTY

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACT I ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DDNR) AND PAC

CHECKNUMBER

I D # I o wa F e d e r a t i o n Re p u b l i c a nCK Wome n , Ka r e n Mc Al l i s t e r 3 d u e s Pa i d @ $ 1 0 . 0 0 $ 3 0 . 0 00 5 - 0 3 - 0 6 #1 2 4 5 3 7 1 7 - 1 90 t h St .

CK #0 5 - 0 3 - 0 6 I D# Mr s . Dean Gr a n t4 t h Di s t r i c t T r e a s u r e r 3 d u e s p a i d @ . 5 0 1 . 5 0CK # 1 2 4 6 2 4 0 4 K i n g s l e y AVe .Ro c k we l l Ci t y , ! a b o r - 7 4 1

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

SUB- TOTAL $ 3 1 . 5 0TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ 5 3 7 . 9 6