Soukup Betty1182scanned

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r: QR, I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

COMMI TTEE ME ( M u s tb e same a s o n S t e me n to f Or g a n i z a d ,

I MPORTANT : I n d i c a t et y p e o f c o mmi t t e ey o u a r e r e por t i n gf o r: a

rJ AN2, 2 2 0 0 2

( t ) S t a t e w i d e f L e g i s l a t f v eCa n d i d a t e ( 2 ) S t a t e wi d ePAC ( 3 ) S t a t eP a r t y( 4 ) Co u nt y / L o ca lCa n d i d a t e( 5 ) Co u n t yPAC ( 6 ) B a l l o ti s s ue / F r a n ch i s eCommi t t e e ( 7 ) C o u n t y / C i t yCe n t r a lCommi t t e e( 8 ) S u pp or t St a t e o fCa n d i d a t e s

FORM

DR- 2( R e v. 0 1 / 9 8 )

F - T-0- 3

1 2&SI GNATURE' OFTREASURE p e r s o nf i l i n gt h i sr e p o r t ) TEL EPHONE DATESI GNED4 1 0 1

Rou t i n eP e n a l t i e sDu eF or L a t eF i l e dRe p or t s Ran g e f r o m$ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONSON BACK AND COM PLETETHEFOL L OWI NGSENTENCE:

I AM F I L I NGA J a n , REPORT FOR AN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR .

( r e p o r td a t e ) I n d i c a t eon e

[ ] CHECK I FAMENDMENT TO REPORT DATED

C3 Che c k i f t 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 d a t t a c h No t i c eo fD i s s o l u t i o nF or m DR- 3.( You mu s tc o n t i n u et o f 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

CASH ON 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 g p e r i o d. ( T h i si st h et o t a lo f a l lmon i e sh e l db y t h ec ommi t t e e. T h i samoun t MUST b e t h es am e a s t h ec a s h on h an da t t h ee n d o ft h el a s tr e p o r t i n gp e r i o d ,o r must b e z er oi ft h i si s f i r s tr e p o r tf l e d. ) .. .. .. .. .. . .. .. . .. .. .. .. . . . . ... .. .. . . . . . ... .. .. .. ... .. .. . . ... .. .. .. .. .. .. . .. $

ADD TOTAL MONEY TAKEN I NTHI SPERI OD

S ch 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 ch e d u l eA ) .. .. . . .. .. .. .. .. .. . . . .. .. . .. .. .. . . .. .. .. . . . . . .. . .

S ch e d u l eF : L o a n s Re c e i v e d t o t a l( A t t a c hSc h e d u l eF ) .. .. . .. . .. . . . . . . .. .. .. .. . .. .. .. . .. .. .. . . .. .. . . . . . .. .. ..

S ch e d u l eH : T o t a lSa l e so fCamp a i g nP r o p e r t y( A t t a c hS ch e d ul eH) . . .. .. .. . .. .. .. .. . . .. .. . .. . . .. .. ..

( S ch e du l eH a p p l i e s - t o - C a n d i d a t e s 'Comn t i t t e wOn l y )

SUBTRACT TOTAL MONEY SPENT THI SPERI OD

S ch e d u l eB: Ex p e n d i t u r e st o t a l( A t t a c hS ch e d u l eB ) .. . . . .. .. . . . . . . .. .. !

S ch e d u l eF: L o a n Re p a y me n t st o t a l( A t t a c hSc h e d u l eF ) . . . . .. .. . .. .. .. .. . .. .. .. .. ... .. .. .. . . . . . .. . . .. . . .. . - -

CANDI DATE COMMI TTEES ONLY :

CONSUL TANT BREAKDOWN ( Sc h ed u l eG A t t a c h e d ? )

VALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l eH - A t t a c hSc h e d u l eH) $

DI SCL OSURE

REPORT

L o c a l Co nx n i t t e e s , e n t e rDa t e o f E l e c t i o

Co u n t y&L o c a lCo mmi t t e e s ,e n t e rC o u n t yi nwh i c hE l e c t i o ni sh e l d

SUB- TOTAL.. .. . .$

. . .. .. ... .. . 1. .. . . . . . . . .. .. .. . . . . ,

CASH ON HAND a t t h ee n d o 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 nc emust

b e z e r o )( A t t a c hDR- 3 ) .... ..... . . .

........ . . . .

...... . . . . .

.... . .. ..... .. . ..... . . ......... . . . .

......... ' ~.

... ~.

... . .

........ . $ 3

.X~ r

UNPAI DBI L L S( F r o mS ch e d u l eD - A t t a c hSc h e d u l eD) . . .. . . . .. .. .. . . . .. .. .. .. .. .. .. .. .. .. .. . .. .. .. .. . . . .. .. .. .. .. .. .. . .. $ p-

I NK I NDCONTRI BUTI ONS ( F r o mS ch e d u l eE - A t t a c hSc h e d u l eE) .. . . .. .. . . .. .. .. .. . . . .. .. . . . . . . . .. .. .. .. . . . . . . . .. $

OUTSTANDI NG LOANS ( F r o mSc h e du l eF - A t t a c hS c h e d u l eF ) . . .. .. .. .. .. .. .. .. .. .. . . . .. .. . . . . . . . . . .. .. . . . . . . . . . .. $p _ -



Fo r I n s t r u c t i o n s ,Se e Ba c k o f Fo r e

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n to f Or g a n i z at i o n)

STATE CANDI DATESNOTE : I FACONTRI BUTI ONI SRECEI VEDFROMASTATE PAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHEPAC I D ENT I F I C AT INUMBER ANDTHE PACCHECK NUMBERI NTHE DESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : S e c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h eu s e o f i n f o r m a t i o nc op i e d f r o mr e p o r t san d s t at e me n t s f o rs o l i c i t i n gc o n t r i b u t i oof o ran y c o mme r c i a l p u r p o s eby an y p er 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 tp a g e o f t h i ss c h e du l e )

D i s c l o s u r el a w r e qu 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 po f a 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 ot h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es h ow n t o t h e t h i r dd e g r e eo fc o n s a n g u 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 )( Se ePage 2 o ff o r m sp a c k e t. ). I fs u r n a me o fc 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 t t h e r ei s n o Page o ff 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 u mn. ( f o rSc h e d u l eA)

SCHEDULE

A MONETARY

( Re v. 0 6 / 9 7 ) RECEI PTS

CHECK THI SBOX IAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT d IRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA

NUMBER I N

V y / s A' s h l a , t 4 AV( - - .CK#

1D# G~ t l 1 v i

i " l e v e l ' - , " I 'd 9 -1- ,CK#

l Ue wa ~n n ~ - - SOl o ` - ~t

ID# Jr a k i K o° - t - to t - j19 t' l ~ygYoI ' ~

1 7 1 ,I D# ~u i s ~ t~ t t t r S ' ~~t i s 1

c 3CK#

I D# 11. o r n A_ - ~ , r m a v 9- Z -__n I

CK#3 : 2 t: ~ . , h / a / - n u - f - - Av e - . 3 5 , E c ~Ne v J ~ a W f o o , 1

I D# Fh~n 4 . 7 3 r.. I c ' k i n 5

CK# Gr e , s Nom, TA 3 '. 2 3L e x )

I D# Ri c Aa r y ~ ~ , e i 2/ C

2 ~ -61 CK#A I` . ~ ?.

L r + ° J / j 5- 2 l 31 P~1 5, co

S c c ~ ,I D# _ ~ - ~ : r t - r rQ , . 7

I D# A 1 ( a i iF F ) ,,d. 2 6 ' 1 CK# 3c3 F / ' r 5 f Ac r e

'~ r 4 r f! ,- 5 6 ; t ~' . G ~ c l t ' o,I D# u t e i - , Cc Me - Y~ - r

/ n ~ ar , - 5-2 I %Z





' Fo r I n s t r u c t i o n s ,Se e Back o f F or e

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a lf u n d s )

COM I T TEENAME ( Mu s t b e s a me a s o n St a t e me n t o f Or g an i z a t i o n)

C I NA T

STATE CANDI DATESNOTE : I FACONTRI BUTI ONI SRECEI VEDFROMASTATE PAC ( P OL I T I C ALACTI ON COMMI TTEE) ,L I S TTHE PACI DE NT I F I C AT I ONUMBERANDTHE PACCHECK NUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : Se c t i o n68B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t st h eu s e o f i n f o r m a t i o nc op i e d f r o mr e p o r t sa n d s t a t e me n t s f o rs o l i c i t i n gc o n t r i b u t i oof o r a ny c omme r c i a l p u r p o s eb y a n y 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 tp a g e o f t h i ss c h e du l e )

' D i s c l o s u r el a wr 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 po fa n y r e l a t i v ema k i n ga c o n t , i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es h own t o t h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o odr 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 eP a g e 2 o ff o r msp a c k e t. ). I fs u r n a me 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 sn o P a g e 3 o ff 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 e r e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA )

SCHEDULE

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


DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v IRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA

NUMBER I NC

I D# Ma r e - ~ l~ ~ ! h l E f ~ c ' !3 - 3 - c ) i

CK# ,X/ ~~ Pr c 5 p e , - 1 -

I D# Al o r me L K : Di r L t t mr v t o r t A

-J c , n i a _ _: t A - 6-e b 5 -I D# ma r i ,

I x i - I Er l u h t i ' . t -

CK# ; ~7 3 5_ ~ a j u s 5 A U E, -

M4 r ^ h I e ' ~ c k ~A 50L53I D#

CK#; I v 6 - W 6 i = t

I D#

- 3 - C7 1 CK# r y a , s ' f , Nw- y 9

I D#Ne a r l e 5 W, ~~ z r t c l L ~r v

3- 3- t / CK# l l r y- l , 4 Ave ,L ~ ~ !hl ~~ L 1 ` ' t . ~

ID# ' T ' ,-P" %cI . s~, a

CK# w i l l- f o p . A `rz S, c w

C p l ~ n t - . - T S c ~ ~ l i ~I D# a a l d 1 - ^ / R' a n l < i r 7

3- 5- c- 4 CK#33c S Wa t f i - At f c ,

' ~ c cI Vew' lq c twf vn, ~ 1 4 Sc % ` %` f

I D# F~ . I a ` , W

4

-P6

060 , , JA . 3 - r L & - l

I D#Ma r - f h a _ ' 6C , 4 n c e , I l e , rp6" Be , k . 2/ ~

CK#' - f - ,A s -et l - _T A moo 47 : x _



' Fo r I n s t r u c t i on s , See Back o f Fo r r

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc an di d at e ' sp e r s o n al f u n ds )

COMMI TTEE NAME ( Mu s t b e s ame as o n S t at emen t o f Or g an i z a t i on )7

STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI SRECEI VEDFROM A STATE PAC ( POL I T ICALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVA I LABLEFROM THE I OWAETHI CS AND CAMPA I GNDI SCLOSUREBOARD .

CAUTI ON : Se c t i on 68 B . 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 ma t i onc op i e d f r o m r e p or t s an d s t a t e me n t s f o rs o l i c i t i n gc on t r i b u t i on so 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 e r s on o t h e r t h an s t a t u t o r yp o l i t i c a lc o mmi t t e e s.

' Di s c l o su r e l a wr e q u i r e sc a nd i d a t ec o mmi t t e e st od i s c l o s et h er e l a t i o n s h i po f a n y r e l a t i v ema k i n ga c o n t * i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmus t b e s h own t o t h e t h i r dd e g r e e o f c o ns a ng u 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)( Se e P a g e 2 o f f o r ms p a c ke t. ). I f s ur name o f c o n t r i b u t o ri s t h e s ame a s c a nd i d a t e , b u t t h er ei s n of 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 pp l i c ab l e "i n t h e r e l a t i o n s h i pc o l u mn .

SUB- TOTAL

TOTAL ( i fl a s t page o f t h i s

s c h e du l e )

SCHEDULE

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

CHECK THI S BOX I FAMENDI NG FORM

P a g e o f( f o rSc h e d u l eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I FRECEI VED ( i fa pp l i c ab l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i fa pp l i c a bl e ) RAI

NUMBER I NC

ID# ~e . u h j ~~ r r na t ' 1

r

I D# T l 1 i- Ti c k - - ( 7T r ^ Ci n

~I -A 5 , 2 i 3 ~ ,I D#

- m i l. - l a m CK#

A

~DOCI D# h en t 3 , t 5 f a .

3 - - 2y.

`

- 0 l CK# 06x _v ~ r

I D# ~ 1~; / J s Kf h nCK#

G! ~a I NC / , , _-f x 5 -6 ,

I D# - T c k nL ob e , I <

>> CK# s ~M~~_ ( ~~i ldN~ W -d ot o f ' c i 7 , EA . 5- ~ -C l C - S d , UC,

I D#~f 1 I l l . ~ f K> l l. r l

- ~ - C~ CK# . 3 2 7 . 5

TA s

I D# k r ; ~ .f a h M . ~.

ya f 4 -

3 - 2 t CK# pc'

N~ m -t ~ n

CK#/ ,. _ z c , 3 L I - ! - n - f ' A v~C C - _Y I I Ie . TI C Sa y 6 , 6

I D# ma r var - f F , Te Kl r c - ~ L>

Ne _ v v I t 4 ` y f o l 7 , 1 A ~G ~ J c lC' n



' Fo r I n s t r u c t i o n s ,Se e Back o f F o r r

CONTRI BUTI ONS - -MONEY TAKEN I N( I n c l u d i n gc an di d at e ' sp e r s o n a l f u n d s )

COMMI TTEE NAME ( Mus t be s ame a s o n St a t eme n t o f Or g a n i z a t i o n )

c a f f u r -To ) ^ ~ewq - ~

STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI S RECEI VEDFROM A STATE PAC ( POL I T I CALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWAETHI CSAND CAMPAI GNDI SCL OSUREBOARD .

CAUTI ON : Se c t i o n6 8B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t st h e u s e o f i n f o r ma t i o nc op i e df r o m r e p o r t s a n d s t a t e me n t sf o rs o l i c i t i n gc on t r i b ut i o n so rf o r a n y c o mme r c i a lp u r p o s eb 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 yp o l i t i c a lc o mmi t t e e s.

SUB- TOTAL

St n'1 3,

. , $ Ir:Come ~c 1 ` 4 Ol t " ' d ~ r i 0 ~I v S~ -v r ~ v - TOTAL ( i fl a s tp a g e o f t h i s

s c h e du l e ) $1 4 v0' Di s c l o su r e l a wr e q u i r e sc a nd i d a t ec o mmi t t e e st od i s c l o s et h er e l a t i o n s h i po f a n y r 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 hc o mmi t t e e. R e l a t i o n s h i pmu s t b es h o w n t o t h e t h i r dd e g r e eo f c o ns a ng u 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)( Se e Pa ge 2 o f f o r ms p a c ke t. ). I f s u r n ame o f c on t r i b u t o ri s t h e s ame a s c a n di d a t e ,b u t t h er ei s n o P a g e - 3- o ff 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 t a pp l i c ab l e "i n t h e r e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA)

SCHEDULE

A1 MONETARYRe 9 RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J IRECEI VED ( i fa pp l i c ab l e ) TO CANDI DATE` RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa pp l i c a bl e ) RAI

NUMBER I NC

I D#Ma y , L . h ' j fI ( ~r

- . ~ - - ~ ICK#

~. _ I 1f s r

I D# . ~ -

CK# ?31

I v e -t " ,ID# 4 -Hami s Ne t v lsy - I ( ,- 0 / ° '

Bo x i sCK#

I D# K4 " 7

. ~ C' f W . f l e t r r r i/ f , nCK#

New Nqt n h v i ` 7 ~~p , .

I D# C~Qr o ( ~c r ~r c

Fl o d , A ~ r c ~ 3 , s . S , c: o

I D# c r - o _M ; l

CK# / Vf W 1 4 , 1m~ ' f o r l ,I - A . S-C ' ~ 1 r c7C7. c + ~~

I D# ~

L - - n 1~~ c l f i Gl u f ` o r ~

CK#t 31x %c.; ~

Mv i v 7 &- - sJ TA 6 -( ) 3 c ~ 1I D# 1 1" 3 FSGMC1T ~ v u Ce a r 7 c / l 6 l

y 3 ' 2 0' V: W" Z" yAVM ;CK# ~ Z y bDe - s Ma 1 n e s , TA S~ - 3 / 3

ID# ~3 0 ow ~ . Roc r a l In l a f e r _5 11- 4 f e - Tc k r _

030 / CK# ( , 7d ~r n l + v n ,TA 5o : Ze B- ~ ' , ~ ~

7~ : o a

fD#Tc t -Ifr i c* I n l m a n- 2 D 5 ~X, Cx , 2t y u



Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r r

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b

70v,

ame a s S t a t e me n t o f Or g a n i z a t i on )

sr~' l ~ ( ~ cc+~__

SUB- TOTAL

TOTAL ( i fl a s tpage o f t h i ss c h e du l e )

STATE CANDI DATESNOTE: I FACONTRI BUTI ONI SRECEI VEDFROMASTATEPAC ( P OL I T I C ALACTI ON COMMI TTEE) ,L I S TTHE PACI DE NT I F I C AT I ONUMBERAND THEPAC CHECKNUMBERI NTHE DESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROM THEI OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD.

CAUTI ON : S e c t i o n6 8 8 . 3 2 A ( 6 ) ,I o wa Co de , p r o h i b i t st h eu s e o f i n f o r m a t i o nc op i e d f r omr e p o r t sa n d 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 oof o r a ny c omme r c i a l p ur p o seb y a ny p er s on 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.

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s et h e r e l a t i o n s h i po f a n yr e l a t i v ema k i n g ac o n t - i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es hown t o t h e t h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da 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 f f o r ms p a c 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 t t h e r ei s n o P a g e o f -7f 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 nt h e r e l a t i o n s h i pc o l umn. ( f o rS c he d u l eA)

SCHEDULE

A0 6 1 9 7 1

MONETARY( Re RECEI PTS

CHECK THI S BOX IAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v IRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RA

NUMBER I NCI D# mi me s -A Er b

J 7 - / o - o l 7 , o f -a ag ' Av e , $CK#

dha r l e5 6TA 3 -o 6 1 6ID# K icTcL r t e ( T, Te . Ki ( ~p E-

D-l D . ~v l

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I D# ( ~OS9 wc L ws m, 0 I f / A I u t o. l i a r U s

S- 1 , c ~- t e n l CK#f l l l l e r - .p q r l < R. 0

We S My ' , h e 5 , . 1 4

CK# ~f j 5 5 y l g n k r %_~ e Pr r _ j o o , c ) o

Mo r r le - 5 D. .

8 - ` - 0 1 CK# 1 7 li ~~y - 3 d- f ~- , ,

. 25 c ~ , 004 ~ 1 es

. f d k s M~ r e s , I A - 5-o, z b 6

I D# 0&VI ' d L . ~ c t l l ~ l ' _ 1^

CK#a ( 3 S 1 r ! T ~ r Mi 1f i r .

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~ { ~ s 3 t ~ ', r C) ` ~y Ma r t -bl v d .

CK#

I D# Nu e 7t e _ r

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I D# e - f ml e u m * v 'h e- f e r s o f To wa_

CK# , c ? ~

- I D# ( ~~7 W, ) - 7 ` ~l - ~ ~ ~ r f ` run ~e r ~ r 1 5 s s > < - , -

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Fo r . I n s t r u c t i o n s , Se e Back o f Fo r m

CONTRI BUTI ONS - MONEY TAK~ . . I N( I n c l u d i n gc a n d i d a t e ' spemand 1 t x x %)

COMMI TTEE NAME ( Mu s t b e s am s o n s t a emen t o f Or g an i z at i o n)

- ( v r c~ a ( f ,

STATE CANDI DATES NOTE: I FA CONTRI BUTI ONI SRECEI VEDFROM ASTATE PAC ( P OL I T I C ALACTI ON COMMI TTEE). UST THE PACI DE NT I F I C AT INUMBER ANDTHE PAC CHECK NUMBERI NTHEDESI GNATEDCOLUMN. A USTOFI DNUMBERSI SAVA I L A BL EFROMTHEI OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.

CAUTI 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 eu s e o f i n f o r m a t i o nc o pi e d f r o mr e p o r t sa n d s t a t e me n t s f o r s o l i c i t i n gc o n t r i b u t i oof o ra n y c o mme r c i a l p ur p os eb y a n y p er 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 ( l fl a s tp ag e o f t h i ss c h e du l e )

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s e t h er e l a t i o n s h i po f a n yr e l a t i v em a l t i n ga c o n t r i b u t i o nt ot h ec o mmi t t e e. R e l a t i o n s h i pmu s t b es h ownt o t h e t h i r dd e g r e eo f c o n s an g u i n i t y ( b l o o dr e l a t i v e s )an 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 m sp a c k e t. ) . I fs u r n ame o fc 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 sn o P a g e 7 -7

f 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. t ) Q / 9 7 ) RECEI PTS


DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P - AMOUNT J IRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MWDD/ YR) AND PAC CHECK ( i fa p p l e ) RA

NUMBER I NC

I D# 6X, ; c 9 M , ~ , P w e s f -C 'ns emu` ' f " ': c l ] / ' o J 4 ' r G-h ' o K4 l

CK# / 5 1 1 I g ao . ~ ~ ~ s 11 f 1v i m,

s MO f i l e s r A 15D j oy

IDO 17 t / ' --CK# , r ~ ~7

411 ~c 7 o , EXJ t

y e s Mo ; r ) c 5I A _5_0 , Y( 2 ' 7

- ID# 6 o y v v a f { - r, t o m -. qh W - P4<, Nc l r n i ni t t ~ c . s D " L oJ " - f i t - o 7 a c , J

a

.

/l l -% /c -- r - K c l/ t o m " . ? , ~O

I D# r , -4 ; 7 C f ,N~i I s e n

' I ds I ~C~ y~ s ~ ~V ~~ 11 7. I D# V aw, 6, wn , , ~~Au -f f m, 6 -v e- V2 t ( e r ' s

CK#/ I j / 0 6~ ; c

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s

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v r l e h _. s

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FOR I NSTRUCTI ONS,SEE BACK FORM

EXPENDI TURES - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES,L I STTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHEDESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI LABLEFROM THEI OWAETHI CS3 CAMPAI GNDI SCL OSUREBOARD .

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f Or g an i z a t i o n)

DATEEXPENDED( MI WDD/ YR)

I D#

CK#

14- o l

1 - . g3e

, - )- / 4 c ,. _C; f

CANDI DATEI DNUMBER( f fa p p l i c a b l e )AND PACCHECKNUMBER

I D#

CK# j l , Z n

I D#

CK# / / , Z (

I N

CK# / IZ : 4 _

I N

CK# I / 2 - 3

I N

l CK# / / , z' r I

NAME ANDADDRESS TO WHOMEXPENDI TURE

( Os b u r s e n r e n t ) WASMADE

U. 5 ,f ' - S ,

Nev" : r A

~>x A.~h c v I 1 ' I A 5 e ' 1 c . 6 -

I~ ~r V l e ~S-s C)

r A 3 6

Ma r ` h

Ne ~ TA 30~ . ~" I

/ U 3 'l ~. c _. s t n 4f .

A v i m " ,

4Cw «N1 f-c , I l / TA s 0 6 S` (

~ e c - _ t t C p " f _ ~5 ~ f c c f ~. . c t ~ ' 4

l r e ~' ~7 ~ a r K l o l v ~ ,T4 . 6 c ' 6. 5 I - ` '

Ci t I f o a t t Gt ' a i ` o r 7' P. c ~~o X S12 , ;Z 2

Des M e ; h e . s , TA 670 3- 1

PURPOSE( DESCRI BETRANSACTI ON)

AMOUNTEXPENDED

Au r ? u a I b e tI ( , o n , , tI i r 7 ~ e c ~ I$ l S ~

~e Vl e ' i. (. ' E = e. 1 / ~ Y' , 3 u ~s t > r ' ~ ISC~ r

f ( e t l e t Ve , ~ S ' o b 5c r 6I '

o h l

Gt l , - En v e , l ' y ®s , r ^

mel l ' / I n ~y

, ~ 7 ' l / XAk j i / /r V

En t - e. r { ~ r i sc: o u : ~n a J

. " Ar ; I A SC% 7Z

1~~ ( A

s e / , i ,// tC c ~ _

~ ' GI - u r ` r r e ~ le o n 4r i b « 'f - ,~ . - ) d a c e' f " S" ' y l ' " - - p C, r f Sh , ,V ._s e l l g o s h f ' t vh 1 ' '. ~ ~c~Ur ^ A4- l a r i. CGte ~ <

Kt ir NCt . ( .~u

G K t "

; 5 t i t we S ~ 7 o " d f ^ Sc h 1 4 C6~ SUB- TOTAL $~ ` !o I . l

r - _-, k

c o r r P 6 A® -

er r o TOTAL ( Ul a s tp a g e o f t h i ss c h e du l e ) $b , k Ak St h VA. ) _ , _ . I , - ~- J ~J _ . . A - . _ . . i r _ I A _

THI SBOX APPL I ESTa CANDI DATES' COMMI TTEES ONL Y : I _ e+ - C p r -

SCHEDULE

B( Re v. 0 9 / 9 7 )

MONETARYEXPENDI TURES

C3 CHECK THI S BOX IAMENDI NG FORM

Pu r c h a s e s o f c e r t a i nc amp a i g np r o b e n -r f u Jp a r t yc o s t i n g$500 o r mo r emust a l s ob e i n v e n t o r i e do S c h ed u l eH. ( R e f e r t oSc h e du l e H i n s t r u c t i o n s. )

E x pe 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 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 gs e r v i c e smust a l s ob e d e t a i li t e m i z e do nSc h e du l eG b y t h eamo u n t ,p u r p o s e ,a n d d a t eo f e ach t y p eo f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h e c a n d i d a t e ' sc o mmi t t e e. ( R e f eSc h e du l eG i n s t r u c t i o n sa n d I o waCode 56 . 6 ( 3 ) ( i ). )

( f o rSc h e du l e B )



THI S BOX APP I L I E STO CANDI DATES' COMMI TTEES ONLY :

Pu r 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 g5 5 0 0o r mo r e mus t a l s ob e i n v e n t o r i e do nSc h e d u l eH. ( R e f e rt o Sc h ed ul e Hi n s t r u c t i o n s. )

Ex p 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 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 smus t a l s ob e d e t a i li t e m i z e do nSc h e d u l eG b y t h eamo u n t ,p u r p o s e ,a n d d a t eo f e a c ht y p e o fe x p e n d i t u r emad e b y t h ep e r s o N e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e f eSc h e d u l eG i n s t r u c t i o n sa n d I o waCod e 5 6 . 6 ( 3 ) ( i ). )

P a g e ' 1 ' o f

( f o rSc h e d u l eB )

FOR I NSTRUCTI ONS,SEEBACK FORM SCHEDULE

- EXPENDI TURES B- MONEY SPENT FROM COMMI TTEE ACCOUNT MONETARY( R e v. 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLATI VE O CHECK THI S BOX I FCANDI DATES. L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THEPACCHECK NUMBER FOR EACHEXPENDI TURE. AL I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS3 CAMPAI GNDI SCLOSUREBOARD .

NAME ( Mu s t b e s ame a s o n St a t e me n to f Or g a n i z a t i o n)

SO2COMMI TTEE

L~ k N S~0a

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

EXPENDED ( i fa p p Bc a b l e ) ( Dt s bws ame n t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

I N Na r f e , 5 ' ( ' e 5 s7 - ~ = v l CK# / 1 , 7 - t,

~o~ R~v ~ r s ~ u r ~ u 6 s c r it pf i n i ~ ~ n e , , ~ n l

$3 9 7a , s , ' T X06 / 6

I D# r ~ n ~ cW

( CK# j / .0 .Box 6 / l ' s, s a bs c r ( F -h o r ) -f f e o e we a l

~ . 9 s7c C/ 1 e. ~ f e / , / ' ` I N. ~ S 5 D c ~ 3 - l r l / ~

CK# f / o Z J O ~e k,v, # ,tm p- - f , I A S -6 5-1

. 2. 3 C , " c t i 1 7a \eA , ci f e - r - ( o r` ' r x t

1 1 ,

A i!e l n f9 a 1 Mp f o a/ -VR n 1

I N ' - p i ( ( ~ r i , n - t e - r s -P r; n 4 I, a 3 3 e - a 1 4 s ,

CK# ~ l~Ma f f -

e " ' v e. ~ 1 e s 4 -o r Ma yI t-n- ~ 9 / , 6 9

l / 3 0 ~ c ° _W C ( a~~ o h7 / ~

I N / / o i-e - l r f , TX- a Mat ` I 4 e SI l e ac } - - ic > Y I- u ~ c cf

,Y - , 2 0 - 0 1 CK# 1 1 -3 1l a c y Wu In u 4 - 9 . -1- . I n s e r ' ~

7 ) , -s Ma i 'n e - 9 ,I - ~ - 5-0 3 c ~ ` ~

I D# . ' t T r r r l{ - er s G jC, / ` S~ he l l VC( . e b( v- v I

CK# t ( 3 Z. ° 2/ ~ < ~ ,t r 1l 1 ( e wI g e t r n F t o n. j A ~ ' c h5 9 ev l < ~ ec ~ ~o r M~ ti I ~n o Z ` 3 ~

I N e . Ne v y f la l f f o r t l r i h u 1 1e

i l - l ~ - ~ ~l c K# l 1 3 . ~P . ~ , ~~x 3 9 0 l 0n

/ 1 / eu J .u r np f o h1 1 R 5 c ' 6 5 Y

SUB- TOTAL $ ~ / ;

TOTAL ( Nl a s tp a g e o f t h i ss c h e du l e ) $



THI SBOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :

Pu r c h a s e s o fc e r t a i nc a mp a i g np r o p e r t y c o s t i n g$ 5 0 0o rmo r e mus t a l s ob e i n v e n t o r i e do n S c he d u l eH. ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )

E x p e n d i t u r e st o p e r s o n s / e n t i t l e s p r o v i d i n gc 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 smus t a l s ob e d e t a i li t e mi z e do nSc h e d u l eG b y t h eamo u n t , p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rtSc h e d u l eG i n s t r u c t i o n sa n d I o waCode 5 6. 6 ( 3 ) ( i ). )

( f o rSc h e d ul eB)

FOR I NSTRUCTI ONS,SE E BACK FORM SCHEDULE

- EXPENDI TURES - MONE Y SPENT FROM COMMI TTEE ACCOUNT MONETARY( Re , 0 9 , 9 7 ) EXPENDI TUR

STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHECANDI DATEI DENTI F I CATI ONNUMBER I NTHEDESI GNATEDCOLUMN AND THE CHECK THI SBOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NGFORMETHI CS3 CAMPAI GN DI SCLOSUREBOARD .

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 n i z a t i o n )

L 77 HA P -r e p r S ( ~ - _. r u t i t-

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

EXPENDED ( i fa p p l i c a b l e ) ( Df s b u r s w r w t )WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D# . T o -I i e L i t ! e r sZn F ' 0 0 ~ - ~ `C - ( - -

-l ow -c e. t i l l s . ~u l n f-e r -v e - ,

` 1.. a.. p f - oI t t ~ : f ~on~ : f - ~f ~s~l e~a -f sI ' 1 - f S- o f CK# l h $ 3 D, C`

m, -

~s Mv i h e s r A ~ c ~ f 9I D# D f t e l

,c c-- 1 ' 1 I ' vr W

- l e a ' Ca ~~/ ~t ~a~

r `

%2 - ; ZD- o J CK# J I 3e23 i ns f Na i ~7 ~

YP -Tv

i t " t p o e , y l Y7 ~ ~ .f ~ e WHa f N' 1 ~ f Ol 7 ~. TA L s ~r c ~ u- / ~~o l ~

1 D# S .

CK#

I D#

CK#

I D#

CK#

I D#

CK#

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CK#

SUB- TOTAL $

TOTAL ( Nl a s tp a g e o ! t h i ss c h e du l e ) $ l ~3 c l



FOR I NSTRUCTI ONS,SEE BACK OF FOF,

COMMI TTEE NAME ( Mu s t b e s ame a s on St a t r n wn t o f Or ga MLMon )t

, 6 o t l l k : t )7 P -~-o r t l -

SU&TOTAL

TOTAL ( I fl a s t

p a g e of t h i s

s c h e du l e )

SCHEDULE

( Re v.E I N KI ND0 8/ 9 7 CONTRI BUTI ONS

El CHECKTHI SBOX I FAMENDI NGFORM

' Di s c l o s ur e l aw r e q u i r e sc a nd i d at e s t o d i s c l os e t h e r e l a t i o n s h i po f an y r e l a t i v ema k i n g a n i nk i n dc o n t r i b u t i o nt o t h e Page / - - o f _L _. _c o mmi t t e e. Re l a t i o ns hi p must be s hown t o t h e t h i r dd e gr e e o f c o ns a ng ui n i t y ( b l o odr e l a t i v e s )an d a f f i n i t y( r e l a t i v e s ( f o rSc h e d ul e E)

by ma r r i a ge ) . ( Se e Page 2 o f f o r ms p ac k et . ) I fs u r n ame o f c o n t r i b u t o ri s t h e s ame as c an di d at e , b utt h e r ei s no

f a m i l i a lr e l a t i o n s h i p ,e nt e r ' n ot a pp l i c ab l e " i n t h e r e l a t i o n s h i pc o l u mn .

DATERECEI VED( MM/ DD/ YR)

NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI PTO CANDI DATE' ( i ta pp l i c a bl e )

DESCRI PTI ONOF I NKI ND

CONTRI BUTI ON

ESTI MATEDFAI R MARKET

VAL UE

J I F FORFUND- RAI SERCONTRI BUTI ON

~ n l

1 - l 7, - Be ( ' J °ou 4 U

1 3 3 /z ac . a s 4 Ave , .

/ 1 ~ c ~1 i 1 IT1~f M ~ " c l 9 , ~ ~ ~C~~o ~ ~l

oS' u ~ ~ ~ ie 5 - f-o r

Fa- hd ' N a t,! ~s i n ~

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Soukup Betty__1182__scanned

Soukup Betty1182scanned