8/7/2019 Appel Staci__1603__scanned

1/5

FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCL OSURE SUMMARY PAGECOMMI TT EE NAME ( M u 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 on )

I M P OR T A NT I n d i c a t e b y # t y p e o f c o m m i t t e e y o u a r e r e p o r t i n g f o r .( 1 ) S t a t e w i d e / L e g i s l a f 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 C o mm i 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 Ot 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

~ ,CANDI DATE COMMf I TEES ONLY :

C a n d i d a t e Name~QG cO f f i c e S o u g h t

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )D i s t r i c t ( i f S e n a t e o r H o u s e )

S a c e - 3 - 7AM F I L I N G A

d - ) ~~l g n c ~

( r e p o r t d a t e )

CCHECK I F AMENDMENT TO REPORT DATED

TELEPHONE

C C h e 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 No t i c e o f D i s s o l u t i o n F o r m D R- 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 DR - 3 i s f i l e d . )

R e s e t F or m

ST AT EMENT 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 e

c o m m i t t e e T h i s a m o u n t MUST b e t h e s a m e a s t h e c a s h o n h a n d a t t h e e n do 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 m u 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 . ) . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 D I S C L O S UR E( R e v 0 7 / 2 0 0 4 )

REPORT

F o r O f f i c e U s e On l yComm # , . -~L o g g e d t n Y " 'S c a n n e dC o mp u t e rA u d i t e d

L a t e r e p o r t s a r e s u b j e c t t op o s s i b l e c i v i l a n d c r i m i n a lp e n a l t i e s .

DATE S I GNED

REPORT FOR ( 1 ) ELECT I ON / ( 2 ) N ON - E L E C T I ON YEARI n d i c a t e b y # T ]

L o c a l C o mm i t t e e s , e n t e r Da t e o f E l e c t i o nC o u n t y & L o c a l C o mm i 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

t R' : 2 ~ 1 C g . 4 1ADD TOTAL MONEY TAKEN I N T H I S PERI OD

o~S c h e d u l e A : C a s h 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 ) . . . . . . . . .

8/7/2019 Appel Staci__1603__scanned

2/5

Fo r I n s t r t wUo m, Se e Back o f Fo r mCONTRI BUTI ONS- MONEY TAKEN I N( i n d u d n g c a n d i d s l e ' s p e r s o n a l f u n d s )COI MRTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n )

STATE CANDI DATES NOTE . I F A C ON T R I B U T I O N I S REC611FROM A S T A T E P A C ( P O L I T I C A L A C T I O N

, L I S T 1 7 E P AC I D EN T I F I C A T I O NNUMBER ANDTHE PACCHeCKNUMBER I N T HE D E S I GN A T E D COLUMN . A L I S T OF I D WI NDERS I S AVAMABLE FROMTHE I OME T H I C S AN D C A MP A N u ' T ID I S C L O S UR E BOARD .

CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa C od 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 n b u t i o n s o rf o r an y c o mr n e r c i a l p u r p o s e b y an y 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 e s .

SCHEDULEA MONETARY( R e v . o 7 r o s ) RE CE I P r sOCHECK T HI S SOX I FAME N D I NGFORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTR I BUTOR REL A T I ON SH I P AMOUNT J I F FORRECE I V ED ( i f a p p l i c a b l e ) TO CANDI DAT E ' RECE I VED FUND-( MMI D DI YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I N COME1 D# a o a y u X A y v e t ~ > t e C N~ $t 1 - 0( 0 CK# I ~ L g R s ~ l . ~ t .

.

u 'I v Vi t s ,

~~Z. r l o CK# ~~ F + ~ 1CC , 1 r Ki C~ "1 D#CK#

~ , r 7 n Rt C~ o1 oS S~ . SE . ` ` A O E : 1I D# ~A! . . ~ J ~ _ ' l + , CCt ~CK#SUSQI D# , Sa n f l v r ~ a~2

CK# 5 ~ ` S t t t c ; ~ J ' t ' . c o/ Ca~, X J z RI D# ,Z y a c u b e . '

5 - 0 3 CK# / ( d J l s i c . , / c o . ` 7I D# c e ~CK# ( 1 9 . 0 R" e . t ~c o o

8/7/2019 Appel Staci__1603__scanned

3/5

f o r I r s n r c t i o ns , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

( I n t A d r r g c a n d i d a t e ' s p e r s o n a l h i n d s )COMMI TTEE NAME ( J o u 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 )A=1 j ~6 - Se

STATECANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( POL I T I CAL ACTI ON COMM1TEE) . L I ST THEPAC I DENT I F r AT I ONNUMBERANDTHEPACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I LABLEFROMTHEI OWA ETHI CSAND CAMPAI GNDI SCL OSURE BOARD.CAUTI ON: Se c t i o n 688 . 3 2 A( 6) . I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r mat i o n c o p i e d f r o m r e p o r t s a nd 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 ut i o ns o rf o r any c o mme r c i a l p u r p o s e b y any p e r s o n o t h er t h an s t a t u t o r y p o l t i i c a l c o mmi t t e e s .

SCHEDULEA MONETARY( Re v . OTM3) RECEI PTS

CHECKT HI S BOX I FAMENDI NGFORM

. DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR REL ATt ONSWP AMOUNT J I F FORRECEI VED ( i f a p p ka b l e ) TO CANDI DATE` RECEI VED FUND-( NMNDDf YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME_ f D#

0AOrt ' + nS. k i k o ~' O c oC a m - r a~~_ I D#CK# PO t iI D# c ~y S c - ~ n s v x r

1 1 i U 1 q ~` ' S~. CK# .I D#CK# EA -I DNCK# ElI D#CK# EJI D#CK#

8/7/2019 Appel Staci__1603__scanned

4/5

FOR I NSTRUCT I ONS , SEE BACK OF FORM ` SCHEDULEEXPENDI TURES B MONETARY- MONEYSPENT FROM COMMI T T EE ACCOUNT ( 1 1 e v . 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COWNKTT EES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEI NI DE OR LEGI SLAT I VECANDI DATES . L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N T HE DESI GNATEDCOLUMNAND THE CHECK T HI S BOX I FPACCHECK NUMBER FOREACH ( PENDI TURE. A L I S T OF 1 0 NUMBERS I S AVA I 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 O r g a n r z a t i o n )

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( d a p p i c a W) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D# ~. I - z s ~ s ~ n ~ ~~soi ' Cv1~e ~ ' ' $q, SR s bI D # D - ' : n X Ca ' ~ cK#, ~ .5 C~

CK# Pa y Pa l- I D #CK#I D #GK#I D #CK#I D #

8/7/2019 Appel Staci__1603__scanned

5/5

I R I NSTRUCTI ONS, SEEBACK OF FORM) MMI TTEE NAME( Mus t b e s ame a s o n S t a t e m e n t o f O r g a n i z a t i o n )

1 - r t e - Se r ) - - \ - P -1 i) T E : T h i s s c h e d u l e r e p o r t s mon e y l o a n e d t o t h e c o mmi t t e e w h i c h I s d e p o s i t e d I n t h e c ommk t e e a c c o u n t .) T AL UNPAI D LOANS FROMLSREPORTI NG PER I OD $ - JCx ! : ) 0 -ART I - MONETARY L OANS RECEI VED=REPORTI NG PERI OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , m u s t b e s h o w n I f e t h i r d p a r t y l aI n v o l v e d . I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

TOTAL ( PART 1 )

' 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 ema k i n g a c o n t r i b u t i o n t o t h e c 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 wn t o t h e t h i r 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 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 y m a r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r I st 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 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 er e l a t i o n s h i p c o l u mn w h e n I t a p p l i e s . - _

- -

PART I I - MONETARY L OAN REPAYMENTSMADE=REPORTI NG PERI OD( L o a n s f o r g i v e n mu s t b e r e p o r t e d o n S c h e d u l e E- I n - I d r n d C o n t r i b u t i o n s . )

TOTAL CASH REPAYMENTS ( PART 1 1 )

$

O

F r o m S c h e d u l e E - TOTAL L OANS FORGI VEN

$

O

OGTOTAL OUTSTANDI NG L OANS END OF REPORT PER I OD

$

Pa g e o f( f o r S c h e d u l e F )

SCHEDUL EF L OANS( R e v . 0 7 / 0 3 ) RECEI VED& REPA I DCHECKTHI S BOX I FAMENDI NGFORM

DATE P AI D( MMI DDIYR) NAME ANDA DDRESS OF LENDER( i n c l u d e E n d o r s e r ' s Name , I f A p p l i c a b l e ) RELATI ONSHI PTO CANDI DATE"i f A p p l i c a b l e )AMOUNTREPA I D

DATERECEI VEDOM/DRa n o nNAME AND ADDRESS OF LENDER( I n c l u d e E n d o r s e r ' s Name , I f A p p l i c a b l e ) RELATI ONSHI PTO CANDI DATE

I f A I I c a b I e "AMOUNTOF LOAN

$