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  • 8/7/2019 Christensen Szalanski Jay__1607__scanned

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    FOR I NSTRUCT I ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me nt o f O r g a n i z a t i o n )

    J Ay c + f R ) 5 TEz v s c / V- s - e t u ws 4 1 WORe s F OR I OWA

    CANDI DATE COMMI TTEES ONL Y :C a n d i d a t e Name

    I AM F I L I N G A mAy I 9 , 2 a o&( r e p o r t d a t e )

    CHECK I F AMENDMENT TO REPORT DATED[ ] 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 an 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 or m DR- 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 . )

    Res t F o r m

    I MPORTANT : 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( F TJ1 ) 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 Ca i t 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 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 I s s u e

    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 m i n a l p e n a l t i e s P u r s u a n t t o I o wa Code 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 t e ' s c o mm i t t e e , a n d 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 mm i t t e e , i s t h er VF- t i y an d a c c u r a t e r e p o r t s .

    REPORT F OR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .I n d i c a t e b y #

    b e z e r o ) ( A t t a c h D R- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* ' UNPAI D BI L LS ( F r o m Sc 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 BUT I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    STATE COMMI TT EES : S u b m i t a r e c o n c i l e d c amp 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

    FORMDR- 2( R e v . 1 2 1 2 0 0 5 )F o r O f f i c e Us e On l yCo mm . # _ _ I _ - _L o g g e d I r -Scan n e dCompu t e r . . . . .A u d i t e dA u d i t e d

    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 mu s t

    NO

    DI SCLOSUREREPORT

    F i l e w i t hI o w a E t h i c s an d Campa i g nD i s c l o s u r e Bo a r d5 1 0 E . 1 2 t " , S t e 1 ADe s Mo i n e s . I o wa 5 0 3 1 9F ax 5 1 5 - 2 8 1 - 3 7 0 1

    L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o nNOVEW3 R2 - 7 , z v o 6Co un 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

    23 7 6 , ! 5

    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

    J D" Al So u l

    c o m m i t t e e T h i s amou nt MUST 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 1 5 8 4 9 7o 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc 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 he d u l e A ) ( ' a l s o s e e i n - k i n d b e l o w ) . . . . . . . . . . . . . . . . . . / 2 00 ,S c h e d u l e F Loan s R e c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OS 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O

    ( Sc h e d ul e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $ z 7 8 4 q 7SUBTRACT TOTAL MONEY SPENT THI S PERI OD

    S c he 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 Sc 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 ) . . . . . . . . . . . . . 4 D8 , 3 zS c he 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 he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O

    ' * OUTSTANDI NG L OANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULT ANT BRE AK DOWN ( S c h e d u l e G A t t a c h e d ? ) _ YESCANDI DATE COMMI TT EES ONL Y :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) $

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    Fo r I n s t r u c t i on s , See Bac k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN 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 ( M u s 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 )J4v Cf t A1eT0NSVJ-S?ALANsl c 1 Wo k v - s R 0 1 2 I OWA

    STATECANDI DATES NOTE I F ACONTRI BUT I ON I S RECEI VED FROMA STATE PAC( POL I T I CAL ACT I ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBERANDTHEPACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I L AB LE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD .CAUTI ON: Se c t i o n 68B. 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 ma t i on c o pi e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on 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 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

    SUB- TOTAL

    TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )D i s c l o s u r e l a w r e q u i r e s c a nd 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 mus 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 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 s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o f -f a mi 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 Sc h e d ul e A)

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

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT v I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMD# FRANK L . MHMI OT 7 j 0 N 1777J a

    O I 1 8 , l O b CK# 46qq RUNNI N4 p e - ER w6M5 Me n l oN~ 21 o w R Cay I A X2240I D# J Ay J . c t - t ws r ~ -Ns~l s - ZALANs 0

    0 / 1q o b CK# I N(CWY Rl t 6 t NE GANDI AhSff ~ 5 70.1 vWk G1TV I / A 5211 0I D# J AY CI { I ~ I STEI v SB' V5 ~4 L Ad ~f i. ~ I L I? ` I CI / i , j CK# 1 HI aOf ZY PU ( s 6NC c A v a 1 500,l I DNR C( 1 1 , ) A 5 ZZ - 4 0I D#

    CK#I D#CK#I D#CK#I D#C K#1 D#C K#I D#C K#I D#C K#

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    T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES ONLY :P u 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 S c h e d u l e H ( R e f e r t o S c 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 mi z e d o nS c h e d u l e G b y t h e a m o 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 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 oS c h e d u l e G i n s t r u c t i o n s a nd I o wa Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

    ( f o r S c h e d u l e B )

    FOR I NSTRUCTI ONS , SEE BACK OF FORM R e s e t F o n n I SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I DE NT I F I CA T I O N NUMBER I N THE DESI GNATED COL UMN AND THE CHECK THI S BOX I FPAC 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 & CAMPA I GN D I SCLOSURE BOARD .COMMI TTEE NAME ( Mu s 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 )J k Y CHf ( S T/ A NS C7 V - Z Z - - A L ANS I CI NDRI r 5 POP- OWA

    CAND I DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I TURE ( DESCRI BE TRANSACTI 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( MMI DD/ YR) A ND P ACCHECKNUMBERI D# NE7W4~~ SUwr l oNS WE6 Si 7~1 2 ~ 3 o ~ D 5 CK# $ l ~r f , 5bf DOl SI D# bay RC~MB. r = r. ~ e AC~Tsur-

    1 2 - 1 3 0 10 5 CK# W7 upI D# 0Fl e , E DST" 5 t l k n ' ~ NE l r ~ (

    ~l 3 ~/ n b CK# , o o s 4a5 HWY 6 "~/ 0 p o i C ! TY / l 4 SX2 - 9 - 0D# PM7MPSTE2 ~75T~FG1_ l NT ~N sT 7 6 ooCK# I 0 0 q 1 0 - Wh CI TY ) / A . S 2 - x . 4 0I D# v0HA_--COdI VTYAMO/ Td2 WO-1 7EW I NFe RWA77e N

    J I / 3 CK# 1 1 1 3 S 0 0 6 ( A QUE/ 0 / 0 /WO- C( " , r 0 y v ~ Sza4oI D# G ~ Z I N T I N 4 / - f D U . s E S T A / Y l ? 0

    Z l 3 0 6 CK# %/ ~ - ( - " , 7 - A 25~/ o l I / 0 Wq C 1 7 t 1 , 1 A S22- ~I D# Q0AvTt 1 6 - > Y4 1 2 1 4 v E 0 BAOG' Es

    3 / / 01 06 CK# 5 l 6 e Ale, l 4 0 . ~O1 0 1 2 1 ,

    I D# OFpeE DEPOT 5 ' ~t T~ON~~Y3` 3 i ~o6 c K# / 0~~ ~~ l c ( PI OWA i t - V SUB- TOTAL $ 384. 5 8

    TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

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    T H I S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :P u 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 S c h e d u l e H . ( R e f e r t o Sc h e du 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 nS c 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 oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 6 8 A . 4 0 2 ( 3 ) ( i ) . ) _ ~, -

    ( f o r S c h e d u l e B )

    FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t f ~ ' SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TT EE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I DE NT I F I CA T I O N NUMBER I N THE DESI GNATEDCOLUMN AND THE DCHECK T H I S BOX I FPAC 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 ( 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 )

    J h Y R( %5Ns o n l ~ - NSK 1 WORKS r - a f _ vwACANDI 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 ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D # d d I I AWCv &VI -13c U0 RF , e 1 l Y l = D

    4 1 1 3 1 0 6 CK# l o / * o l 6 S , d ) u &X, ~ UE $ l 4 . Zr v A - ca ~ ASya4v1 D #CK#I D #C K#D#C K#D#C K#I D #CK#I D #CK#I D #CK#

    SUB- TOTAL S l 4 ~ > ~TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ 4