8/7/2019 Cohoon Dennis__376__scanned

1/3

. FOR I NSTRUCT I ONS, SEEBACK OF FORM

DI SCLOSURE S U i . AARY, PAGECOMMI TT EE NAME ( Mu s t b e s ame as o n St a t e me n t o f Or g a n i z a t

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 : 4( 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 mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mm i 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 s ,J a n . 1 5 , 2 0 0 2SI GNATURE OF TREASORt Ko- r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE S I GNEDY / I L 7 7 y /1 3 19 - 7 52 - 9 52 4

P e n a l t i e s Du e Fo r La t e F i l e d Re p o r t s Ra n g e f r o m $ 1 0 t o $ 4 0 0SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLL OWI NG SENTENCE :I AM FI L I NG A Dec embe r 3 1 , 2 0 0 1 . 1 - 1 1 - 6 0 _ 1 " N ,- REPORT FOR AN! A ( 1 ) ELECT I ON 42 ) NOWELECTI ON YEAR .( r e p o r t d a t e ) I n d i c a t e o n enCHECK I F AMENDMENT TOREPORT DATED

pCh 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 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 Fo r m DR- 3 .( Y o u mus 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 . )

FORMDR- 2 I DI SCLOSURE( Re v . 0 2 / 9 6 ) REPORT

Fo r Of f i c e Us e On l yComm. #I n d e x e dA u d i t e dComp u t e r L LP6. o

L o c a l C o m m i 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 m m i t t e e s , e n t e r C o u n t y iw h i c h E l e c t i o n i s h e l d

CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? ) YES X NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e du l e H - A t t a c h Sc h e d u l e H) $ ;

STATEMENTOF 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 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 mmi t t e e . T h i s amou n t MUST b e t h es ame 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2 , 8 89 . 8 3

ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A: Ca 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 Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5 . 2 1Sc h e d u l e C: F u n d - r a i s i n g E v e n t s t o t a l ( A t t a c h Sc h e du l e C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : L o a n s Re 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H : T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca nd i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $ 2 , 9 35 . 0 4

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 Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 550 . 0 0Sc h e d u l e F : L o an Re p a y me n t s t o t a l ( A t t a c h Sc 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 al a nc e mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2 , 3 85 . 0 4

UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I ND CONTRI BUTI ONS ( F r o m Sc h e du l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h e du l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :

8/7/2019 Cohoon Dennis__376__scanned

2/3

SCHEDULEA MONET ARYCONTRI BUTI ONS - MONEY TA KE N STATE RECEI PTSCANDI DATE( 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 ) CHECKA ME N DI N G

COMMI TT EE NAME ( M u s t b e s a m e 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 ) FORMCohoon f o r Re p r e s e n t a t i v eSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T T HE PACI DENI F I CATI ON NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI L ABLE FROM THE I OETHI CS AND CAMPAI GN DI SCLOSURE BOARD.c a u t i o n : S e c t i o n 6 8 b . 3 2 a ( 6 ) , I o w a C o 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 f r o m r e p o r t s a n 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 r f o r a n y c o mm e 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 a n s t a t u t o r y p o l i t i c a l c o mm i t t e e s .

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 5 . 2 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 mm i 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 m m i 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 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 ym a r r a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s am 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 - I o f I -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 m n . ( f o r Sc h e d u l e

DAT ER E CE I VE D

PA C I D NUMBER& PA C CHECK

n u mb e r

NAME A ND ADDRESS OF CON T R I BUT OR R EL A T I ON SHI PT O CA N DI A T E

AMOUNTR E CE I VE D

1 / 1 / 0 1 I D# Ca s e b i ne C r e d i t Un i o n - i n t e r e s t $t h r u CK# 2 1 1 5 De s Mo i n e s Av e 4 5 . 2 1

1 2 / 3 1 / 0 1 B u r l i n g t o n , I o wa 5 2 6 0 1I D#CK#

I D#CK#

I D#CK#

I D#CK#

I D#CK#

I D#CK#

I D#CK#

SUB- TOTAL 4 5 . 2 1

8/7/2019 Cohoon Dennis__376__scanned

3/3

EXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNTSTATE PAC COMMI TTEE : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI S LAT I VECANDI DATES, L I ST THECANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHEPAC CHECKNUMBER FOR EACH EXPENDI TURE. AL I ST OF 1 1 ) NUMBERS I S AVAI LABLE FROMTHEI OWAETHI CS &CAMPAI GN DI SCLOSURE BOARD .COMMI TTE E 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 )Coh oon f o r Re p r s e n t a t i v e

SCHEDULEB MONETACANDI DATE I EXPENDI TU

c h e c k i f a m e n d i n g f o r m

SUB- TOTAL I $ 5 5TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

THI S BOX APPL I ESTO CANDI DATES' COMNI I TEES ONLY :P u r c h a s e s o f c e r t a i n c a m p 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 H . ( R e f e r t o Sc h . 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 , m a 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 s eS 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 A6 6 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 a t e ' s c o mm i t t e e . ( R et o S 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 wa Code 5 6 . 6 ( 3 x i ) . )

P a g e 1 o f 1( f o r S c h e d u l e B)

DATEEXPENDED

( MM/ DD/ YR)

CANDI DATE1 1 ) NUMBERAND PACCHECK #

NAME AND ADDRESS TOWHOMEXPENDI TURE( D i s b u r s e m e n t ) WAS MADE

PURPOSE( DESCRI BE TRANSACTI ON)

AMOUNEXPENDE

I D# 3 7 6 Tr u ma n F un d Do n a t i o n t o S t a t e P a r t y1 / 7 / 0 1 CK# 4 6 1 5 6 6 1 F l e u r Dr f u n d r a i s e r $ 3 0 0De s M o i n e s , I o wa 5 0 3 2 1I D# 3 7 6

CK# 4 6 2 v o i d $I D# 3 7 6 Tr u ma n F un d D o n a t i o n t o S t a t e P a r t y1 0 / 2 0 / 0 1 CK# 4 6 3 5 6 1 F l e u r Dr f u n d r a i s e r $ 2 5

De s M o i n e s , I o wa 5 0 3 2 1I D#CK#1 D#CK#

HOCK#

I D#CK#

I D#CK#

I D#CK#I D#CK#