fairchild ann1696scanned

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FOR I N STRUCT I ONS, SEEBACK OFF

DI SC LOSURE SUMMARY PAGECOMMI 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 )

I MPORTANT : I n d i c a t e b y # t y p e o f c o mmi 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 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

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 an 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 C o d e 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 mmi t t e e , a n d t h e c h a i r p e r s o n , f o r an y o t h e r t y p e o f c o mmi t t e e , i s t h e

i n d Mu a l r e s p o n s i b l e f o r f i l i n g t i r t me l y p n d ' a c c u r a t e r e p o r t s .

S I GNATURE OF PERSON HUNG REPORT TELEPHONE DATE S I GNED

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

CHECK I F ANFJ VDMENT TO REPORT DATED

0 C h e c k i f t h i s i s f i n a l ( t e r mi 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

( Yo u mu 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 . )

REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .

I 1 A F _ I F 1 1 C S & CA PAI CN

Qu I SCLOSURE BOARDo t i o n Fo r m DR- 3 .

N OV 2 0 2 0 0 6

I n d i c a t e b y #a

STATEMENT OF CASH ON HAND

CASHON 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 mmi t t e e . T h i s amou n t MUST b e t h e s ame 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 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 OD

S c h ed 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 ed u l e A) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . . . .

S c h ed u l e F : Lo a n s Re c e i v e d t o t a l ( A t t a c h S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sc h e d u l e H : T o t a l S a l e s o f C ampa 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( S c 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 )

S UB- T O T AL . . . . . . . . . . . . . . . . . . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI OD

S c h ed 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 ed 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 ) . . . . . . . . . . . . . . . . .

S c h ed u l e F : Lo a n R ep a y me n t s t o t a l ( A t t a c h S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ONHAND 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 mus t

b e z e r o ) ( A t t a c h DR - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORM

DR- 2 DI SCLOSURE

( Re v . 1 2 / 2 0 0 5 )

IREPORT

F o r Of f i c e Us e On l y

Comm . #

L o g g e d I n

S c a n n e d

L o c a l C o mmi t t e e s , e n t e r Da t e o f E l e c t i o n

Co 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 n

wh i c h E l e c t i o n i s h e l d

* " UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h S c h ed u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .~. . . . . . . . . . . . . . . . . . . . . . .. . . . $

) C . 1

' . . . . .

,* I N KI N D CONTR I BUT I ONS ( Fr o m S c he d u l e E - A t t a c h Sc h e d u l e . . . . . . . : . ~ . . ) . . . . . . . . . . . . . . . . . . . . . . . . . . .

$

* * O UT S T ANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ; . . . . . . . . . . . . $

CONSULTANT BREAKDOWN ( S c h ed u l e G At t a c h ed ? ) ( ~ e . : - ) G r G j y v i , Y ' C ) Or - YES ~4_ NO

CANDI DATE COMMI T T EES ONLY : . = 1 ~ j

VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H) ~ L $ . - -S TATE COMMI TTEES : S u b mi 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 .

( 4 ) C o u n t y C e n t r a l Commi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6P 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

S 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

) 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 O t h e rPAC ( 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 l C omp u t e r

k e , 1 R 1 5

CANDI DATE COMMI T T EES ONLY ; A u d i t e d

C a n d i d a t e Name 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 ) F i l e w i t h :

I o wa E t h i c s a n d C amp a i g n

D i s c l o s u r e B o a r dO f f i c e S o u g h t D i s t r i c t ( i f S en a t e o r Ho u s e ) 5 1 0 E . 1 2 ` " , S t e . 1 A

De s Mo i n e s , I o wa 5 0 3 1 9

Fa x : 5 1 5- 2 8 1- 3 7 01



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 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 m o r e m u 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 l 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 m u 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 t h x e made b y t h e p e r s o n l e n f 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 mm i 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 Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

V i 1 Cs u R BOWD

a j s C % o

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

FOR I NSTRUCTI ONS, SEE BACK i ^ ORM R e s e t ' " j SCHEDULE

EXPENDI TURESB MONETARY

- - MONEY SPENT FROM COMMI TTEE ACCOUNT( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR C ON T RI B UT I ON S MADE T O S T AT E WI D E OR L E G I S L A T I V EC A ND I D A T E S , L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER 1 N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECKNUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMENDI NGFORME T H I C S & CAMPAI GN DI SCLOSURE BOARD.

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 )

An n F a i r c h i l d f o r I o wa S t a t e Hou s e

CANDI DATE NAME AND ADDRESS TOWHOM

PURPOSEAMOUNT

DATE I D NUMBER EXPENDI TURE ( D ES CR I B E 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 D D I Y R ) AND PAC

CHECKNUMBER

I D #P i t S t o p P r i n t i n g P a ym en t f o r Camp a i g n F l y e r s

0 7 / 1 8 / 0 6 C K # 1 0 3 N o r t h Mi l l $ 1 9 . 6 5L a k e Mi l l s , L 4 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0

I D #S t a p l e s P a ym en t f o r Camp a i g n F l y e r s

0 8 / 1 6 / 0 6 C K # 3 4 40 4 t h S t r e e t SW 6 5 . 3 8Ma s o n C i t y , I A 5 0 4 0 1 6 4 1 - 4 2 3 - 4 0 1 2


0 8 / 1 8 / 0 6 CK# 1 0 3 N o r t h Mi l l 2 0 . 7 6L a k e Mi l l s , I A 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0


0 9 / 1 6 / 0 6 C K # 3 4 4 0 4 t h S t r e e t NW 2 4 . 5 8Ma s o n C i t y , I A 5 0 4 0 1 6 4 1 - 4 2 3 - 4 0 1 2


0 9 / 1 9 / 0 6 C K # 1 0 3 N o r t h Mi l l 8 5 . 6 0L a k e Mi l l s , I A 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0

I D #G a r n e r L e a d e r &S i g n a l P a ym en t f o r Camp a i g n A d v e r t i s e m e n t

0 9 / 2 7 / 0 6 C K # 3 6 5 S t a t e S t r e e t f o r a p u b l c i me e t a n d g r e e t w i t h t h e 3 2 . 0 0G a r n e r , I A 5 0 4 3 8 6 4 1 - 9 2 3 - 2 6 8 4 c a n d i d a t e


0 9 / 2 8 / 0 6CK#

3 4 40 4 t h S t r e e t SW 4 8 . 1 1Ma s o n C i t y , I A 5 0 4 0 1 6 4 1 - 4 2 3 - 4 0 1 2


0 9 / 2 9 / 0 6CK#

1 0 3 N o r t h Mi l l 4 2 . 8 0L a k e Mi l l s , I A 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0

SUB- TOTAL $ 3 3 8 . 8 8

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



T HI S BOX APPL I ES TOCANDI 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 er 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 am , 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 l 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 _ r y g t c y l ~ ( P Co d e 6 8 A . 4 0 2 ( 3 ) ( 1 ) . ) .

Ol SGpSUFt E . 0V

2006

Page o f

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

FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s c t Fo r m' SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI T T EE ACCOUNT

( Re 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 D E NT I F I C A T I O N NUMBER I N THE DESI GNATEDCOLUMN AND THE CHECK T HI 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 Or g a n i z a t i o n )

An n F a i r c h l d f o r I o w a S t a t e H o u s e

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( d a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ 0 0 / YR) AND PAC

CHECKNUMBER

I D #P i t S t o p P r i n t i n g P a y m e n t f o r Y a r d S i g n s

1 0 / 1 2 / 0 6 CK # 1 0 3 N o r t h M i l l $ 1 2 8 . 4 0L a k e M i l l s , 1 A 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0

I D #P i t S t o p P r i n t i n g P a y m e n t f o r Y a r d S i g n s

1 0 / 2 3 / 0 6 CK # 1 0 3 N o r t h M i l l 1 2 8 . 4 0L a k e M i l l s , I A 5 0 4 5 0 6 4 1 - 5 9 2 - 2 5 2 0

I D #

s - a 1 s S

I D # f ~ ~ ~ A c ~ t t r + P J 6 , 9 , v k1 f - T w J - # k ) 11 1 - 7 4 - ~ g a m c , U

91 1 , 51 0 6 ,CK# f ' a r ' t _ e , a ~ , . T ~ wr 9 S DV ? , ( o

c a l - - d8 ast D# 1 9 N f k d - a r Ps 6 , 4 N K t - T l -u s

CK# y c r e s / C, ~ / : 1c . ~ . v f 1 SZXI : j I : o

& I - sSS- ' ; q r S

I D # p i U.~trCf u ` , ~. f i 8 f ) NK

y - - T r u a , 6A, I ~

. ~

CK# 5 z + Y 34 " V / S$ - - ~ ~S

I l I 6 1 0 ( o 1 ~s6 'f avWef l A-~0,e> 1 0

I , q j -

I D#

L CK#

SUB- TOTAL- $~ ? 4 f o

TOTAL ( I f l a s t p a g e o f t h i s s c h e du l e ) $



P r i n t e d u s i n g t h e I E CDB Web p o r t i n g Sy s t e m o n 1 0 / 2 4 1 2 0 0 6 1 2 : 5 9 : 1 0

FORM DR- 2 : D i s c l o s u r e Summar y P a g e

S t a t u s F i l e d

I D # 1 6 9 6

Commi t t e e An n F a i r c h i l d f o r I o wa S t a t e Hou s e

Comm T y p e S t a t e Hou s eD a t e Du e 1 0 / 1 9 1 2 0 0 6

R e p o r t Yea r 2 0 0 6

T r e a s u r e r An n F a i r c h i l d

Pr i ma r y Ph ( 6 4 1 ) 7 9 7 - 2 2 2 1 Se c o n d a r y Ph ( n u l ) I n u - n u l l Gr~~C h a i r r

Co u n t y NA

Amen d e d 1 0 / 2 1 / 2 0 0 6

St a t e me n t o f Cas h o n Han d

A d d i t i o n a l As s e t s a n d L i a b i l i t i e s

FORM DR - 2 An n F a i r c h i l d f o r I o wa S t a t e Ho u s e

DR- 2

S t a t u t o r y Du e Da t e

A d j u s t e d Du e Da t e

Re c e i v e d Da t e

P o s t ma r k D a t e

Amen d e d

1 0 / 1 9 / 2 0 0 6

1 0 / 1 7 / 2 0 0 6

1 0 / 1 6 / 2 0 0 6

1 0 / 2 1 / 2 0 0 6

P r i n t e d u s i n g t h e I E CDB Web R e p o r t i n g Sy s t e m o n 1 0 / 2 4 / 2 0 0 6 1 2 : 5 9 : 1 0 Pag e 1 o f 1I OWA E THI CS AND CAMPAI GN DI SCLOSURE BOARD 1 5 1 0 EAST 1 2 t h , SUI T E 1 A DES MOI NES, I A 5 0 3 1 9 ( 5 1 5 ) 2 8 1 - 4 0 2 8

Cash o n Hand a t S t a r t o f P e r i o d $ 0 . 0 0

S 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 $ 6 3 0 . 0 0

S c h e d u l e F L o a n s Re c e i v e d T o t a l $ 0 . 0 0

S c h e d u l e H Campa i g n P r o p e r t y S a l e s $ 0 . 0 0

SUB- TOTAL $ 6 3 0 . 0 0

Sc h e d ul e B E x p e n d i t u r e T o t a l $ 1 , 0 6 3 . 6 4

Sc h e d ul e F Cash Loan Re p a y me n t s

( Ca s h o n Hand A t En d o f P e r i o d - 4 3 3 . 6 4

L o a n s i n P l a c e a t S t a r t o f P e r i o d $ 0 . 0 0

Sc h e d ul e D Un p a i d B i l l s $ 0 . 0 0

Sc h e d ul e E I n - K i n d C o n t r i b u t i o n s $ 0 . 0 0

S c h e d u l e F F o r g i v e n L o a n s

S c h e d u l e F Ou t s t a n d i n g L o a n s $ 0 . 0 0

S c h e d u l e G C o n s u l t a n t Br e a k d o w n ? No

( S c h e d u l e H Campa i g n P r o p e r t y V a l u e $ 0 . 0 0



t 2 1 0 6 0 9 : 1 4a L i b r a r i a n 6 4 1 - 7 9 7 - 2 7 8 7 p . 2

Fo r I n s t r u c t i o n s , See Back o f Fo r m

CONTRI BUTI ONS - - MONEYTAKENI 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( Mus 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 )

~

! ` t r ) n Fa - > ^ c . I " , ; 1 j n r , ~ r A ` ; kAf > ° _ J d c x 1 P

STATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O N

NUMBER 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 BOARD

NOTE . ANY PERSON, OTHERTHANAN I NDI V I DUAL , THAT CONTR I BUTES MORE THAN $ 7 5 0 TO YOURCAMPAI GNMAY HAVE FI L I NG

RESPONS I B I L I T I ES ANDSHOULD I MMEDI ATELY CONTACT THE BOARD.

Re se t For m

CAUTI ON: Se c t i o n 6 BB . 3 2 A ( 6 ) , 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 pi e d 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 yc o mme r c i a l p ur p os 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 mmi t t e e s .

. . . . , . . . : . RD

0r T

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i s s c h ed u l e )

P a g e I o f( f o r S c h e d We A )

SCHEDULE

A MONETARY

( R e v _ 0 7 1 0 3 ) RECEI PTS

©CHECK THI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT q I F FRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE" RECE I VED FUND( MMI DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S

NUMBER I NCO

Al( ~o 7 1 4 ` ' ~ 5 ' fseer f ~ , 1 . i t ~ . Swr ` f e. "5 ' C? O

$

CK# f 00o f - '

I D# ' OJnCL' " c ( ; . I I C L~

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Cl -~VV~V

C' ~ , 1 ~1 " F " 1 0 ( - r ~ . l t t l t CG I t . c ; C ; F [ ~ f 25

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CK# 9c0 c e c ; en4) S - f r n w,

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, ~O C27u . . c ~ - / y " I wJ r ~ C . f Z c - c _ , G ' Y i , i ' + 7 t i f v . .

CK# c . -( . t - " ' v ~ n e _ C2 , . . c , o G I z , _ , L r , - 4 - V S c a r e - r ` "

f ^ r y e ( v Q~ 1 0 - ) C « r ) C r ~ ~ C~ , u r f i , r ~ e . t ~ , ' ~

C i r _ a q . _ p c _ rI D# t - k e r l HCa 1 . r ,

CK# P c ~ 1 3 c % u T

CK# ~ - ~ s L 3 - 4 1 o Sf c c <- - t

CK# s 8 `T 10 t , r e~f i c y _. _

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IDe. r ' r I c n c - b b

_ . 5 ."

CK#3%z s a _ l = o i - c ~ - S f - Ca m ; . . i e

oc f _ I uA L t - , . 4 y -. , L 7I D#

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t 2 1 0 6 0 9 : 1 4 a L i b r a r i a n 6 4 1 - 7 9 7 - 2 7 8 7 p . 3

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T HI S BOX APPL I ES TO CANDI DATES ' COM* n7E ES ONLY :

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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 l 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 , manag i n g , o r g a n i z i n g s e r v i c e s mus 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 nd 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 nd I o wa Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

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E x p e n d i t u r e s t o p e r s o n s l e n l 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 mus 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 mad e b y t h e p e r s o n l 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 w a C o d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

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E x p e n d i t u r e s t o s p e r s a n s l e n t i f i e s p r " d i r i 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 ma d e b y t h e p e r s o n l 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 mm i 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 Co d e 6 8 A . 4 0 2 ( 3 ) ( 1 ) . )

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EXPENDI TURESB MONETARY

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STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE

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EXPENDI TURES - MONEY SPENT FROM COMMI TT EE ACCOUNT

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T HI S BOX APPL I ES TOCANDI DATES ' COMMI TT EES ONLY :

P u r c h a s e s o f c e r t a i n c amp a i g n p r o p e r t y c o s t i n g $5 0 0 o r m o r e must 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 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 l e n t i f e s p r o v i d i n g c o n s u f t h r 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 mus 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 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 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 m m i 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 nd I o wa Code 6 8 A . 4 0 2 ( 3 ) ( t ) . )

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E x p e n d i t u r e s t o p e r s o r r s l 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 m u 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 i , 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 r 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 r o n e a n d I o wa Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

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FOR I NSTRUCTI ONS, SEE BACK OF FORM I R e s e t F or mi ~ SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEG I SLAT I VECANDI DATES, UST THE CANDI DATE I D ENT I F I CA T I O N NUMBER I N THE DESI GNATED COLUMN AND THE D CHECK T HI 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 a m e a s o n S t a t e me n t o f Or g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDA7E I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

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WHEN TO F I L E :T h e N o t i c e o f D i s s o l u t i o n mus t b e f i l e d w i t h i n t h i r t y ( 3 0 ) d a y s o f c o mp l e t i o n o f a l l t h e f o l l o w i n g :

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