8/7/2019 Lalk David__1359__scanned

1/4

F O' R I NSTRUCTI ONS . SEEBACKOFFORM FORMDR- 2 DI SCL( Re v . 0 1 / 2 0 01 ) REPO

DI SCLOSURE ) ' UMMARY PACECOMMI TTEE NAME ( M u 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 )

L . i AL k r z ~ STATE r k o " e C. cmmx - EEI MPORTANT: i n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p o r t i n g f o r : 1 9( 1 ) S t a t e Md e &e g L I a r i v e Ca n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e Pa r t y ( 4 ) C c u i n t y l L o c a l Ca n d i d a t e( t i ) Co un t y PAC ( r 3 ) 8 a l l a t I s s u e / F r a n c h " Co mmi t t e e ( 7 ) C oun t y / Ci t y C e n t r a l C ommi t t e e( t i ) S up p or t S l a t e o f Ca n d i d a t e sCANDI DATE COMMI TTEES ONLY:Ca nd i d a t e Name P o l i t i c a l P a t t y

i 1US, LA6y_O f f i c e S o u g h t D i s t r i c t ( i t S e n a t e o r H o u s e )

C . T a 4 , . 9 EA- T AaAL-

~a n , o c I l . . a Ag . h i _ S&3 - S 1 , t - e ) s c. - r i I ~ - 1 l o t -S I GNATURE F REASU ER ( o 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 SI GNEDR o u t i n e P e n a l t i e s Du e F o r L a t e F i l e d R e p o r t s Ra n g e f r o m $ 2 0 t o $ 8 0 0

UCTI ONS ON BACK ANDCOMPL ETE THE FOLLOWI NG SENTENCREPORT FOR ANNA ( 1 ) E L E CT I ON / ( 2 ) NON- E L ECT I ON Y E A RI n d i c a t e o n e

I AMFI L I NG ASu p L i Ke n/ t ALL 1 - 1$ U 2_ ( r e p o r t d a t e )

OCHECK I F AMENDMENT TO REPORT DATED -C j Ch 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 s s o l u t i o n Fo r m DR- 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 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 . )

STATEMENT OF CASH ON HAND

F o r O f c e Us e o n I vComm . #I n d e xA u d i t e dC o mp u t e r

J AN 2 2 2 0 0 2) 9 f t , i - i ~

L o c a l Co mmi t t e e s , e n t e r D a t e o f E I e dI t z 61-Co u n t y a L o c a l Co mmi t t e e s , e n t e r Co uwh i c p El e c t i on i s h e l d

1; k y f r z f1~ f 3 x c , r ~ s ~e ~ ~n L ---CASH 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 l o f a l l mo n i e s h e l d

b y t h e c o mm i t t e e T h i s a m o u n t 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 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 mus 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ( ) 0. 00ADD TOTAL MONEYTAKEN I N T HI S PERI ODS 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 ( 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 ) . . . . . ' 7 2 z S 7 , 0 r -S c h e d u l e F L o a n s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WoVS 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 ) . . . . . . . . . . . . . . . . . . . . . . . 0 6 , c c v

( S c h e d u l e H a p p l i e s t o C a n d i d a t e s ' Commi t t e e s O n l i dSUB- TOTAL . . . . . . $ - 1 ZZS , v cSUBTRACT TOTAL MONEY SPENT T HI S PERI OD

S c 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 S c 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 ) . . 7 ( , 7 . ' 7 7S c h e d u l e F : L o a r Re p a yme n t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . , . . . . . . . _ A ) I ACASH 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 t f i n a l r e p o r t , b a l a n c e m u s tb e z e r o ) ( A t t a c h D R - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ~ + s 7 ~ 23

* * UNPAI D B I L L S ( F r o m S c h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ A* I N K I ND CONTR I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~' * OUTSTANDI NG L OANS ( F r o m S c h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ J ACANDI DATE COMMI TT EE S ONLY:CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES rNOVALUE 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 ) $ A ) 1 1 4

8/7/2019 Lalk David__1359__scanned

2/4

For I n st r u c t i on s, SeeBack o f F -m

CONTRI BUTIONS- - MONEYTAKENI N, i n c ) u d ' a n g c a n d i d a t e ' s p e r s o n a l f u n ds )

COMMI TI TEENAME( Mus t be s ame a s On St a t ement Of Cr g a n i z a t f o n )Lpz > { ~~ 5-Wr f Aoz SF Ck -~; : ' T ' T 9 I E

f SCHEDULL- S" - s I A ACh i

( Re v . O 6 6 i 9 7 ) RECECHECKT HI SAMENDI NG F

STATE CANDI DATES NOTE. I F . A CONTF I ZUT I ON I S RECEI VEDFROMA 3 +ATEP+1C WOL t T i C . t L ACTI ON COMMt 7 r EE) , L ; S T T 1 _ l F PACI DENTLFFCATNUMBER ANDTHEPACCHECKNum8EP I N THEDESI GNATEDCOLUMN . A L I S TOF i D NUL I BE . A S i S AVAI LABLEFROMTHE I OWA ET HI CS ANDCAMPADI SCLOSURESCARD.CAUTION: Se c t i o n C8B. 32 A( 6 ) , I o wa Code, p r oh i b i t s t h e us e o f i n f o r ma t i on c op i e d f r om r e p or t s a r c s s t a t e me n t s f or s o l i c i t i r g c o n t r i b uf o r any c o r t u r i e r c i a l p u r p o se by an y p e r s o n t i n i e r t h a n s t a t u t o r y p o l t i c a i c o mmi t t e e s .

PACI D NUMBER( i f a pp l i c a b l e )ANDPACCHECKNUMBER

NAME. ANDADDRESS Or " ?: ON" ! T ?I L I L TOR RELAT) ONSi - HPTOCANDI DATE'( f f a pp l i c a b l e )

Di s c l o s u r e f 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 os e t h e r e i a do r 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 or n mi t t e e . Re t a t Fx t s h l p r o u s t b o shown t o t h e t h i r d d e g r e e o f c on s an gu i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t v e s b yma r r i a ge ) ( Se e Pa g e 1 o f t o r ms p a c k e t . ) . I f su r name o f c on t r i b u t o r i s t h e s u r e a s c a nd i d a t e , b u t t h e r e i s n o Page . _ / . - - o ff 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 pp l i c a b l e " i n t h e r e l a t i on s hi p c o l u mn . ! t a r Sc h e d u l e A;

AMOUNTRECEI VED

/ / O CL ; " x 1 ( ( o 2 - 3Hr , ; t Ot r SaI Ui rCK# 2q34 W=s s1 s y ~ l, : r , 4 . - _ . . . _ . . . ~. a. . _I ' I D # SoS f 3 2 oy33 C. t Ar t E~ C- r G G- 1 - I o FF~ + A~ ' 7 1 s - 6 7 1 f - 37&v

i 4 a / ' o Z CK# 3> y Z ( P a 6 - , S 3 l oa . 00Cuwr t r E. , + - o A t , - ,I D S W~L L Aw, C- 1 7 2 X 3 ' - b sU' S - f o 74 ud i p / o z - CK# 7 ' 7 y s ' 3J 1 S a u - + % W. A 6_ n r A Tr c &, ZZO ; ZOO , c 4 +SME~ . t _ e 2 - o c . k , . -zA s o i ~ ' t e - - Ozz ~ _i I S ' - 1 l ( o z - S ' a i ' r

l l l u l a L CK# - 7s ' . 9 / SZY / - / w 7 i v 9 g r , o~. W- ) - - s s _ ; , s A , S a t - r 3ND# VJZ wG S' 1 / 7? pus a~ v k j ~ `LsT

i l l ul az ` CK# 3b ar e ` 4 1 9 - 3 / 4 04 . 5 u+ 319 . / v !t u i a . v a r t , t . s A - Sob - r 2 iI D* er v , j c . A. u 1 l s v ICK# 3/ 7 ( o

~ n Ave . 7140, Su . J , ! c D r ~ J1qS t . be s I n , . e j zA S- o3Vguwr a. r F RL p " ` t : , r , P& . k t oF $o 4A ' .l ~J n / c z CK#M"ay ( s v c , a . , ~ :

I D# 4 ! 11 S4 ~Z 1 y C e i - f v o, 1 s A .1~ i z ~OL - 3 2 -i l s i Pt = c c ) ) , - ~ ~ t 1 1 2 7 ~ / t ' 3~CK# / 9Z

TO- n LAKE. 7 ; 4 S' D Y' r 0 , _ _ . . . . . . _ _ . . . ~ , _ . . , . . . . . . . _I D# ~U I ' Y I R , J 1 1 F A c T. e" F4 . x s , Pr I - 1 ; , i A , - ) , ' : n Cesan, A= / o z i ~ I o e t ) ~ a~ auc 5- r s - zt . r - i + 1 97 w~a

l ~ t s o, nGj , ; TA

Gy ~ S' # " Av t 5TE 333

SUB-TOTAL

TOTAL ( i f l a s t page of MI S - 72_2Ssah e du t e ~ $

8/7/2019 Lalk David__1359__scanned

3/4

' FOR 1 P I S T RU C 7 1 0 t i S , SEE BACK OF FORMEXPENDI TURES - MONEYSPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENTI F I CAT1ON NUMBER I N THE DESI GNATED COLUMN AND THE?AC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF l D NUMBERS I S AVA I LABLE FROMTHE I OWA( ETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( 1 l d u s t b e same a s o n S t a t e me n t o f Or g an i z a t i o n )

CANDI DATEI D NUMBER( i f a p p l i c a b l e )AND PACCHECKNUMBER

~~V- s 6 VA\ k j

NAME AND ADDRESS TOWHOMEXPENDI TURE~ Df s b u r s a me n t ) WAS MADE

THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :

PURPOSE( DESCRI BE TRANSACTI ON)

SCHEDULE

( Re v . 0 9 1 9 7 )

7OTAL ( i f h u t p a g e o f t h i s s c h ed u l e )

QCHECK THI SAMENDI NGF

Pu 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 Sc h e d u l e H . ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s . )Ex p e nd i t u r e s t o p e r s o n s f 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 mus t a l s o b e d e t a i l I t e mi z eSc h e d u l eGb y t h e a mo un t , p ur p os e, a n d d at 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 a 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 eSc h e d ul e G i n s t r u c t i o n s a n d I o wa C c d e 6 6 . B ( 3 ) ( i ) . )

( f o r Sc h e d u l e

8/7/2019 Lalk David__1359__scanned

4/4

WOR, T I ST RUCT I ONS, SEEBACKOFr , . j F ? M

COMMI TT EE NAME ( Mu s t b e s ame a s o n S f a t e m e r r t c f O r g a n i z a t i o n )i ' At e - f ~ m ST A TL t W. i $ E(!. . r M= T T CAL

TOTAL ( i f ! a sp a g e o f t h i ss c h ad u l s )

I SCHEDULE'I N K' P e v . 0 6 1 9 7 ) CONTRi

1 1 7 CHECK T HI S BAMENDI NG FO

' D! s c i o s ur e l a w r e q u i r e s c a n d i d a t 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 n i n k i n d c o n t r i b u t i o n t o ` h e P a g e i of - /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 w n t o t h e t h i r d d e g r e e o f c o n s an g u i n i t y ( b i c w o d r s f s t i v e s ) v i d a f f r k y ( r e l a t i v e s ( f O r S Ch E U l 9b y ma r r i a g e ) . ( S ee P a g e 2 o f f o r ms p a c k e t . ) i f s u n l a r n e o f a n t r i b u t o r i s t h e s ame a s c a r d i d a t s , b o a t t h e r e i s n ot a r r a i l l 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 .

DATERECEI VED NAME AND ADDRESS( MM/ DDI YR ; OF CONTRI BUTOR

R EL A T I ON SS Hf l a` T O CANDI DATE` ( i f a p p l i c a b l e )

DESCPt PT I ONOF I N K I NDp G G N T R " i B UT I O N

ESTI MATED - J 1F A I R MARKET F U N D -VALUE C ON T R Ia o o ~/ ~02 . . e Pu b l ~ t P~ PF 1 r i ; h of Sc~A ~ Ap t o Ac t s

- _~ ' t `

! o L . y r . 3 : 1

f C . Z I l . t P i t b ~ i Ce . . P An~ y CF 2 a . . ~ A ~ AS A. . g t r ~ . ~ J ' 1 71 5t

v .

i