Gross Doug5107scanned

8/7/2019 Gross Doug__5107__scanned

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FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )

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GgWi 2NO2I 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 :I( 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( 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 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 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 PAC ( 9 ) C i t y PAC ( 1 0 ) S c h o o l B o a r d o r Ot 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

CANDI DATE COMMI TTEES ONLY :Ca nd i d a t e Name

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OCHECK I F AMENDMENT TO REPORT DATEDCh 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 No t i c e o f D i s s o l u t i o n F o r m DR- 3 .

( Y ou mus t c o nt 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 ) ELECTI ON / ( 2 ) NON- E L ECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HAND

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1 - C A S H ON HAND a t t h e b eg 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 ec 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 an 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2DI SCLOSURE( Re v . 0 7 / 2 0 04 ) REPORT

F o r Of f i c e Us e On l yComm . #L o g g e d I n ~%

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L at e r e po 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 mi n alp e nal t i e s .

DATE SI GNED

L o c a l C omm 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 Co u n t y i nw h i c h E l e c t i o n i s h e l d


2/8

Fo r I n s t r u c t i on s , See Back 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 ( Mu s t b e s ame a s on S t a t e me n t o f O r g a n i z a t i o n )I D gv 6

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STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMASTATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBER AND THE PACCHECK NUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code, 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 o n c o p i e d f r o m r e p o r t s a n d s t a t e m e 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 rf o r a n 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 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( Re v . 0 7 / 0 3 ) RECEI PTS0CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL AT I ONSH I P AMOUNT J I F FORRECEI 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 SERNUMBER I NCOME

I D#

I D#CK# E JI D#CK# E : 1I D#CK# E : I _I D#CK#I D#CK#


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Co mmi t t e e Name : D o u g Gr o s s f o r Go v e r n o rI D : 5 1 0 7S c h e d u l e A: C o n t r i b u t i o n s - Mo n e y T a k e n I n

Da t e PACRe c ' d #

Ck# Name a n d A d d r e s s o f C o n t r i b u t o rRe l . t oC a n d . A m o u n t P a g eT o t a l

1 / 3 1 / 2 0 04 I n t e r e s t I n c o me , F i r s t A me r i c a n B a n k 8 4 . 0 31 2 0 7 C e n t r a l A v e n u eF o r t D o d g e I A 5 0 5 0 1

2 / 2 9 / 2 0 0 4 I n t e r e s t I n c o me , F i r s t A me r i c a n B a n k 7 5 . 8 61 2 0 7 C e n t r a l A v e n u eF o r t D o d g e I A 5 0 5 0 1


4 1 3 0/ 2 0 0 4 I n t e r e s t I n c o me , F i r s t A me r i c a n B a n k 8 0 . 3 21 2 0 7 C e n t r a l A v e n u eF o r t D o d g e I A 5 0 5 0 1




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Co mmi t t e e Name : Doug Gr o s s f o r Go v e r n o rI D : 5 1 0 7Sc h e d ul e A: C o n t r i b u t i o n s - Mon e y T a k e n I n

Da t e

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Page

Re c ' d # # Name a n d Ad d r e s s o f C o n t r i b u t o r Ca n d . Amou n t T o t a l

1 1/ 3 0 / 2 0 0 4 I n t e r e s t I n c o me , F i r s t Ame r i c a n Ba n k 1 6 . 0 11 2 0 7 C e n t r a l A v e n u eF o r t Dodg e I A 5 0 5 0 1

1 2 / 3 1 / 2 0 04 I n t e r e s t I n c o me , F i r s t Ame r i c a n Ba n k 3 9 . 1 5 5 5 . 1 61 2 0 7 C e n t r a l A v e n u eF o r t Dodg e I A 5 0 5 0 1

6 4 1 . 5 4


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FOR I N STRUCT I ONS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONT RI B UT I ONS MADE T O STATEWI DE OR L E G I S L AT I V EC A ND I D A T E S , L I S T THE CAND I DATE I D E NT I F I C A T I O N NUMBER I N THE DES I GNATED COLUMN AND THE CHECK THI S BOX I FPA C CHECK NUMBER FOREACH 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 AMEND I NG FORME T H I C S & 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 )

D dv ~ G ~A s J Fb 2 G ov1 t Lwa112 . -CANDI 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 m e n t ) WAS MADE( MM/ D D/ Y R ) AND PACCHECKNUMBERD#CK # $L I ' T 61 7 A c N4 4 L A B 2 ~1 . y 9I D #CK #D#CK #I D #CK #D#CK #I D #


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Co mmi t t e e Name D o u g Gr o s s f o r Go v e r n o rI D 5 1 0 7Sc h e d u l e B : E x p e n d i t u r e s - - Mo n e y S p e n t F r o m Co mmi t t e e A c c o u n t

Da t e Ck A m o u n t P a g eE x p e n d e d # Na me a n d A d d r e s s Pu r p o s e E x p e n d e d T o t a l s

6 / 3 0 / 2 0 0 4 F i r s t A me r i c a n Ba n k Ba n k s e r v i c e f e e 1 6 . 3 71 2 3 3 3 U n i v e r s i t y A v e n u eC l i v e , I A 5 0 3 2 5

7 / 3 1 / 2 0 0 4 F i r s t A me r i c a n B a n k B a n k s e r v i c e f e e 1 5 . 5 91 2 3 3 3 U n i v e r s i t y A v e n u eC l i v e , I A 5 0 3 2 5



1 0 / 1 9 / 2 0 0 4 1 5 4 9 Se n a t e L e g i s l a t i v e Ma j o r i t y F u n d P o l i t i c a l c o n t r i b u t i o n . 1 , 0 0 0 . 0 06 2 1 E a s t 9 t h S t r e e tDe s Mo i n e s , I A 5 0 3 0 9

1 0 / 3 1 / 2 0 0 4 F i r s t A me r i c a n B a n k B a n k s e r v i c e f e e . 1 5 . 6 01 2 3 3 3 U n i v e r s i t y A v e n u eC l i v e , I A 5 0 3 2 5


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FORI NSTRUCTI ONS, SEEBACK OF FORM

THI S FORMI S USED BY CANDI DATES' COMMI TTEES ONLYCOMMI 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 )D%\ 4 6

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PART I - ONGOI NGI NVENTORY OF CAMPAI GN PROPERTY

PART I I - SALES OR TRANSFERSOF CAMPAI GN PROPERTY * *

TOTAL VALUE CAMPAI GN PROPERTY THI S REPORT( TRANSFER TO SUMMARY PAGE) $* * PROPERTY SALES & TRANSFERS TOTAL( TRANSFER TO SUMMARY PAGE) $-

SCHEDULEHCAMPAI GN( R e v 0 7 / 0 3 ) PROPERTYATTACH SCHEDULE H TOEACH REPORT, MAKI NGCHANGES AS REQUI RED

El CHECKTHI S BOX I FAMENDI NGFORM

TOTALS

* I f e s t i ma t e d , s h o w e s t b e s i d e f i g u r e

( A t t a c h A d d i t i o n a l S c he d u l e s i f Needed )

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Da t e P u r c h a s e d( S c h e d u l e B )o r Da t e R e c e i v e d( S c h e d u l e E )MM/ DD/ YRD e s c r i p t i o n o f P r o p e r t y P u r c h a s eP r i c e o r E s tV a l u e WhenA c q u i r e d *

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Gross Doug__5107__scanned

Gross Doug5107scanned