Peterson Judith1538scanned

8/7/2019 Peterson Judith__1538__scanned

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FOR I NSTRUCT I ONS, SEE BACK OF FORM

DI SCL OSURE SUMMARY PAGECOLR4,rT,T , E. . ~ E NAME ( M e same a s o t a t e m e n t o f O r g a n i z a t i o n )l r . P / I P. l S O N ~ u r ~,OJGI 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 ) 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( 5 ) C o u n t y PAC ( q ) B a l l o t I s s u( 8 ) S y p p : ~ t S l a t e Cao i d ) *

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; o m m 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 mmi t t e e

Z - 7 7 3 - ) VSI GNAT RE " I T T WSUNER- f s f p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE -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 R a n g e f r o m $ 1 0 t o $ 4 0 0

SEE I N S T R UC T I O N S ON BACK AND COMP L E T E T H E FOL LOWI ASENENCE :I AM FI L I NG A ftw REPORT FORA~ A ( 1 ) E L ECT I ON / ( 2 ) NON- E L ECT I ON YEAR.n( r e p o r t d a t e ) I n d i c a t e on e[ ] CHECK I F AMENDMENT TO REPORT DATED ` 4 \ 10 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 and a t t a c h N o t i c e( 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 N o t i c e

STATEMENT 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 h i s i s t h e t o t a l

o f a l l mon i e s h e l d b y t h e c ommi t t e e. T h i s amount MUST b e t h esame as t h e c a s h on h an d a t t h e en 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 must b e z e r o N t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N T HI S PERI ODSc h e du 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 Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : Loan s Re 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 du l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a v a l i e s t o Ca n di d a t e Commi t t e e s On l y )SUB- TOTAL . . . . . S

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e du 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : Loan Repa y men 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 a l a n c e mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ,

UNPAI D B I L LS ( Fr om Sc h e du 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 S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTST ANDI NG LOANS ( Fr om 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 :CONSUL TANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( Fr om S c h e d u l e H - A t t a c h Sc h e d u l e H) $

FORMDR- 2 I DI SCLOSURE( Re v . 1 1 / 9 7 ) REPORTF o r O f f i c e Un On l y WComm. #I n d e xA u d i t e dCo mp u t e r

L o c a l C o mmi 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 mmi t t e e s , e n t e r C o u n t yw h i c h E l e c t i o n i s h e l d

U9 1 & t

YES NO


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Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN 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 )CO I T TEENAME ( Mu be s ame a s St a t eme n t o f Or g a ni z a t i o n)

SCHEDULEA MONETARY( R ev . 0 7 / 0 3 ) I RECEI PTSOCHECK T HI S BOX I FAMENDI NG FORM

STATECANDI DATES NOTE: I F ACONTRI BUT I ON I S RECE I VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE ) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L AB LE FROMTHEI OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se ct i o n 68B . 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 pi e d f r o m r e p o r t s an d 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 bu t i o ns o rf o r any c o mme r c i a l p u r p o s e by an 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 f f f l as t page o f t h i s s c h e du 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 n d i d a t e c ommi 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 ny r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p must be 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 nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b u t t h e r e i s no P ~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 umn . ( f o r Sc h e d ul e A)

DATERECEI VED

PAC I D NUMBER( i f a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE' AMOUNTRECEI VED d I F FOFUND-( MM/ DD/ Y R) ANDPACCHECKNUMBER ( i f a p p l i c a b l e ) RAI SERI NCOM

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F o r I n s t r u c t i o n s , S e e B a c k o f F o r mC O N T R I B U T I O N S - M O N E Y T A K E N 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 )CO ~/ / 5

t 7~( Mu s t

V4s aGt Ye a s o P O r g a n i z a t i o n )STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I VED FROM A STATE PAC ( P O L I T I C A L ACTI ON C O M M I T T E E ) , L I S T T HE PAC I D E N T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa 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 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 .

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 m a k i n g a c o n t r i b u t i o n t o t h ec o mm 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 wn 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 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 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 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 S c h e d u l e A

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSOCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT d I F FORECE I VED( MWDD/ YR) ( i f a p p l i c a b l e )AND PAC CHECK TO CANDI DATE '( d a p p l i c a b l e ) RECE I VED FUND-RA I SENUMBER I NCOMD# 10~qw ' T L , w I j i l P ( , -c / 6 $y e al D#

/ S r CK#I D#c K# 0CK# G~ -

. . ~J 4I r a I D# Y i ALGA Y~~~~~ N I N e IcK# Y , 0, 5L q CK# 3 . Zs 0S&4 * - W%1I D# y h l l " r v A , . Dv ' N - eWA~ cK# ~o S3I V C Uf fmI D # V~~ 1 1 ~ n . ' w l bWd v n r 5 t j J ~ ' "C K # ` S4t L UY G c1 D # OW K ) - 7 4&C K # 3 ; S C t r , K a ' e

~ v C G ,


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Fo r I n s t r u c t i o n s , Se e 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 )COMY( f TEE NAME ( Mu s tbe s ame a s o n S t a t 9 f i -* n t o f O r g a n i z a t i o n )

X/ 1U50N -

f o r an y c omme r c i a l p u r p o s e b y an 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 ommi t t e es .

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A S T A T E PA C ( P O L I T I C A L A C T I ON C OMMI T T E E ) , L I S T THE PA C I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAUT I 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 m a t i o n c o p i e d f r o m r e p o r t s an 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 r

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 mm 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 i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d 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 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 S c h e d u l e A )

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECE I PTS0 CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT d I F FORECE I V ED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI V ED FUND-( MM/ DD / YR ) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMI D#CK# s $ 1C n ~ 0uI D#CK# Z4* e -CK# g o o 5 1 V 1 j Q L , 4%K- 0w t o - -9 4i D#cK#

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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUT I ONS - MONEY TAKEN 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 )CO I TTEENAME ( M s ame a s o n t emen t of Or g an i z a t i o n)

k~ 12- '

Rese t F ez t n 1

STATE CANDI DATES NOTE: I F A CONTRI BU T I ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TT EE) , L I S T THE PAC I DENT I F I CAT I ONNUMBERAND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I L ABLEFROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : S ec t i o n 68B. 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 or mat i on c o pi e d f r o m r e p o r t s an d s t a t eme n t s f o r s o l i c i t i n g c on t r i b ut i on s o rf o r an y c omme r c i a l p u r p o s e b y an y p e r s o n ot 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 .

' D i s c l o s u r e l aw r e q u i r e s c a n d i d a t e c ommi t t e es 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 any r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must b e s hown t o t h e t h i r d d eg 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 ) an d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) . I f s u r name o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b ut t h e r e i s no 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 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 S c h ed ul e A)

SCHEDULEA MONETARY( R ev . 0 7 / 0 3 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VED

PAC I D NUMBER( i f a p p l i c a b l e )

NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE'

AMOUNTRECEI VED

d I F FOFUND-( MM/ DD/ YR) AND PACCHECK

NUMBER( i f a p p l i c a b l e ) RAI SERI NCOM

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MI D # W~=f - ' j , b w- r s y0~ 0Moat 1 0 e~ u t S l VI CPICK# c1 D#CK# v a f ~ - j k 1 1C I O- t "44~Za 00t v G ,AzrwlCK # tL IAr 4 5 -


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F o r I n s t r u c t i o n s , S e e B a c k o f F o r mCONT RI B UT I ONS - MONEY TAKEN 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 )CO I T T EE NAME ( Mu s s a s o n S t a t e t o f O r g a n i z a t i o n )~t ~~

S TATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PA C ( P O L I T I C A L ACT I ON C OMMI T T E E ) , L I S T T HE PA C I D EN T I F I C A T I ONNUMBER AND T HE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o m t a 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 omme r c i a l p ur 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 .

' 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 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 m u s t b e s h o wn 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 yma 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 Pa ge 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 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 S c h e d u l e A)

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

DATE PA C I D NUMBER NAME ANDADDRESSOF CONTR I B U TOR RELA T I ONSHI P AMOUNT d I F FORECE I VED ( i f a p p l i c a b l e ) T O CANDI DAT E' RECEI V ED FUND-( MM/ DD/ YR) AND PA C CHECK ( i f a p p l i c a b l e ) RA I S ERNUMBER I NCOM

F/I hMCKID# 0- K~ L _Q,^ V4i c e b a h a M , a d;CK # ' N c % k E]WAXCK# - 7 E : 1WA 1 o # N i W~ t Ov QhAl3 u 3WSL,~"CK# . ,

F A ~ CK# ~ ~ ~TJ ~ u 1 + t s ' t i l o d ~ fI r v r t - - 1 # W X 4 7 1 1 = Su x . C -CK# K1F I D# vwnI D #C K # V i s a P ,


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Fo r I n s t r u c t i o n s , Se e Ba c k o f F or mCONTRI BUTI ONS - MONEY TAKEN 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 )

l ~, NCOMMI TTEE NAME ( u s t b e s ame a l ~ o n St a t e men t o f O r g a n i z a t i o n )

Rus t F o r m 1

STATE CANDI DATES NOTE . I F A CONTRI BUTI ON I S RECEI VEDFROM A STATE PAC ( P OL I T I C A L ACTI ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co 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 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 an y c omme r c i a l p u r p o s e b y an 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 es .

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 r t 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 mm 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 wn 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 i a g e ) . f f s u mame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa ge 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 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 S c h e d u l e A)

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECE I PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PA C I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT d I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DDI YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOM

q 1 3 7 1 0 K # ~~ 0 94 9 . ;q 1 ? ~ ' D#CK# ~! c a l , 1580" l

I D# M~ ~ t i ~ . / A a v r ~Q - ` hCK# 3 0 l ~ ~ r vW

CK# ~~ S* p ~ ' ~ NI D#CK# / 0

40w~ L a G

n uI t o CK#1 i

CK#-_. .

_I D# Z Z107 ~f , tp~.CK# A44WQ- Z5 ,0 iCK# _ _ 4 J a - d - 0 4 ; i P~


8/13

. Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN 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 )COM TTEENAME Mus s a son St a t t 0 f o an i z a t i o ne~y 7

Rese f or m

STATE CANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I C AL ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER AND THEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L AB LE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use o f i n f o r ma t i o n c o pi e d f r o m r e p or 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 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 er 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 .

D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c ommi 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 mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must b e sh own 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 yma r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same as c an d i d at e , b ut t h e r e i s n o P a g e o ff a m i l i a l r e l a t i o n s h i p , e nt 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)

SCHEDUL EA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTSQCHECK T HI S BOX I F

AMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J 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 SER

NUMBER I NCOME' I D #CK# ?7 3 r " ~I D#330 1 7 " 4 0 1 11 C' 6 1 1C- - V/ ( oCK# a t i a c VVL I N I D #CK# ~~~v a s ! z 3 E :I D#

CK#C o s x 4e , Ely h w 7 ~WA I D #CK# 3 ~G~ev ' LU

r m mI D# r l ~ ~ . . .CK#WA I D#CK# i ~ 0I D# c ~ ~ y NE - 0 1 I CK# a ~wCK# 1 1 0 1 6 1 1 O


9/13

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEYTAKEN I N

( I n c l u d i n g c a nd i d a t e ' s p e r s o na l f u n d s )CO I l t E NAME M u s t bye s a o n S t a t e7t o f O n i z a t i o n 1

P ~ QNSa vSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON C OM MI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co 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 c o p i e d f r o m r e p o r t s an 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 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 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 .

D i s c l o s u r e l a w r e q ui 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 m a 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 mu s t b e s h o wn 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 i a g e ) . I f s u mame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa ge 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 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 . j r S c he d u l e A )

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT J I F FORECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI V ED FUND-( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME

II D# OV

U~ U CK# wl U 1 ~~~q~o73 ~ i I l u ~` t a * 4 . 0

I D# 0U Ge tc K# Z~1a~ ~~ -TI D# ~6 OA_ d , I CUCK# I ~ 5y

CK# ~O " P ~ z5iI D# Uh . e c f l~ZCK#i D#CK#I D#CK#I D#CK#I D#CK#


10/13

T HI 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 ( 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 , 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 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 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 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 Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Pa g e Of

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

FOR I NSTRUCT I ONS, SEE BACK OF FORM R e s t F SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI T T EE ACCOUNT ( Re v . 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI 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 D CHECK T HI S BOX I FPAC CHECK NUMBERFOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMT HE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .CO t T T EE NAME ( Mu s t me o n S t a t e t o f ~ a n i z a t i o n )

CANDI DATE NAMEAND ADDRESS TOWHOM PURPOSE AMOUNTDATEEXPENDED I D NUMBER( N a p p l i c a b l e ) EXPENDI TURE( D i s b u r s e me n t ) WAS MADE ( DESCRI BE TRANSACTI ON) EXPENDED( MM/ DD/ YR) ANDPACCHECK

NUMBER_ 7 / ~ T (o~d $

6i o #CK#~f I ( I ~r i r ~ . 1 8

I #CK#

~- o/ CK# 1 J o sCK# c v O~ Z ' , 9 - e d - t r 1 3Z"o f ~CK# ~ -

1/ 6 ~ l l r ' 1 1 1 ~ j ~ j d1 X~ UCK# 4 -1/WAAA CK# ~. , c h i 1~ r a c e r - ~ c . Yt ~ 1 / ' l ~ I J - ~ h ~ L l l t ut u ' 5b)P. '.

SUB- TOTAL $ 1 ,TOTAL ( I f l a s t p a g e o f t h i s s c h e du l e ) $


11/13

T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TT EES ONLY :P ur 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 er t y c o s t i n g $ 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d ul e H. ( Re f e r t o S c he d u l 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 i 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 an i z i n g s e r v i c e s mus t a l s o be d e t a i l i t e mi z e d o nSc h e d ul e G b y t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x pe nd i t u r e made by 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 nd i d a t e ' s c o mmi t t e e . ( R e f e r t oSc h e d ul e Gi n s t r u c t i o n s and I o wa C o d e 6 8 AA0 2( 3 ) ( i ) . )

P a g e 4( f o r S c he d u l e B)

FOR I N S T RUC T I ON S, SEE BACK OF FORM 1 - R e s e t Fo r m SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R ev . 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE: FORCONTR I BUT I ONS MADE TO STATEWI DEOR L E GI S L AT I V ECAND I D ATES , L I S T THECANDI DATE I DE NT I F I CA T I O N NUMBER I N THE DESI GNATED COLUMN AND THE DCHECK THI S BOX I FPAC CHECKNUMBER FOR EACHEXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI L A BL E FROMTHE I OWA AMENDI NG FORME THI CS & CAMPAI GN DI SCLOSURE BOARD.CO I T T EE NAME ( Mu s b e same a s o n n t o f O r g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE( MMI D D/ Y R) AND PACCHECKNUMBER

~ l 3 "1I D*CK# $ AS

yCK#1D#CK#I D# f v , , , , ~ 1 1 ~ . ~ I l a l e s t Ca ~ l h , ~v nCK#

j o r i ~~ y3CK# Z- c ~ Cv ` ~ - t Z9- C c ~ o ~CK# I VAVAMI D# U, J o I v y ~ i W~v I d . C' A 4K-CK# ~ C1 ,

v~ v N p C

I D# WYa A - ,4 , t , Y i Y ~ r 1 tG t ' + CK# 1SUB- TOTAL $ ~~ 7J

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


12/13

T HI S BOX APPL 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 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 / e n t i t y o n b e h a d 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 l o ws Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Pa g e Of

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

FOR I NSTRUCT I ONS, SEE BACK OF FORM R e s e t Fo r m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . O T / 0 3 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T T HE CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND T HE 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 NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.CO E NAME ( Mu s t s ame a s o n ' " 7 7 j me n t o f O r g a n i z a t i o n )

CGr ) e~ l aCANDI DATE NAME AND AI 3DRESS 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 PACCHECKNUMBER

o l G3h12 4 ~ _ e . , C 4&j >~I J ~ CK# V4CK# ~ y s ) CD# . 1 1Or 0 ~ d l Cc r. ~ ' d V J 9

4 0 ,CK# 0 ZD * ,~ ~ l

I D#~21~0~ / C~ ry+~~ B y Z 7r o CK#

CK# v

l ~I D#

SAk 1 0 Z nZ2 CK# *7

l Dl l U~I ~ CK# - _ SUB- TOTAL $ 9 l l t ~TOTAL ( N l a s t p a g e o f t h i s s c h e du l e ) $


13/13

FOR I NSTRUCTI ONS, SEE BACK OF FORMEXPENDI TURES - - MONEY SPENT FROMCOMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DEORLEGI SLAT I VECANDI DATES, L I ST THECANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECKNUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI L ABLE FROMTHE I OWAETHI CS & CAMPAI GNDI SCLOSURE BOARD.

SCHEDULEB I MONETARY

( Re v . 0 7 t 0 3 ) EXPENDI TURESDCHECKTHI SBOXI F

AMENDI NG FORM

I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#

r%dam. O~q 9 -t ~ . S- p a- , ~' .

PURPOSE( DESCRI BETRANSACTI ON)

P" j v ~ * r j ' Ct 0 wt j wy jVAl y wP r i Pr 1 - Cd Nt i ~ d4 / 'r , \ ,yw

C~a wL ~~yu ~ ~ l r ~ ~ ~

C4I n" I a t l w - 1 1 1 J Awi s i

AMOUNTEXPENDED

37 ~'

SUB- TOTAL 1 $ 1z53VTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )F~

T HI S BOXAPPLI ES TOCANDI DATES' COMMI TTEES ONLY :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 o o s t i r g $ 5 0 0 o r mo r e mus 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 / e n t i f 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 be d e t a i l i t e mi z e d o nSc h e d u l e G b y t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x pe nd i t u r e made by t h e p er s o Ne n t i t y o n b e h a l f o f t h e c a nd 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 and I o wa Code 68A. 4 0 2 ( 3 ) ( i ) . ) _

( f o r Sc h e d u l e B)

C I T TEENAME( Mus t s ame a s o n n t o f Or g an i z a t i o n)~J-wWN j e ~ Qc ~ ~ ~ , o k ~

CANDI DATE NAME AND ADDRESS TOWHOMDATE I D NUMBER EXPENDI TUREEXPENDED ( i f a p p l i c a b l e ) ( Di s b ur s e me n t ) WASMADE( MM/ DD/ YR) AND PACCHECKNUMBER

1 I D# UuradN ~Av e0 / 1 4 / 0 4 CK# ~t 6 Ki ) Li v ~ I D#

CK#P0L46 r d PY' 1'4

I D# eOVA 6J,CK# Al l

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Peterson Judith1538scanned