Rasmussen Dan1329scanned

8/7/2019 Rasmussen Dan__1329__scanned

http://slidepdf.com/reader/full/rasmussen-dan1329scanned 1/18

f : ~ r I NSTRUCTI ONS . SEE BACK 7 : FORM

[ DI SCLOSURE - , JMMARYPAGE

I AM F I L I NGA

CANDI DATE COMMI TTEES ONLY :

Ca n d i d a t e Na me

P o f , ~ i c a l P a r t y

` DAAJ R4SmusseAI

KI t t 6 / ; ( Ak

O f f i c e So u g h t

S a l e. k - 4 s 2 1 f z f ' 4 '

1 i V CD i s t r i c t ( i f Se n a t e o r H o u s e )

I 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 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 ( o" ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y i C i t y C e n t r a l C o mmi t t e e( a ) Su p p o r t S l a t e o f C a n d i d a t e s

3 / 9

3 3 y - X390

SI GNATURE OF TREASURER ( o r p e r s o n p i l i n g t h i s r e p o r t )

TELEPHONE

0C h 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 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 F o r m D R- 3 .( Yo 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 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

CASH ON HAND a t t h e b e gi 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 db y t h e c o mmi t t e e . T h i s amo u n t MUST b e t h e s a me a s t h e c a s h o n h a n d a t t h e e n d

FORM

( Re v . 0 1 / 2 0 01 )

F o r Of f i c s t l s e On l y

Comm. #

15 . 2 L

J AN 1 4 2 0 0 2

~ - 1- ~= bATE-ZMN~sD

Ro u t i n e Pe n a l t i e s Due F o r L a t e F i l e d ) Re p o r t s Range f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON HACK AND COMPLETE THE FOLLOWI NG SENTENCE :

REPORT FORAN/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .( r e p o r t d a t e )

I n d i c a t e o n e

CHECK I F AMENDMENT TO REPORT DATED 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 n

C 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 y i nw h i c h E l e c t i o n i s h e l d

p , o v

DI SCLOSURE

REPORT



F o r l n s t r u c t f c n s , Se e EBCk o f Fo r m

CONTRI BUTI ONS - MCNE" 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 )

COMMI TTEE ; N AME ( M u s t b e same 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 )

4 11~~ c

- S / h l . ~ s s c ° ~ t~ -Su1c~

use

SCHEDULE

( R e vC I ~ _

MCNE- ARY! i " REc s: P T _ q

CHECK T H I S SOX i FAMENDI NG FORM

I

S T A T E C A N DI D ATE S E M C i F _ I F A CO NT R I B U T I O N I S R E C- E V E D F R O M A S T A T E P A C ( P O L I T I C A L A CT I O N CCMMf T I ? 9 , L I S T TH E P A C I D E I T I F I C A T I O NN U M B E R AND T H E P A C C H E C K N U M B E R I N T H E D ES I G N A T E D C O L U M N A L I S T O F I D N U M B E R S I S A VA I L A B L E F R O M ' T E l E I O WA E T H I CS A N D C AMP A I G ND I S C L O S U R E B O A R D .

CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , l o w s , 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 r n m e r c i a i 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 .

DATE PA C I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT d I F FOR

RECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND- .

( MMI DD/ YR) AND PAC CHECK ( I f a p p l i c a b e ) RAI SERNUMBER I NCOME

I D# I N

$CK# 137 ` 1 ( - c u b d r ' ~> r l v e Z. 0 0~30 O ,

a I n ~ F~ ,

3yZ39v I D #

_ Dr g bl sy , ,P DY I H P l l

Awy s9 / L e, c K#c~~S7~1

Z t y s" ~csKl ~r P. r ~ r ~ hc. s o ~ y y

9/ Z9~0/ I D#

CK# 1 1 , 6 2 - 4. 1 y S - r t i r e r ~ l r 7 s PR- k~ r l ~ Y 7 > °N~e° 4 LP ~a~~ . s a y u 9

9/ Z_7/0~ I D# l ~ t l SWe3v

~

r `

-

~Qo_ _

CK#L

P- 5 - S7 .a " x f r

T~c ~ ~ ~ ~ ' 7 t ~ c ~ s l l P . I " 4 , SU l 0 4 S i

9 z y / a /

l D#%ly 3 ,

CK# s i o s _ sof ~~~~~

~. r ~ t - Pr l ~ ~ ~ ! ' . ~aW4 SOkCI c /

/ b ~I D#

~ r r e n l <l 7 / ~ f ~ f ~P r hzoy Sc

c x #Y- C7

wn 7



" F o r I n s t r u c t i o n s , S e e S a c k o f F o r m

CCNT- I H l 3 T I C N S - MCNEY 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 )

C O MMI T i I E E MA ME ( M u s t b e s a me 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 )

M C N E T A R YR E C c : P T S

C H E C K T H I S B OX I FA ME N D I N G F O R M

S T A T E J . A I D I D A i E S

I F A C O N T R I B U T I O N I S R E C - V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T I O N C O M M I T r E E ) , L I S T T H E P A C I D E N T t F I C A T I O N

N U M B E R A N D T H E P A C C R E - - < N UMBE R I N T H E D E S I G N A T E D C O L U M N . A L I S T O F I D N U M B E R S I S A V A I L A B L E F R O M T 1 4 S I O W A E T H I C S A N D C A M P A I G ND I S C L O S U R E BOARD .

C A U T I ON : 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 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 r` o r a n y c o m m 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 m m i t t e e s .

DATE PACI D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FOR

RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND_

( MMI DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RA I S I NNUMBER I NCOME

9 1 L 9 / o l

I D #S1 , t C 6 ) 1 0- ' r - Wt

a140LV

I e

CK# syU3 a l o ~y~ ~ 5' o l P~ l 4

I DO, arMDw' l ' t

9 l Z fr 1 OJ CK 3a

`l D #

9 l z 9 l e c x # s6 ~ c I i s 1 4 1 4 . Et i ~ P . ~ c ~ O J o U

I D #

9 / z f / 0 1a<#

. 2 q 5 - , S f~ ~ ~ i . ~ n d e . r c ~ r ~ l p t e a . sows

I D#

~~6 ~ ( ~ ~ r s s

9 ~ i 4 f o lCx #

~ q s ~ -c t T c w> ' L p s i ? wr 'p z a , SZ 329

~ / t l ' I ~~t ~n r c a S

s . o ~ C x # z . l a me s f w y



F o r I n s t r u c t i o n s , Se e B a c k o f F o r

CCNT RI BI J T I CNS - AWNEYTAKEN 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 TT EE NAME ( M u s t b e s ame a s o n S t a t e m n n t o f o r g a n i z a t i o n )

l %r 'l e7Us o

) 69- 6 pw&c~t

rZL~Alt ~e

SCHEDULE

} IMCNETARY

( Re v . 0 6 9 7

RECSPTS

( Z3CHECK T HI S BOX I FAMENDI NG FORMA

STATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECE I VED FROM A STATE PAC ( P OL I T I C AL ACT I ON COMI AI T TE ! , UST THE PAC I DE NT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA E THI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : Se c t i o n 6 8B . 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 op i e d f r o m r e p o r t s a n d s t a t e me nt 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 ny c o r n me n 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 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 .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR R EL A T I ON S HI P AMOUNT J i F FCR

RECEI VED ( { f a p p Uc a b l e )( MMI DD/ Y R) AND PAC CHECK

TO CANDI DATE ' RECEI VED

( l f a p p l i c a b l e )

FUND..

NUMBER RAI SERI NCOME

I D#

I D*~LKQNel ( / I f n<SSPw

CK#

I D#.

CK# i ~7o L c ~ s °

I D#e" Wy

CK# f ~U

I D#

CK#

hi s f ' < / <r °h. SD k2S

I D#U~ r r l fr Y<Y

1 4 - - 1 - 0 I v ( l 5 /2- '



Fo r l n s t r u c t ( I On s , See Back o f Fo r

ccNTRI BLMCNS- 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 o n St a t e me n t o r Or g an i z a t i on )

~ c ~7c l s o

~r?~~~set c

, - ~Cc~,

SCHEDULE

A

I MONE' ARY

( Re v . 0 6 / 9 7 )

RECZPr S

CHECKT HI S BCX i FAMENDI NG FORM

STATE CANDI DATES , 1 i O T E I F A CONTRI BUT I ON I S REC- VEDFROMA STATE PAC (POUTONC OM1 A I T r E E ) , USTTHE PAC I DENT I F I CAT I ON( UMBER AND THE PAC CHECKNUMBER I N THE DESI GNATEDCOLUMN. A USTOF I D NUMBERS I S AVA I LABLE FROMTHE I OWA c 7 H i CS ANDCAMPAI GNDI SCL OSURE BOARD.

CAUTI ON: Se 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 a n d s t a t e me nt 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 a n y p er 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 es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR R EL A T I ONS HI P AMOUNT J I F FCR

RECEI VED Of a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUNO-

( MM/ DD/ YR ) AND PACCHECK ( i f a p p l i c a b l e ) RAI S ER. - NUMBER I NCOME

I D# r '

~l ~ a g oCK# ~ r f ~ d 5 ~ - I t , ~ s o / o l Sr J

I D# ~~X5 5

/ eNa / CK#

-7 AeeC

t ~ f Y~P~~ ~~ r °/ s

l a- svSod~~

I D#

l 0 ~ 3 / 0 / CK# ~ o l , 9 d E

I D#~t r ~z i t D/ 7r

CKi l=n x n~Pa r ~ , r S~ S 7 J ( u ~ l q

l o l 3~0 /

I D# T~a' L~r ~i f Z - 1

CK#305 a - s ~ d ' a)

~"nc l r ~t q ~~¢ ee' t c ~ S' o %4 V

. I D#~~DQ ~ ~4 h L ' OL I ~f .

CK# . , e 2



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

CONTRI BUTI ONS - j 1 4On 1 E V 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 )

COMMI TTEE yAME( Mu s t b e s ame a s o n St a t e me n t o r Or g a ni z a t i o n)

l C7U~ S ' oA: 5 ~ 74o zQCo t r . ,

CHECK T HI S BOX I FAMENDI NG FOR I A

STATE CANDI DATES NOTM - I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PA C ( POUnCAL ACT I ON COMMI TTEE) , L I S T T HE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECKNUMBER I N THE DESI GNATED COLUMN. A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA - c T H I C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : Se ct 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 op i e d f r o m r e p o r t s a n d s t a t e me nt 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 r t 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 er 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 .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELA T I ON SHI P AMOUNT W I F FCRRECEI VED O f a p p l i c a b l e ) TO CANDI DATE' RECEI VED

( MMI DD/ YR) AND PAC CHECK ( 1 1 a p p l i c a b l e ) RAI SERNUMBER

I NCOME

I D# DC7y ~S ~~L l J Cc 2 i ~ C~ .

l a l 3 / f i r C33~~

meo w- c . K :~c , So ! r ~ ~z

I D#~ee t u , e~~p 5 c ~ l . we~~ " z r " ~

/ 0 1131 , ( CK# , 1 s o R s - h ~ ~~-~.

d~ e~~+wc P ?~e - s o ! o ~ ! ~ l

I D# / ~ ~ . » ~ f t s i n c r s ' r t ~

CK#

I D#

~0~ l ~3~o iCK# 71, SShWc" .

z - 0

I D#

p/ 0 / l 3 o i CK# 3. d ` d ~

0

I D#

CK#2 - 0



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

C- NTRI ELMONS - 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 ( a n d s )

COMMI T ' i E t , ' . MAME( ' Mu s t be s ame a s o n St a t e me n t o f Or g a n i z a t i o n)

~r/ r7US o

SCHEDULE

I MONETARY( Re v . o s l s

RECEMr S

! ~ CHECK T HI S BOX I FI D/AMENDI NG FOR I I

STATE CANDI DATES NOTE I F A CONTR I BUT I ON 1 S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI T TEE) . UST THE PAC I D E NI T I F I C A T I O NNUMBER AND THE PAC CHECKNUMBER I N T HE DESI GNATED COLUMN. A US T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA r T HI CS AND CAMPAI GNDI SCL OSURE BOARD .

CAUTI ON: Se c t i on 688 . 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 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 Comme 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 es .

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FCR

RECEI VED Of a p p l i c a b l e ) TO CANDI DATE RECEI VED RJND-( MMI DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER

NUMBERI NCOME

1 D# 7 5 ~ Z n k h7 ~ h l 4 ~ f P

CKIi 3 U3

$/ 00

_

. . .

ge a r - Z d r r ~ ~ t . - SO.~d 1

I D#

CK# 7 - ~ d u d2" n~ ~ r r ~ c r l r ~ J a ~ u c l a~

I D#

CK# 7 i Z 3 . d ' l ~. e e ; 9 ,zC, I ler a - SOI c y ~l

I D#, ~ 6 f r r ( ~~c ~ 1

a c #. ~a ~. x o : s o w y f ~ o

I D#

MAO"e l f , 2 1 5" W S - e

CK#

< v r i - Sr i ~ 1 y So

l 0~ l 3 ~0 / CK#



Fo r I n s t r u c t i o n s , Se e Back o r F or - -

COPLTRI BUTI CNS - MCNE' l TADCEY 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 RAME ( Mu s t b e s ame as o n S t a t eme n t o f O r g a n i z a t i o n )

MONETARYRECEI PTS

CHECK THI S BOX ! FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEVEDFROM A STATE PAC ( P OL I T I C A L A CT I ON COMMn TFE) , UST THE PAC I D EN T t S C A T I O NNUMBER AND THE PAC CHEi ( NUMBER I N TH E DESI GNATEDCOLUMN . A UST OF I D NUMBERS I S A V A I LABLEFROM THE I OWA ETHCS 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 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 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 Co mme 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 o m m i t t e e s .

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

RECEI VED Of a p p l i c a b l e ) TO CANDI DATE' RECEI VED R

( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e )

RAI SE

ERNUMBERWCONE

I D#

h wJ f$CK# ~

/ Tw~Ct l i a r ~ r . r - c a m - . So c z s So

1 1 3 #~4 / + ~ c a -

~ -y r - Qn`

CK#

SS/ 4 w~OKi ~ t . : $ 07 / l 0 / / 100

I D#

' I b i s f ~ P~ s~ " c r v

/ aj l 3/ l CK# / oz ~ / wr y ~ t c a r

CK#

I - 1 0 , 0 , ~ n ~ ~ c . - S ' 2 3 / p Z ZO

I D#/ Qi t r ~~~ r

CK# ?d , ~ ~ 3 a

/ ~« s l ~ - f Say.

S / o 2 ~.

75

/ 0 / l 3 j o ~

l o #T - 7 / s~~~ c l

CK# 6q7So



Fo r I n s t r u c t i o n s , Se e Sa c k o f F o r

CONTRI 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 TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o r O r g a n i z a t i o n )

l c ' ~ 7 U 5 '

o

I K

7 ~ l aSe f t

1 - - - d C t

, . ,

SCHEDULE

A

I MONETARY( R e v . 0 6 / ! 7 )

RECEi P r S

L I CHECKTHI S BOX I FAMENDI NG FORI A

STATE CANDI DATES NOTE I F A CONTRI BUTI ON I S RECE?V ED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMAMTTF- 9 , L I S T THE PAC I DENTI F I CAT I ONNUMBER AND THE PAC CHEKNUMBER I N TH E DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETH I CS AND CAMPAI GNDI SCLOSURE BOARD.

CAUTI ON : Se c t i o n 68 B . 3 2 A ( 6 ) , I o wa Co de , 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 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 e s .

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FOF

RECEI VED Of a pp l i c a bl e ) TO CANDI DATE' RECEI VED

( MM/ DD/ YR) ANDPAC CHECK ( ( f a p p l i c a b l e )

FUNE

RAI SERNUMBER I NCOME

I D#~y -

CK#9l Ol i ~ ' r ~r . . c . ~ $

. . . = d c 1 Xc e / / - 7 : 522C~ ~ - . 2 . S -

I D #

/ v ~ i 3 ~ Q lVw

4 - 7 4CK#

Qker o~~ . St o ~a So

I D# .

4 4 u ` + ' ' ` S f

I D#

CK# S 4 - k

°~~e~~

. . 1 3 Z 2zo

I D #-

1 -917 1 1 0

1

CK# Sr f e / y e ' n ~ l ~ ' a e r o Sa , . . SOG f i b / / OU

I~/ v / z l / m i l WCK# S ' i o ' v i 3 4 -



Fo r l n s t r u c t f on s , See Back o f Fo r

CONTRI 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 h i n d s )

COMMI TTEE' YAME ( Mu s t b e game as o n S t a t eme n t o f O r g a n i z a t i o n )

l C7GCS O

4 e Ag 2 71 1 5 SE/ ' t

I - - ~ k t 7 , ~

SCHEDULE

MONETARY( R e v . 0 6 1 9/7 ) RECc r PTS

L 7 CHECKTHI S BOX I FAMENDI NG F OR t i 1

STATE CANDI DATES ' V OT E; I F A CON TRI B UT I ON I S R E C E R '"VED FROM A STATEPAC ( P OU T I C AL A CT I ON COM 1A I T t ' E _ ) , L I S T THEPAC I D E N T I F I CA T I ONNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L - FROM THE I OWA E 7 1 - I 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 w a Code , p r o h i b i t s t h e u s e o f I n f o ml a d 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 a n y c o n v n e 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 o mmi t t e e s .

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT q I F FOR

RECEI VED a t a p p l i c a b l e )

( MM/ DD/ YR) AND PACCHECK

. TO CANDI DATE'

( I f a p p l i c a b l e )

RECEI VED FUND-

NUMBERRAI SER

I NCOME

l ~ o , n 5 41 , c k k e ~ ' s $C I O# - ~ q a - E 7 t c . k , \ w q ` ~ S4

G7 ) KF& v c k - ~" J at , . S00; 7 3 / a o

I D#

/ a / L 1 1 o CK# . a~~/ , ~ 1 ~ 97 r ' l/ 3 ~ / r a y 2 c c , . S o o s l / s o

I D#

.

l O Zf O/ CK# i >a s f

Sr4/~ ~Cr ~~<~cc . ~ . S OGv i / boa

I D#

l ~ZFs / Ol CK #T_ Br c ~d f c P T o m ~6 v o . t e a

I D#~osr p h . Kr~~r^

/ ~z&~~ CK# l 2 . ( e S ' q " 9 4

va s ~. . So ~4 0 1 9 . / a aI D# wok ~~ n ~nr~JG~2~



Fo r I n s t r u c t i o n s , S e t = 8 ac i c o T Fo r

CONTRI 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 i 4AME ( Mu s 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 )

l c ' ~ ! US o ~~~~

SCHEDULE

MONETARY

( Re v . 0 6 / 9 7 )

CHECKT HI S BOX t FAMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTR I BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTE- 9, L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECKNUMBER I N T HE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROMT HE I OWA ETHCS AND CAMPAI GNDI SCL OSURE BOARD .

CAUTI ON: Sec t i on 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 op i e d f r om r e p o r t s a n d s t a t emen 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 es .

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELA T I O NSHI P AMOUNT J I F FCRRECEI VED Of a p p l i c a b l e ) TOCANDI DATE' RECEI VED

( MM/ DD/ YR ) AND PACCHECK ( ( f a p p l i c a b l e ) RAI SERNUMBER

I NCOME

I D#

~o r l l c r~D4 ~ l ~ 2 t $CK#

I D#-

CK#

/p(//v

. . ; ,as_ , z 2 _ Go ~ b r e a l~vl d, e. e ~- ~ t ~h . c ~ x o~ , S a l P t ! / ~a

q / a t I D# l or r a . L d ` t wt G Sr

CK#

y 1 1 ' t '~I v e c w emu D~~4g So

I D#- -Pr t o 14 r n R K L % _ x 1 _ Q

I D# ( e l k l 6 f ~m~~u t ( ~c ~ A , , ' l i 6 a / 1 k ei 1

A10CK#

t D# / e4, ~ / ~ 1 ! o l r

CK# . a ~ s ~ - U



Fo r I n s t r u c t i o n s , - See Bac k o f Fo p,

C%NTRI BI I T I CNS - I MCNEY 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 )

COMMI TTEE MAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n)

~l C7US' o AA5rnmc~t r

SCHEDULE

AJ I MONE7ARY

( R ev . 0 6 1 9 7 )

REC2Pr S

CHECK T HI S BOX I FAMENDI NG FOR I W

STATE CANDI DATES NOTE: I F A CONTR I BUT I ON I S REC - VED FROMA STATEPAC ( P OL t t 1 C A L ACT I ON COMMr r r E ? ' ) , L I ST THE PAC I DENT I F I CATI ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S TOF I D NUMBERS I S AVA I LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD.

CAUTI ON : Se c t i o n 6 8B . 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 pi e d f r o m r e p o r t s an d s t a t e me nt 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 any c o mme r c i a l p u r p o s e b y a n y p er 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 es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR REL AT I ONSHI P AMOUNT d I F FCF

RECEI VED a t a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-

( MMI DD/ YR ) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#l ~ eZ i n

R c s k '~

5 7

1 0 ~, z 33

l / < o y f c r T " ~c f ~4 r l ~, ,

CK#c ' ~, ~~« _ - SdbUL /

I D# , ~ ~ , r ' ~ r t iGCo

/ l / l DlCK#

CK#

I D# .

111- 7711 )

l c K*

I D*emu~ Vl s eI , ( t ~

CK# a o 4 k &ewt ~ ' w A-e / v O



F o r I r s t r u c t i c r s , Se e S a c k o r F ,

CONTRI L UTI CNS - - 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 )

COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e me n t & O r g a n i z a t i o n )

F, c J X5 0 ~ RA . S n , 4 k s s e , 0 ~ - , ,T

,) W.Rouse

N

SCHEDULE

MCNE : . A F Y( R e v . 0 6 / 9 7 ) R E C E F 7 S

CHECK T H I S S OX I FA ME N DI N G F O I 3

IN

I

S T A T E C AN D I D A T E S N O T E : I F A CO NT R I B U T I O N I S R E CE I V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T 1 0 N C t 5 A A I T T E E ) , L I S T T H E P A C I D E N T I F I C A T I O NN U M B E R A ND T H E P A C C H E C K N U M B E R I N T H E D E S I G N AT E D C O L U M N . A L I S T O F I D N U M B E R S I S A V AI L A B L E F R C M T H E I O WA E T H I C S A N D C A MP A I G ND I S C L O SU R E B O A R D .

CAUTI ON : S e c t i o n 6 8 8 . 3 2 4 ( 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 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 r` c r a n y c omm e r c i a f 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 .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL A T I ON S HI P AMOUNT J I F FC IRECEI VED ( i f a p p l i c a b l e ) TO CAND I DATE ' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I S EF

NUMBER I N CO I V I E_ -I D# ~ / L I ( O YDm&- dWe r s ~ ] SS~C; a~ov o l ; ~ ~ l ~ I

CK# 1 3 q4Adi DN t l ~ oAr ~ t f I C > °

ONE'$ l b o .

-

" ~Ps l ' Y I D n l l S I . . L J t v k

I D #R ~ ` l 4 - ~ ~ - - h w- s l ~ I ~ Ss e . N J

9~aq D/ CK # 519 Duk S l r e e - i UNCl

/

~~Ro r v l / Z ' o c v G Sa3a9

I D# Ri c a t a r c , ( , / ) l l ~ - r ` ~ AK I N Rash, u , S s e Aj

CK#~l I 3 A

e

r r c Sw ' ~r

t . G~ t I Cl e, d e w ( e L OAf Zo 06~~

-I D # T e a j e l f e S c ( i o - e ; 4 z e r

c K#. l 5 v 9 s W

~~~

ae ~ i~

Br u c e 1 ~vwk ~o ~ 5 / ~ - -

I D# R i c k L ) / ) ~ L " > R&s t i l u s s - CN

/ 0%3CK #

7 o & 1 3 Av e N~

Tv t t - e , C, I J e We f Jvuxso l 44 ( 1 1 0 a . 5 ; r l / 0I D# M; I c e ' 7 / - , ) r , - ; e / ~ c e 5 A ) 5 . e d

J ~ ~ l i ~ o l c K# .5 L C A J S e - F5 aa 1 6 1 V 1 ( _

%~ 5 d . -. . p



FOR I NSTRUCTI ONS, SEEBACKOF FORM

EXPENDITURES- - MONEYSPENT FROMCOMMI TTEE ACCOUNT

STATE PACCOMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI S LAT I VECANDI DATES, L I ST THE CANDI DATE

I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMNAND THEPACCHECK NUMBERFOR EACH EXPENDI TURE . A L I ST OF i D NUMBERS I S AVA I LABLE FROMTHE I OWAETHI CS & CAMPAI GN D I SCLOSURE SCARD.

COMMI TTEENAME ( Mu s t be s ame a s o n St a t e me n t o f Or g a ni z a t i o n)

SCHEDULE

MCNETARY I( Re v . 0 9 / 9 7 )

EXPENDI TURES

[ -1 CHECKTHI S 8 0 -Al FAMENDI NG FORM

- e s ; N ~ d Or ' ~ C , t l 4 G . k e r

( ~ Nyu l ~ f i r ,

p: . , e , u u ,

I

CANDI DATE

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

AND PAC

CHECKNUMBER

NAMEANDADDRESS TOWHOMEXPENDI TURE

( D i s b u r s e me n t ) WAS MADE

PURPOSE

( DESCRI BE TRANSACTI ON)



FOR I NSTRUCTI ONS, SEE BACX uFFORM

EWXEENDI TURES - - MONEYSPENT FROMCOMMI TTEE ACCOUNT

STATE PAC COMMI TTEES: NOTE: FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBERFOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWAETHI CS & CAMPAI GN DI SCL OSURE BOARD.

COMMI T" TEE NAME ( Mu s t be s ame a s on St a t e me n t o f Or g an i z a t i o n)

> I P U S o f 4 a w, "SW. f o r TOwa f i i u s c

SCHEDULE

MONETARY I( Re v . 0 9 / 9 7 )

EXPENDI TURES

QCHECKTHI S B O^ ' 1 F

AMENDI NG FORM

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

EXPENDED ( 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/ DD / YR) AND PAC

CHECK

NUMBER

1 D# 1 3 2 1 o r / we e u ~ l i J q / ? F5 i t l C' Shds~~ . ~ l o oN .; f i t

~ l ~o~ CK#as i S . S t c ' f F ~ ~ c r }

SD$ DP~~~u ~ Z"vwk Sv b b oZ

I D#

CK#

I D# v

CK#

I D #

CK#

I D#

CK#

I D#



FOR I NSTRUCTI ONS, SEE BACK OF F Oh r v 1

COMMI TT EE NAME ; M u s t b e same 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 )

F r ~ ; CNd s of R~. s AI i t 5 s cN - ~ , Pr T WA 1 , A t f s e

SCHEDUL E

I N K I ND

( Re v . 0 6 / S7 )

CONTRI BUTI ONS

( ] CHECK THI S BOX I F

ANI E : ND I NG FORM

DATE

RECEI VED

( MM/ DD / YR)

NAME AND ADDRESS

OF CONTRI BI J TOR

RELATI ONSHI PTO CANDI DATE

' ( i f a p p l i c a b l e )

DESCRI PT I ON

OF 1 N K I NDCONTRI BUTI ON

ESTI MATEDF AI R MARKET

VALUE

J I F F GR

FUND- RA I SERCONTRI BUT I ON

~ u pr e s s7 , 0 1 g , - , t Av e S . , C

T A~- e - e wJ e u c e zvwa

a F6 . 1 1~ r x p l -, - s s



A t 11 uU I I k VV I wI VJ , J GL OMUA Ur PUKM

COMMI TT EE NAME( Mus t b o 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 )

i ' r i e i I J S o f Ra Sn I c ~ S . S e N ~r l o we r AD_se

NOTE T h i s s c h e d ul e r e p o r t s mone y l o a ne d t o t h e c o mmi t t e e wh i c h i s d e p o s i t e d I n t h e c o mmi t t e e a c c o u n t

TOTAL UNPAI D LOANS FROM LAST REPORTI NGPERI OD $ -

d -

PART 1 - MONET ARY LOANS RECE I VED JSREPORTI NGPERI OD( O r i g i n a l s o ur c e o f l o a n , s u c h a s a b a n k , mu s t b e s h ow n I f a t h i r d p a r t y I s

i n v o l v e d I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d. s . )

PODTOTAL ( PART I )

$

' 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 $ e t h e r e l a t i o n s h i p o f an y r e l a t i v e

ma k i n g ac o n t r i b u t i o n t o t h e c o mmi t t e e . R e l a t i o n s h i p must b e s h ow 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 ) an d a f f i n i t y ( r e l a t i v e s b y ma r r i a g e ) ( S e e Page 2 o f f o r m s

p a c k e t . ) 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 a s c a nd i d a t e , b u t t h e r e I s n o f a m l 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 umn whe n I t a p p l i e s

SCHEDULE f

I " LOANS

( Re v 0 8 / 9 6 )

RECE I VED& REP AI D

a CHECKT HI S BOX I FAMENDI NGFORM

PART 1 1 - MONET ARY LOAN REPAYMENT S MADE j f S REPORTI NGPERI OD( L o a n s f o r g i v e n must b e r e p o r t e d o n S c h ed u l e E - I n - k i n d C o n t r i b u t i o n s . )

TOTAL CASH REPAYMENT S ( PART l r )

F r o m S c h ed u l e E - TOTAL LOANS FORGI VEN

TOTAL OUTST ANDI NGLOANS END OF REPORT PERI OD

Pa g e

( f o r S c he d u l e F )

DATE

RECE I VED

MMI DD/ YR

NAME ANDADDRESS OF r ENDER

( I n c l u d e En d o r s e r s Name, I f A p p l i c a b l e )

RELATI ONSHI P

TO CANDI DATE

( I f r t y ~ w =.

AMOUNTOF LOAN

J i au , c l s s eu

8

R~ ~Ave . N. : e

~2~eacc e NCP f . ~DCVa

506

SDOD

DATE PA I D

( MMI DDI YR)

NAME AND ADDRESS OF LENDER

( I n c l u d e En d o r s e r s Name, I f A p p l i c a b l e )RELAT I ONSHI P

TO CANDI DATE'I f A l i c a b l e )

AMOUNT

REPAI D



T HI S FORM I S USED BYCANDI DATES' COMMI TTEES ONLY

COMMI TT EE NAME( Mus 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 )

~r ~cN~S ~ - ~ 1 ~ ~ 5 n ~ ~ s s ~ n 1 - ~r T~w~ I l o ~s c

PART I I - I T EMI ZED BREAKDOWN OF UNREI MBURSED EXPENSES P AI D BYCONSULTANT

TOOTHERS I N PERFORMI NG SERVI CES OF CONTRACT ( T h e se e x p en s es s h ou l d NOT b ePART - NAME AND ADDRESS OF CONSULTANT

r e p o r t e d o n Sc h ed ul e B , a s t h e y a r e d i r e c t p a yme n t f r o m t h e c o n s u l t a n t . )

Name o f Co n s u l t a n t

- T / ) C 1Y1 P 5 5" c , ) e

N ' ' n g Ad d r e s s

1 - 7 o 1 Lake

C i t y

S t a t e

Z i p Cod e

wa l ~ ~~ l t 7 0

~ To l v a

S~ 7v a

TOTAL ANT I CI PATED

CONTRACT

PERFORMANCERI

Mi D

COMPENSATI ON FOR

- T 5 M

T o \ Co l d - , - 6 ( 4

ESTI MATES OF PERFORMANCE

sSOD , Dv

U BREAKDOWN

OF MONETARY

( Re v 0 2 / 9 6 ) EXPENDI TURES

BYCONSULTANT

0CHECK T H I S BOX I F

AMENDI NG FORM

Pa g e

( f o r Sc h e d ul e G)

DATE . '

EXPENDED

MM/ DDI YRNAME AND ADDRESS TOWHOMEXPENDI TURE

( D i s b u r s e me n t ) WAS MADE PURPOSE

AMOUNT

EXPENDED

$

SUB- TOTAL

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

Documents

Rasmussen Dan__1329__scanned

Rasmussen Dan1329scanned