Post on 08-Apr-2018
8/7/2019 Terry Michael__1332__scanned
1/8
FOR .; ` ~ , I S TRUCT I ONS. SEE BACK OF FORM
DI SCLOSURESUMMARY PAGE
COMMI TT EE NAME ( Mu s tb e s ame a s o nSt a t eme n t o f O r g a n i z a t i o n )V l
,5; 1 nb 0 vs 4o V - Y 1r 1Ic 1 1 WITe r r ! /
I MPORTANT: I n d i c a t et y p eo fc o mmi t t e ey o ua r er e p o r t i n gf o r: Lo
( 1 ) S t a t e w i d e / L e g i s l a t i v eC a n d i d a t e( 2 ) S t a t e w i d ePAC( 3 ) S t a t eP a r t y( 4 ) C o u n t y / L o c a lC an d i d a t e( 5 ) C o u n t yPAC ( 6 ) B a l l o tI s s u e / F r a n c h i s eC ommi t t e e( 7 ) C o u n t y / C i t yC e n t r a lC o mmi t t e e( 8 ) S u p p o r tS l a t eo fC an d i d a t e s
SI GNATURE OF TREASURER ( o rp e r s o n f i l i n gt h i sr e p o r t )5 / s - Z&R - 3 9 1 4 2
Ro u t i n eP e n a l t i e sDu e Fo rL a t eF i l e dR e p o r t sRange f r o m$ 2 0t o $ 8 0 0
SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :
I AM F I L I NGA 3- AnuaY' h Z ZZ i - ) ,PQ - - SPO RT FOR AN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR .( r e p o r td a t e )
CHECK I FAMENDMENT TO REPORT DATED
[ ] Check i ft h i si s f i n a l( t e r mi n a t i o n ) r e p o r tan d a t t a c h No t i c eo f D i s s o l u t i o nF or mDR- 3.( Yo umust c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo f D i s s o l u t i o ni s f i l e d. )
STATEMENTOF CASHON HAND
I n d i c a t eon e
CASH ON HAND a t t h ee n d o ft h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a nc emu s tb e z e r o ) ( A t t a c hDR- 3) . .. .. .. .. . .. . . .. . . ... . .. . .. .. .. . . .. ... .. .. . . . . . . . . . .. . . .. . .. ... .. . .. .. . . . . . . . .. . .. . . . . .. . . .. ... .. .. ... .. ..$
FORM
DR- 2 I DI SCLOSURE( R e v. 0 1 / 9 8 ) REPORT
Fo rO f f i c eUs e On l y iComm. #
r
I n d e x e d _
A u d i t e d
C o mp u t e rLL/ - V u v
TELEPHONE DATE S I GNED
L o c a lC ommi t t e e s ,e n t e rD a t eo fE l e c t i o n
C o u n t y&L o c a lC ommi t t e e s ,e n t e rC o u n t yi nwh i c hE l e c t i o ni s h e l d
CASH ON HAND a t t h eb e g i n n i n go ft h e r e p o r t i n gp e r i o d. ( T h i si s t h et o t a lo f a l lmon i e s h e l db y t h ec ommi t t e e. T h i samount MUST b e t h es ame a s t h ec a s h o n hand a t t h ee n d o f t h el a s tr e p or t i n g p e r i o d ,o r mu s t b ez e r oi ft h i si sf i r s tr e p o r tf i l e d. 0
ADD TOTAL MONEY TAKEN I NTHI SPERI OD
Sc h e d u l eA : Cash C o n t r i b u t i o n st o t a l( A t t a c hSc h e d u l eA) .. . . . . . . .. . . . .. .. .. . . .. . . . .. . . . .. .. .. . . . .. .. . . . . .5 7 0 7 0 . dO
Sc h e d u l e F: L o a n s Re c e i v e dt o t a l( A t t a c hSc h e d u l e F ). .. ... .. .. . . .. .. . . . . . . . . . .. . . . .. .. ... .. . . . . . .. .. .. . . . . . C) . OU
Sc h e d u l e H: T o t a lSa l e s o fCampa i g n P r o p e r t y( A t t a c hSc h e d u l eH) . . . .. .. . . . .. ... .. .. .. . . . . . .. . . . . . 0- 00
( Sc he d u l eH a p p l i e s t oCa n d i d a t e s ' Commi t t e e sOn l y )
SUB- TOTAL . .. .. $
SUBTRACT TOTAL MONEY SPENT THI S PERI OD
Sc h e d u l e B: E x p e n d i t u r e st o t a l( A t t a c hSc h e d u l eB ) . . . .. . .. .. .. .. . . . . . . . . . . . . . . . . .. .. .. . . . . . . . . . . .. .. .. ... .. ..
Sc h e d u l e F : Loan Rep ay men t s t o t a l( A t t a c hSc h e d ul eF ) .. .. . .. . .. . . . .. . . . .. . .. . .. .. . . . .. . . .. . . . .. .. . .. .. ..
- 7 0` ] 0 . C~0
0- c o
35! l . 33
6- 00 ,~
1 4 9o - 440 . 00
UNPAI DBI L L S( F r o mSc h e d u l eD - A t t a c hSc h e d u l eD) . .. . .. .. .. .. .. . . . .. .. .. . . . . .. . . . . . .. . . .. . . . .. . . . .. . . . . .. . . . .. .. . . .. $
I NK I NDCONTRI BUTI ONS ( F r o mSc h e du l eE - A t t a c hSc h e d u l eE). .. .. .. .. .. . .. .. .. .. .. . . . .. . . . .. .. .. .. . . ... .. .. .. $
OUTSTANDI NG LOANS ( F r o mSc h e d u l e F - A t t a c hSc h e d u l eF ) . . . .. .. .. . . .. .. . .. .. .. . . . . .. . .. . . . .. .. .. .. .. . .. .. . . . .$
CANDI DATE COMMI TTEES ONLY :
CONSULTANT BREAKDOWN ( Sc h e du l eG A t t a c h e d ? ) YES \ N J NO
VALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l e H - A t t a c hSc h e d ul eH) $
8/7/2019 Terry Michael__1332__scanned
2/8
Fo r I n s t r u c t i o n s ,Se e Ba c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )
COMMI TTEE NAME ( Mu s tb e s ame a s o nS t a t eme n t o fOr g a n i z a t i o n )
CI Snho t - s Gi c y r Mi choe I Tcr r y
SCHEDULE
A MONETARY( R e v. 0 6 / 9 7 )I RECEI PTS
Q CHECKTHI SBOX I FAMENDI NGFORM
STATE CANDI DATESNOTE: I FACONTR I BUT I ONI SRECE I V EDFROMA STATE PAC( P O L I T I C A LACTI ONCOMMI TTEE ) ,L I S TTHE PACI DENT I F I CAT I ONUMBER ANDTHEPACCHECKNUMBERI NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVA I L A B L EFROMTHE I OWAETHI C SANDCAMPAI GNDI SCLOSUREBOARD.
CAUTI ON: S e c t i o n6 8 B. 3 2 A ( 6 ) ,I o waC o d e ,p r o h i b i t st h eu s e o f i n f o r m a t i o nc o p i e df r o mr e p o r t sa n d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o no r
f o ra n yc o mme r c i a l p u r p o s eb ya n yp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.
0 0 10
TOTAL ( i fl a s tp a g e o f t h i ss c h e du l e ) r
SUB- TOTAL3 5
D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s e t h er e l a t i o n s h i po f a n yr e l a t i v em a l t i n ga c o n t r i b u t i o nt ot h e
c o mmi t t e e. R e l a t i o n s h i pmu s t b es h o w nt ot h et h i r dd e g r e eo f c o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb y
ma r r i a g e )( S e eP a g e2 o ff o r m sp a c k e t. ). I fs u r n ameo f c o n t r i b u t o ri st h es ame a s c a n d i d a t e ,b u tt h e r ei sn o Page o f
f a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i nt h er e l a t i o n s h i pc o l u mn.( f o rS c h e d u l eA )
DATERECEI VED
PAC I DNUMBER( i fa p p l i c a b l e )
NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE'
AMOUNTRECEI VED
4 I FFUN
( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAII NCONUMBER
S~ 1 oI D#
y~ , I a i r c
5 s i -~ I s i , $ SG . o c - )
CK# Nws + Oe s Won ? e s , VA So - 7 0 5
g/ 2 - 7/ 0 1
I D* I Z Q C. 1 1 , ,I ( A ) 4 )I ' e r sW 3 I ' 7 Sj -r e e t 4* I Z ~ i a c. c z
. r' -, 60 . 0 0CK# 1 7 - k -s I i I ' - g
' 1 17 - 1 10 1
I D# 1 2 a r Va e - l 2 l f e 1 r ~3 I
~s s ~ - I 7 - > a>7~~
rs 7 s.00CK#Ol z s Momeq - Ch 5 03 1( 4
W21 -1 1 0 1ID#
CK#
k ad j = ( t A j a 1} i er S7 1 3 / -7 4 i g I r c 4t f l Ar c c 5 00b , ( 3 0Det M o l y ) e C 5 0 3 1 q
I D# M44Mk r C0 91 1 2 - 1 1 0 1CK#
~
Not he 52 - %- 0 0
0 3 ? 1
1 0/ / / 0 J
I D#
CK# K- O
k t 3 y r ) e
ZZ- a o n eT e r r y
Qr i m b r h e r - 5 0 . 0 0I 4 u r n e 3 4
I D#bat u4ne McAs1r =1 ,V
015101 4800 Gat A Or t ue - S f i e. 1Z5~ ' ZSo . oo
CK#Wegf h
I D#-
. _
I ZAr d t , ~ U1a i t s
1 1 1 7 1 0 1 CK# 2 - 1 7 1 Gr and Aue 5
S" SO b . 6 o
We v ~ o i ne s =f t OZ
1 11 1- 5 / 0 1 .
I D# L l k l 4ne I1
r r yeOZZ Tc r ne o r c s t b r , u e b - h~n Si S6, 00CK#
I T f" T i l1 6 l e _ c > S 7734
I D# TOhj L l 1 Qj ` f b n1 1 1 6 1 0 1 CK#
14 5 / 4 Al p n7 c p r . S a . oaUr ho r d ~ l e , , o ~ . SO3aa
8/7/2019 Terry Michael__1332__scanned
3/8
Fo r I r i s t i r u c t i o n s ,Se e Back of Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o na lf u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s on St a t e me n t o f Or g a ni z a t i on )
Y) Ql shbor s - Gov l m* 1 c. Yl o e ! - r e i ^ r , J 1
STATECANDI DATESNOTE : I FACONTRI BUTI ONI SRECEI VEDFROMASTATE PAC( P OL I T I CA LACTI ON COMMI TTEE) ,L I S TTHE PACI D EN TI F I C AT I ONUMBER ANDTHE PACCHECK NUMBERI NTHE DESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSANDCAMPAI GNDI SCLOSUREBOARD.
CAUTI ON : Se c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code, p r o h i b i t st h e u s e o f i n f o r m a t i o nc op i e df r o m r e p o r t san d s t a t e me nt s f o r s o l i c i t i n gc o n t r i b u t i o no rf o r an y c omme 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 rt h an s t a t u t o r yp o l i t i c a lc ommi t t e es .
SUB- TOTAL
TOTAL ( i fl a s tpage o f t h i s .70s c h e d ul e ) $
Di s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s et h er e l a t i o n s h i po fan y r e l a t i v ema k i n ga c o n t r i b u t i o nt ot h ec o mmi t t e e. Re l a t i o ns h i pmustb e s h own t o t h et h i r dd e g r e eo f c o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb yma r r i a g e )( S e eP a g e 2 o ff o r ms p a c k e t. ). I fs u r n ame o f c o n t r i b u t o ri s t h es ame a s c a n d i d a t e , b u t t h e r ei sn o P a g e o ff a m i l i a lr e l a t i o n sh i p ,e n t e r" n o ta p p l i c a b l e "i n t h er e l a t i o n s h i pc o l umn. ( f o rSc h e d u l e A)
SCHEDULE
A MONETARY( Re v. 0 6 / 9 7 ) RECEI PTS
CHECK THI SBOX I FAMENDI NG FORM
DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I FRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PAC CHECK ( i fa p p l i c a b l e ) RAI
NUMBER I NCO
I D#he l da+i z o} - ~ - Y ) ' ) i r J l ~ / e
l 1 I L5 10I CK# 7 1 1 1v oO0LANO Z S .dD5 ,0 10
f1 5 / 0 1I D#
1 -4k - a r c1
3 1 1 6Sow + - 2 0 4 4 i
So 1Mm k U l s t ' v kDr . s 3 0 - 00CK# rs , e S 503a 1
~1 a lI D# Ha r p - YA . /wr t l S
2 1 1 W . ma t adowl Ac s l o b - a o VCK#MOVKhq ( 1+OW y 1 ZA 5 0 / 5,P
I Zl ~1 ~ 1I D# 2 7 nGr am i 4 0
~ .CK#"
+ _0" r n o yes _ Zk.
I D# - r e r e s o . MCC o r n r n eI I j Zc J o r CK# I I Oy Cr n ~ t - i s Av e . S 1 60 . 0 0
De sMonne s?A 5 0V 5!D#
CK#
ID#
CK#
I D#
CK#
ID#
CK#
ID#
CK#
8/7/2019 Terry Michael__1332__scanned
4/8
THI S BOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :
Pu r c h a s e s o fc e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 4 0 o r mo r e mus t a l s ob e i n v e n t o r i e do n Sc h e d u l eH. ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )
Ex p e n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc 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 gs e r v i c e smus t a l s ob e d e t a i li t e mi z e do n
Sc h e d u l eG b y t h eamou n t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emad e b y t h ep e r s o n i e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e f et
Sc h e d u l eG i n s t r u c t i o n sa n d I o waCode 5 6. 6 ( 3 ) ( i ). )
( f o rSc h e d u l eB)
FOR I NSTRUCTI ONS,SE E BACK OF FORM SCHEDULE
B MONETARYEXPENDI TURES- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v. 0 9 1 9 7 ) EXPENDI TURES
STATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VE CHECK THI S BOX I FCANDI DATES,L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .
COMMI TTEE NAME ( Mu s tb 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 o n)
( 2) ~ ) b pv ' S 9c w - 1 c ~pQ~~2 r rCANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED
EXPENDED ( i fa 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 PAC
CHECKNUMBER
I D # ( p r l - r r ~P r i n l - a v P ! - r r , h ' 1 ' 1 bo F l e f-I r h a a c J P
y 1 2. 1l o f h1 73 ` I C . G r a r 4 Av e . e l l u c ) 0 , e .
$39Z . z , ,CK# ~r , p
0 e 5MD1 r e Z, , ~~S03 1 1U
,
I D# S e s ( -1 ' - o s fPr i n 4e r P 1 - - o o f i oCop e u e f e rq / 2 1 t o I N24 t o t- " ' 1-1 W~- 1 ' ~ q~ S f i Y ar o ~ ~o r mS (. p
CK# 2 . 0 1 1 ~~ mo l n e s ~~ So3c~I D# K , l )l u , s p r o p r o o f so f '
S Z ( a. I FSl a ~ ) / o l L i D 1 0 S ` ' 1 5 0 Co r n p o; o)r GQr d SCK# Zb) ZS
mb t i n e s , ' A So3c9
I D# I < I n k , o s GOl o r p y o a F S O~ r
) b j ZJ OI L 4 0 0 C. o ~f z + s ( - e! - ~ c aw+~j g y, ~, I S S2 t ~ . y ~1
CK#Zb/ 3f l e s Mof neS V 4 , r o c
,~ k4 I
I D# 9Aj Cn - l SLUE 12 1 ' Y ~ o Y~. } ~ S p f ' r/ 0 15 ~a 1 I 1 + s~ - s i t a o s ' I t i b 97 + 1 + t, 1 ~~- ) n 5 S
yZD . pOCK#Zp14 r - >-- S YboW1e% 1CA
I D# I ' Y ). ~h o ~ Tcr r y 2e i r " b ur c r : 47i 3 I ? s i - 1* f L S E' ~ ~r s Or ~ -. Ta ck s on n l n C1Y 5 ' ZOO . Od
CK# 2 . 0 15 Ocs Mo ) e s , a t e . 5 , 0 31 1 4 Ti r l c Z1s ( , Pa r l - y Fon~~) o h
I D# n r a ' 1 Oe I Tt r l ^ Y 2C IMbb f s M, - j f i r ,
7 ) 3 ( t 4 S l - 1 2 - M ) m. c . x pt ec l o g S 12 - 6 . a - 4 '
101 - 401 CK# w1( vr i e s Y ) ' ) DI e 5 503/ U
*j mf OPCr eAr " S i v .
I D# bar kv Pt i n l e l - r ' r o r Y4 r Q i ' s C A> t ,.
J0 7- 1 01 20117 . 3 41 E, &r a , , A AI D- e - coyj S, l o ll ) S c - 1 C YS
S l O Co6 , ~UCK#
bec %01 ) csS t c
Ca m. A a ; l , ,i o1 3 0 SUB- TOTAL $
TOTAL ( i fl a s t page o f t h i ss c h e d u l e ) $
8/7/2019 Terry Michael__1332__scanned
5/8
T HI SBOX APPL I ESTO CANDI DATES'COMMI T T EESONLY :
P u r c h a s e so fc e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0o rmo r emu s ta l s ob e i n v e n t o r i e do nS c he d u l eH. ( R e f e rt oS c he d u l eH i n s t r u c t i o n s. )
E x pe n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc 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 gs e r v i c e smu s ta l s ob ed e t a i li t e m i z e do nS c h e d u l eG b yt h ea mo u n t ,p u r p o s e ,a n dd a t eo f e a c ht y p eo f e x p e n d i t u r emade b yt h ep e r s o n / e n t i t yo n b e h al fo ft h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c h e d u l eG i n s t r u c t i o n sa n dI o w aCo d e 5 6. 6 ( 3 ) ( 1 ). )
( f o rS c h e d u l eB )
FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDULE
EXPENDI TURES B MONET ARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESTATEPAC COMMI T T EES: NOTE: FORCONTRI BUTI ONSMADETO STATEWI DEOR L E GI S L ATI V ECANDI DATES,L I S TTHECANDI DATEI DE NT I F I CATI ONNUMBERI NTHEDESI GNATEDCOLUMNAND THE E CHECK T HI SBOX I FPACCHECK NUMBERFOR EACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHEI OWA AMENDI NG FORMETHI CS &CAMPAI GNDI SCLOSUREBOARD.
COMMI TTEE NAME ( Mu s tb e s am e a s o nS t a t e me n to fO r g a n i z a t i o n )~ , , .
` Ae I N b o y s~~ %I LA- Vaq\ ' Ter YCANDI DATE NAMEAND ADDRESSTOWHOM PURPOSE AMOUNT
DATE I DNUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i fa pp l i c a b l e ) ( Di s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PAC
CHECKNUMBER
l o j q1 011D#
z ~ MI e C~ ' t p ho 4r c p ) pi nsc K# Z, c ~ 1 8
yes I T 01b e S~ Svs/ ~ ~Y c 1 ~ r kn n$~3.53
I D#
-
~~r ~ T Sp I h ~ JI o 1 1 ( J 1 0 I - S J o oW { ' r o l es c k l t u l ) t n gl e f L S
3 1 ~. ` ~ CK#ZbI I b c s " wt e s X A St d oI D# RQ .' . ' QS>~E Web g i 4 ,- - Y~2U ~ h ~ ~ ' S10
/1 9101 St C 9S6 2 5V 00cK#~ZO oe' Y) ) Z
y ) 4 Q- , TA 5036
I D#
~~ o ~sr' 1 ~i o s 4 h s ~ ~ f i r m s . s // _5U1 0 1 Z 3 c K# Zt J 2 . 1Oes Mor n e S, ZA S03oq
I D# ~~~
~~
S~ mQsS
1 0 12 - 3 ] b I CK # 2 - p22 Des "
35 . aO
b w, e s , ~ So3Dc,
I D# Kt r I Go Sqao Looos~ - S~ ' e
~~ ~
l
Go r f r o ) SQY
l l bLC} o I ~ P.
CK# ZoZ3 LUCAS " 61 - 1: k S03~f
I D# ~x ' QSS Y 1~ ' Ihg ~aa~b TI CS
h/ ~1~ol CK#X708 ~ ~ r o ye r ~ l 1 S 3 . 3q
~z~ o~ ( ~ l o me s , ~ . ~ so3 ~ a
I D# Pa 9 f
p ~Zl aI 0 1 y' 00L
CK# Z- OZ5ces b l ` ( Y ? S. S 503
- r er r y
SUB - TOTAL $
dTOTAL ( i fl a s tp a g e o f t h i ss c h ed u l e ) $
8/7/2019 Terry Michael__1332__scanned
6/8
T H I SBOXA P P L I E STOC A ND I D AT E S 'COMMI TTEESONLY:
P u r c h a s e so fc e r t a i nc a m p a i g np r o p e r t yc o s t i n g$ 5 0 0o rmo r e mu s ta l s ob ei n v e n t o r i e do nS c h e d u l eH. ( R e f e rt oS c h e d u l eHi n s t r u c t i o n s. )E x p e n d i t u r e st o p e r s o n s / e n t i t i e sp 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 gs e r v i c e sm u s ta l s ob ed e t a i li t e m i zo nS c h e d u l eGb yt h ea m o u n t ,p u r p o s e ,a n dd a t eo fe a c ht y p eo fe x p e n d i t u r em a d eb yt h ep e r s o n / e n t i t yo nb e h a l fo ft h ec a n d i d a t e ' sc o mm i t t e. ( R e ftS c h e d u l eGi n s t r u c t i o n sa n d I o w aC o d e5 6. 6 ( 3 ) ( 1 ). )
( f o rS c h e d uB )
FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDULE
EXPENDI TURES BMONETARY
- - MONEYSPENTFROMCOMMI TTEEACCOUNT ( Re v. 0 9 / 9 7 ) EXPENDI TURESTATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VE CHECK THI S BOX I FCANDI DATES,L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE. A UST OF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .
COMMI TTEE NAME ( 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)
e , h b o r s ~- o ~- ' mI' C69, 1l- - _ Rr r \ JCANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa 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 PAC
CHECKNUMBER
ID# k i n k _ 0 3 Phbk ezpnm OP
1 0 1 z . 8 ~o I c K# Zo z ( D4 0 0 L o eo s - I- s f i e1 _cK #Z o, > 3 1 b e s Y' UTg s , _ e mSD3aI D# ck : e 6 l s >=c r - ~ l r a l s e r ~od . s
I t 1 5 d o t CK# 3 40 16 Zr l we ml )AKC~S. Sa
Z 0 3 a DO&md v =, Z s a 3 ),: ~I D# E+C . r 1 4 1 9LUE De l l phone r ~b v r ~
I z J 3 ~o~550 1 1~ S~ - - 5 f c a c s
c K # ? o 3 3 Des r n o ,y ) MTA 6 13PSUB- TOTAL$ a
T~TOTAL( i fl a s tp a g eo ft h i ss c h e d u l e )$
8/7/2019 Terry Michael__1332__scanned
7/8( f o rSc h e d ul eB )
FOR I NSTRUCTI ONS,SEE BACK OF FORM SCHEDULE
EXPENDI TURES B MONETARY- - MONEY SPENTFROM COMMI TT EEACCOUNT ( Re v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLAT I VECANDI DATES,L I S TTHE CANDI DATEI DENTI F I CATI ONNUMBER I NTHEDESI GNATEDCOLUMN AND THE CHECK THI SBOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. AL I STOF I DNUMBERS I SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD .
COMMI TTEE NAME ( Mu s t be s ame a s on S t a t e me n t o f Or g a ni z a t i o n)
e ) ~nhon "-o v Ni Cx We ` ' T q -r YCANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i fa 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 PAC
CHECKNUMBER
I D# t ' Y I k 1 TCr r y f Ge n ~ bD l I v1Z)4 1 0 1 J - 4P PY ) ~ } C,r i r ~ ' v 1 c I g GS ( ! ~ 7CK# ZV3~ ' ~ S ' Y~ ' b l GS. $ D a_ , A ShSI ~
I D# d 9 b 1 1 GC) 0 0 nN hW Ibm Wk r1 0 0 1 0 1 c o c ) r ) -q v e S Ci
ZCK# 2 0 3 5 Df t No I n e S, -
8/7/2019 Terry Michael__1332__scanned
8/8
' F ORI NSTRUCTI ONS,SEE BACK OF FORM
COMMI TT EE NAME ( M u s tb e s ame a s o n S t a t e me n to fO r g a n i z a t i o n )
b Q i ghbcY s q r 1 ' Y )i c ho e I Ter r y
SUB- TOTAL
SCHEDULE
E I NK I ND( Re v . 0 6 / 9 7 ) 1CONTRI BUTI ON
F- 1 CHECK T HI S BOX I FAMENDI NG FORM
I 4go, 44
TOTAL ( i fl a s t $
p a g e o f t h i s11M . 44
s c he d u l e )
` D i s c l o s u r e l a w r e q u i r e sc a nd i d a t e st o d i s c l o s et h er e l a t i o n s h i po f an y r e l a t i v emak i ng a n i n k i n d c o n t r i b u t i o n t ot h e Page~- o f
c ommi t t e e. R e l a t i o n s h i pmust b e s hown t o t h e t h i r dd e gr e e o f c o n s an g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e s ( f o rSc he d u l eE )
b yma r r i a g e ). ( Se e Pag e 2 o f f o r ms p ac k et. ) I fs u r n ame o f c o n t r i b u t o ri s t h esame a s c a n d i d a t e ,b u t t h e r ei s n of a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta 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 pc o l umn .
DATERECEI VED( MMI DDI YR)
NAME AND ADDRESSOF CONTRI BUTOR
RELATI ONSHI PTO CANDI DATE' ( i fa p p l i c a b l e )
DESCRI PT I ONOF I NK I ND
CONTRI BUTI ON
ESTI MATEDFAI R MARKET
VALUE
4 I FFORFUND- RAI SERCONTRI BUTI O
$ 1 2 . 7 1 0 11 ~ 8 e 4n ) o 1 ' n asZ$ Z8 S . - 9 ' 7 ' ! ;;
I y e a rd or ut n hQMG j 5
" OU
De s YY? o i r l e s So 3 1 7 ~1 I SI ~~ ~ - i nc ~ a ~ c Ri s ~ 3u G s , ~ I ~ ~ s
q1f i 7o' t c o + +
Wesgt
F I J c sYY7 0 f b e r z~ 5o a ( 9 5f ~ ~.
I o/ i 1o 1Qac . 1 Y 1 q 11 NA I J Mr S7 3 1 - 74 4 , S+ J * /Z~S Mo i s ~, 5 o 3 I q
f i a r w ~ e4 ! o rL
- e a s en r t i r nCAm" I I 7 ~ h .s16Qo . o a
1 1 1 1 5 1 0 1Gr e e d i - 1 *l e n we I I s1 7 o I I wc o nt ANt oCes Mo l "e s . z a 5a 3 0~
Foop F o r tF u n d r a I s e 1 r s 36 5 . A3
I I ~ I S ~ oI4 ? n c h c r ef U1 al + er s7/ 3 1 7 S~ ' ' i - ZQe3 Mome4, -ZA S 0 3 I l i
I a n C c ~l - 1 o s ' I - c s sChP i -Rd r aYSaY
3 d - ~
I I ~ ~ 1