8/7/2019 AFL CIO_2004_OTC

1/5

8/7/2019 AFL CIO_2004_OTC

2/5

FOR I NSTRUCT I ONS , SEE BACK OF FORMCHECK ONE :E ] T hi s i s a n i n i t i a l ' S t a t e me n t o f Or g an i z a t i o nE l T hi s i s a n amend ed' S t a t e me n t o f Or g a ni z a t i o nAn i n i t i a l S t a t e me n t o f Or g a ni z a t i o n mus t b e f i l e d w i t h i n 1 0 d ay s o f t h e c o mmi t t e e' s ac c e pt i n g c o n t r i b u t i o n s ,ma k i n g e x pe n d i t u r e s , o r i n c u r r i n g i n d eb t e d ne s s e x c e ed i n g $ 7 5 0 . Amendment s must b e f i l e d w i t h i n 3 0 d ay s o fa c h a n g e . P en al t i e s may b e i mp o s e d f o r l a t e - f i l e d S t a t e me n t s o f Or g a ni z at i o n .

COMMI TTEE NAME 1 -AFL - CI O Commi t t e e o n P o l i t i c a l E d u c a t i o n - T r e a s u r y Ac coun t - I OWAI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u ar e r e p or t i ng f o r : I I( 1 ) S t a t e wi d e/ L eg i s l a t i v e / J ud ge S t a n di n g f o r Re t e nt i o n Ca nd i d a t e ( 2 ) St a t e wi d e PAC ( 3 ) S t a t e P ar t y ( 4 ) Co un t y C en t r a l Commi t t ee( 5 ) Co un t y Ca nd i d at e ( 6 ) C i t y Ca nd i d a t e ( 7 ) S c h oo l Boa rd o r Ot h e r P o l i t i c a l Su bd i v i s i o n C an d i d a t e ( 8 ) Co u nt y PAC ( 9 ) C i t y PAC( 1 0 ) S c h oo l Bo a r d o r Ot h e r P o l i t i c a l S ub di v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s ueCOMMI TTEE TREASURER ( ma nd a t o r y f o r a l l c o mmi t t e es COMMI TTEE CHAI R ( ma nd a t o r y e x c e p t f o r a c an di d at e ' s c o mmi t t e eName 1 1 Name 1 ~ .Mar k L . S mi t h J o h n J . SweeneyMa i l i n Add r s s 1 I M a i l i n g Ad d r e s s ~ 12 0 0 8 Wal ~Ce r S t r e et . , S u i t e A 8 1 51 6t h S t r e etC i t y , S t a t e - 1 Z i p C o d e ~ . 1Des Mo i n e s , I A 5 0 3 1 7Phone ( 5 1 5 ) 2 6 2 - 9 5 7 1_ e - M a i l I i e - M a i lI NDI CATE PURPOSEOF COMMI TTEE- Chec k One Bo x C Ad v o c a t e f o r / a g a i n s t c a n d i d a t e ( s ) Ad v o c a t e f o r / a g a i n s t b a l l o t i s s u e ( s )

Commen t o r des c r i p t i o n : TO PROMOTE T HE I N T EREST OF WORKI NG FAMI L I ESA l l C an d i d a t e s E nt e r :O f f i c e S o u g h t

C o un t y :

Bank A c c o u n t NameAFL- CI O Commi t t ee o n P o l i t i c a l Ed uc a t i o n T r e a s ur y Fund

Name o f F i n a n c i a l I n s t i t u t i o n / t y p e o f A c c o u n t 1 1Ama l g ama t e d BankMa i l i n g Ad d r e s s 1 11 8 2 5 K S t r e e t , N. W.

C i t y 1 1 S t a t e 1 1 Z i p 1 1Wa s h i n g t o n D . C 2 0 0 0 6

I t i 7p I L_A~~. _ I R~~t F o r l ~

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )C ou nt y l L o c al Ca nd i d at e s a nd L o c a l Bal l o t l Fr a nc h i s e C mi t t e " J ANI 4

C i t y , S t a t e , I - 1 Z i p C o d e 1Wa s h i n g t o n D . C 2 0 0 0 6P h o n e ( 2 0 2 ) 6 3 7 - 5 2 2 1

M a i l i n g Ad d r e s s 1 18 1 5 1 6 t h S t r e e t , N. W.C i t y 1 1 S t at e 1 1 Z i p 1 1Wa s h i n g t o n D . C 2 0 0 0 6

P h o n e ( 2 0 2 ) 6 3 9 - 6 2 5 3e - M a i l

STATEMENT OF AFF I RMAT I ON : By f i l i n g t h i s d o c umen t t h e c ommi t t e e a f f i r ms t h e f o l l o wi n g :

e ar S t a nd i n g f o r E l e c t i o n :a t e o f E l e c t i o n :

S i g n a t u r e o f C a n d i d a t e / O R , f o r a l l o t h e r c o mmi t t e e s . J a i r p e r s o n D a t e S i g n e d

FORMD R - 1( RE V . 0 7 / 2 0 0 4 )Fo r O f f i c e Use Onl yComm #I n d ex e dAu di t e dC ompu t e r

STATEMENTOF

ORGANI ZATI ON

o r P a r e n t E n t i t y ( P AC s , i f a p p l i c a b l e ) .Af f i l i a t eo r Sponsor

1 . T h e c o mmi t t e e an d a l l p er s o ns c o nn ec t e d w i t h t h e c o mmi t t e e u n d er s t a nd t h a t t h e y a r e s u b j e c t t o t h e l a w s i n I o wa C o d e c h a p t e r s 68Aan d 6 8B an d t h e a d mi n i s t r a t i v er u l e s i n C h ap t e r 3 5 1 o f t h e I o wa A d mi n i s t r a t i v e C o d e .2 . T h at I o wa C o d e s e c t i o n 68A. 4 0 2 and r u l e 3 5 1 - 4 . 9 r e q u i r e t h e f i l i n g o f d i s c l o s u r e r e p o r t s an d t h a t t h e f a i l u r e t o f i l e t h e s e r e p o r t s o n o r b e f o r e t h e r e a u i r e d d ue d a t e ss u b j e c t s t h e c a nd i d a t e o r c h a i r p e r s o n ( i n t h e c a s e o f c ommi t t e e s o t h e r t h a n a c a n d i d a t e ' s c o mmi t t e e ) t o t h e a u t o ma t i c ass ess ment o f a c i v i l p e n a l t y an d t h e p o s s i b l ei m p o s i t i o n o f o t h e r c r i mi n a l and c i v i l s a n c t i o n s .3 . T h at I o wa Co d e s e c t i o n 6 8A . 4 0 5 and r u l e s 3 5 1 - 4 . 3 8 t h r o u g h 4 . 4 3 r e q u i r e t h e p l a cemen t o f t h e w or d s " p a i d f o r b y " and t h e name o f t h e c o mmi t t e e o n a l l p o l i t i c a lma t e r i a l s e x c e p t f o r t h os e i t e ms e x emp t e d b y s t a t u t e o r r u l e . A c o mmi t t e e f i l i n g t h i s s t a t emen t f o r p u r p o s e s o f u s i n g t h e s h o r t e r " p a i d f o r b y " and who h a v e n o t c r o s s e dt h e $75 0 s h a l l n o t i f y t h e Boa r d t h a t t h e $75 0 t h r e s h o l d w i l l n o t b e c r o s s e d .4 . T h a t I o wa Co d e s e c t i o n 68A. 5 0 3 and r u l e s 3 5 1 - 4 . 4 4 t h r o u g h 4 . 5 2 p r o h i b i t t h e r e c e i p t o f c o r p o r a t e c o n t r i b u t i o n s b y a l l c ommi t t e e s e x c e p t f o r s t a t e w i d e and l o c a l b a l l o ti s s u e PACs5 . A c a n di d a t e an d a c a n d i d a t e ' s c o mmi t t e e may o n l y e x p en d c a mp a i g n f u n ds a s p e r mi t t e d b y I o wa c o d e s e c t i o n s 6 8A . 3 0 1 t h r o u g h 68A. 3 0 3 an d r u l e 3 5 1 - 4 . 2 5 .6 . T h a t t h e c ommi t t e e w i l l c o n t i n u e t o f i l e d i s c l o s u r e r e p o r t s u n t i l a l l a c t i v i t y h as c e a s e d , c o mmi t t e e f u nd s s p e n t , d eb t s r e s o l v e d , an d a f i n a l r e p o r t and a s t a t e me n t o fd i s s o l u t i o n ( M- 3 ) h a s b e en f i l e d .

- ~ 5 i g n a t u t d ' o f f r e a s u r e r D a t e S i g n e d

8/7/2019 AFL CIO_2004_OTC

3/5

SI GNATUR OF PERSON I L I N G REPORT

I AM F I L I NG A J a n u a r y 1 9 , 2 0 0 5

RCHECK I F AMENDMENT TO REPORT DATED

FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARYPAGE

COMMI 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 )AF L- CI O Co mmi t t e e o n P o l i t i c a l E d u c a t i o n - T r e a s u r y Ac c o u n t - I OWAI 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 : L u( 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 C o 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 O t 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 eCANDI DATE COMMI TTEES-ON~1 A 1 0 1 - 0 .C a n d i d a t e Name

J AN 2 4 2 0 0 5O f f i c e S o u g h t

( r e p o r t d a t e )

SUBTRACT TOTAL MONEY SPENT THI S PERI OD

l i t i c a l P a r t y ( i f a p p l i c a b l e )

TELEPHONE

C h 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( Yo u mu 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 DR- 3 i s f i l e d . )

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HAND

1 1- 1

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 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 amoun t MUST b e t h e s ame 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL MONEY TAKEN I N THI S PERI ODS c h e d u l e A : Cas h 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 ) ( " a l s o s e e i n - k i n d b e l o w ) . . . . . . . . .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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e H : T o t a l S a l e s o f Camp a 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )

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 ) . . . .Sc h e d u l e F : L o a n Re p a y me n 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 mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * UNPAI D B I L LS ( 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . , . . . $" I N K I ND CONTRI BUTI 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 LOANS ( 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m 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 DI SCLOSURE( R e v . 0 7 / 2 0 0 4 ) REPORT

F o r O f f i c e Us e O n l yComm . #L o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

L a t e r e p o 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 a lp e n a l t i e s .

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

0 . 0 0

$ 1 0 , 0 0 0 . 0 00 . 0 00 . 0 0

SUB- TOTAL . . . . . $ $ 1 0 , 0 0 0 . 0 0$ 1 0 , 0 0 0 . 0 00 . 0 00 . 0 00 . 0 00 . 0 00 . 0 0

YES NO

8/7/2019 AFL CIO_2004_OTC

4/5

F o r I n s t r u c t i o n s , Se e B a c k o f Fo 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 )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 )AFL - CI O Co mmi t t e e o n P o l i t i c a l Ed uc a t i o n- Tr e a s ur y Ac c o u n t - I OWA

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

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C AL 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 ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM T HE I OWA E T HI C S AND CAMPAI 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 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 ny 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 .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e d u 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 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 m m 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 y 1 1m 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 f -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 u mn . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI 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 NCOMEI D# AFL - CI O1 0 / 0 8 / 2 0 0 4 $ 1 0 , 0 0 0 . 0 0CK#I D#CK#D#CK# E: : ]I D#CK# ElI D#CK# El

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

8/7/2019 AFL CIO_2004_OTC

5/5

THI S BOXAPPLI ES TO CANDI DATES' COMMI TTEES 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 e r 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 u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x pe nd 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 mus t a l s o b e d e t a i l i t e mi z e d o nSc h e d u l eGb y t h e amo 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 pe nd 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 ha 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 a n d I o wa Cod e 68A . 4 0 2 ( 3 ) ( i ) . )

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

FOR I NSTRUCTI ONS, SEEBACK OF FORM R e s e t F or m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TO STATEWI DEOR L EGI SLATI V ECANDI DATES, L I ST THE CANDI DATE I D ENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHE CHECK T H I S BOX I FPAC CHECKNUMBER FOR EACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE 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 )AF L - CI O Commi t t e e o n P o l i t i c a l E d u c a t i o n - T r e a s u r y A c c o u n t - I OWA

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI 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 ) WASMADE( MM/ DD/ YR) AND PAC

CHECKNUMBERI D # 9 0 9 g I o wa De mo c r a t i c S t a t e P a r t y L e v i n F u n d C o n t r i b u t i o n1 0 / 1 8 / 2 0 0 4 CK#000373 $ 1 0 , 0 0 0 . 0 0

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

SUB- TOTAL $ 1 0 , , 0 0 . 0 0TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ 1 0 , 0 0 0 . 0 0