Bartz Merlin318scanned

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FOR I NSTRUCTI ONS, SEE BACK OF?M

DI SCLOSURE SUMMARY PAGE

E NAME ( Mu s t b e s ame a s o n St a t em

t o f O r g a n i z a t i o n )

I 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 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 ( 6 ) 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 / C i t y C e n t r a l C o mmi t t e e( 8

r t S l a t e o f C a n d i d

NATURE OF TREASURER ( o r p er s o n f i l i n g t h i s r e p o r t )

TELEPHONE

Ro u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Rep o r t s Range f r o m $ 2 0 t o $ 8 0 0

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

JAM 2 2 2 0 0 2

I AM F I L I NG A

ORT FOR ANI A ( 1 ) ELECTI ON / ( 2 ) NON- E L ECT I ON YEAR .

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

I n d i c a t e o n e

2 1

r m

I - / y

OCHECK I F AMENDMENT TO REPORT DATED

M Che 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 DR- 3 .

( Y ou m u 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 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 beg 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 mo n i e s h e l d by t h e c o mmi t t e e . T h i s a m o u n t MUST be t h e

s ame a s t h e c a s h o n h a nd 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 mu s t be 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 OD

Sc h ed u l e A : Ca s 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 ed u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sc h ed u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a l l

FORM

DR- 2DI SCL OSURE

( Re v . 0 1 / 9 8 )

REPORT

F o r O f f i c e Us e On l y

Comm . #

VN

I n d e x e d -A u d i t e d

Comp u t e r

4 - D3

f - f - 4 - I n . ) ,

DATE SI GNED

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

Co 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 n

w h i c h E l e c t i o n i s h e l d



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 l

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

O

STATECANDI DATES NOTE : I F A C ON TRI BU TI O N I S R EC EI V E D FROMA STATE PAC ( P OL I T I CAL A CT I O N COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ON

DI SCLOSURE BOARD .

CAUTI ON :

o r

f 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 er 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 .

SCHEDULE

A MONETARY

( Re v . 0 6 1 9 7 ) RECEI PTS

CHECKT HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT l I F FORRECEI VED ( i f a p p l i c a b l e ) TO C A ND I D A T E ' RECEI VED FUND-

( MM/ D D/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ER

NUMBER I NCOME

I D# 60 , 7 _ -D

lCK

61CJ

O4 -D~CK# l G a l l

CK#/

l G~ , s oC

K#

- l _ ~Dn CK#

CK#

I D#



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

CONTRI 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 St a t e me n t o f O r g a n i z a t i o n )

~1 ! _ 7 1 1 1_ 1 ZZ7 ; ' S467

' / ) Cc~VZe, _7 2 , 1 9 / 7 ? r : Z ' 1 - Z / -

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECENED FROM A STATE PAC ( P OL I T I C A L A CT I 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 N

DI SCLOSURE BOARD .

CAUT I ON :f o r any c o mme r c i a l p u r p o s e b y any 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 es .

o r

SCHEDULE

A MONETARY

( R e v . 0 6 1 9 7 ) RECEI PTS

CHECKTH I S BOX I FAMENDI NGFORM

DATE PA C I D NUMBER NAME ANDADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT q I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DDNR) AND PA C CHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D# ° -

ovCK#~3 l 0

`

$ QD

; ~ ~~ s z 3DI D#

C K#

I D#

I D#

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FOR I NSTRUCTI ONS, SEEBACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY-MONEYSPENTFROMCOMMI TTEEACCOUNT( Re v . 0 9/ 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI V ECANDI DATES, L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECKTHI S BOXI F

PACCHECK NUMBERFOREACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI L ABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEENAME( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )

CANDI DATE NAMEANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE

( MM/ DD/ YR) AND PACCHECK

NUMBERI D#

CK# $' 9 12 y t ~)

I D#/ ~~~1

CK# Oe l

1VVI D#

I D#

~ 1 - / C7 I X4SX' "

CK#

CK#

: x. m1 ~,m l , , ,

CK#, y~



FOR I NSTRUCTI ONS, SEEBACK OF FORM SCHEDULE

EXPE NDI TURES B MONETARY- MONEYSPENT FROMCOMMI TTE E ACCOUNT

( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TOSTATEWI DEOR LEGI S LAT I V E

CANDI DATES, L I ST THECANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATEDCOLUMNANDTHE CHECKTHI S BOXI FPACCHECK NUMBER FOREACHEXPENDI TURE. A L I ST OF I D NUMBERS I S AVAI L ABL E FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCL OSURE BOARD.


Q

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNT

DATE 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 me n t ) WASMADE( MM/ DD/ YR) AND PAC

CHECK

NUMBER

I D #

1 D #

CK#I 7d ? ~~ : ~ 1 -A ~ V i m 7 2 4 6 " YL

Dr OD#

/ / l l n 4 - 2 1 F ~ 3 1 ~ ~ - l ' l ~ l J

C

K# l l 1 -~~%nc v2

CK# - 9 e - 0



FOR I NSTRUCT I ONS , SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT

( R e v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE

CANDI DATES, L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 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 NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .


4 / / , / - 7 ~ a ' G6v a ~ / -f ~ - 1 2/~CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE 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) ANDPACCHECK

NUMBER

I ,

'1 D#

0 / l / nm i

I D #

L ' ca

l

CK#

0 2 / ` 7 8I D#

CK#

I D#

CK#

1 D# ( ?-

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Dr ~



FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TOSTATEWI DEOR 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 THE [ I CHECKTHI S BOXI F

PAC CHECK NUMBERFOR EACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )

a/ 7

CANDI DATE NAME ANDADDRESS 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 me n t ) WASMADE( MM I DD( YR) AND PAC

CHECK

NUMBER

~oC

CK# r - , 3 1/ 107 4 $ o 2. ~eD

l Z /l 3

I D#

7I D#

I D#

CK# / D J 11 7 ~7

1 D# ~/ r YJ L ~ ~' S

C K #



FORI NSTRUCTI ONS, SEEBACKOFFORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TT E E ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TOSTATEWI DEOR L EGI S L AT I V ECANDI DATES, L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMNAND THE F1 CHECKTHI S BOXI F

PAC CHECKNUMBERFOR EACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVAI L ABL E FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.

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 an i z a t i o n)

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 ) ( Di s b u r s e me n t ) WASMADE( MM/ DD / YR) AND PAC

CHECK

NUMBERI D# R, -~~~ccc~s a r ~~

CK#

1 D# b y° - ~

1 1 E Q Ol 1C K #l OD

~~

~GI D# W,

4 2 Y 1 _ t 1 /CK#

l QD ~ 1 7 - 1.

t a i - ~ ' l C K l DD i / ~s v r ~I D#

CK#

I D#

CK#



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1 ?9 7

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FORI NSTRUCTI ONS, SEEBACKOF FOR. -

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 )

NOTE : D e b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p a i d mu s t b e i n c l u d e d o n t h i s

S c h e d u l e , a s w e l l a s a ny n ew o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

DEBTS/ OBL I GATI ONSREMAI NI NG THI S REPORTI NG PERI OD

( DO NOT I NCLUDE LOANS - - SHOWLOANSON SCHEDULE F )

SCHEDULE

D I NCURRED( R e v . 0 8 / 9 8 ) I NDEBTEDNESS

CHECK THI S BOXI F AMENDI NGFORM

An " i n c u r r e d d e b t " i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . ,

r e g a r d l e s s o f wh e t h e r a n i n v o i c eh a s b e e n r e c e i v e d .

DATE

I NCURRED( MMI DDI YR)

NAME AND ADDRESS OF PERSONTOWHOM DEBT OROBLI GATI ON I S OWED

DESCRI PTI ON OF GOODS OR

SERVI CES PROVI DED ORPURCHASED

BALANCE OWED ATCLOSE OFREPORTI NG

PERI OD'

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FOR I NSTRUCTI ONS, SEESACKOF FORM

THI S FORMI S USED BY CANDI DATES' COMMI TTEES ONLY

COMMI TTEE 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 )

PART I I - I TEMI ZED BREAKDOWN OF UNREI MBURSEDEXPENSES PAI D BY CONSULTANTTO OTHERS I N PERFORMI NGSERVI CESOF CONTRACT ( T h e s e e x p e n s e s s h o ul d NOT b e

PART - NAMEAND ADDRESS OF CONSULT ANT

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

Name C o n s u l t a n t

M a i l i n g Ad d r e s s

C i t y

S t a t e

Z i p Code

~G

s 7 ~ ' r c Cl l z ~

TOTAL ANTI CI PATEDCOMPENSATI ONFOR

CONTRACT PERI OD ( MWDDI YR)

PERFORMANCE

F r o m

To

; a - 3 1 - ' ~ J /

ESTI MATES OF PERFORMANCE

7

Page

/ o f /

( f o r S ch e du l e G)

SCHEDULE

G BREAKDOWN

OF MONETARY( R e v 0 2 / 9 6 ) EXPENDI TURES

BY CONSULTANT

CHECK THI S BOX I F

AMENDI NG FORM

DATEEXPENDEDMMI DDI YR

NAME AND ADDRESS TOWHOMEXPENDI TUREDi s b u r s e me n t WAS MADE PURPOSE

AMOUNT

EXPENDED

s

SUB- TOTAL

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

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