crowley cory1510scanned

8/7/2019 Crowley Cory__1510__scanned

http://slidepdf.com/reader/full/crowley-cory1510scanned 1/6

FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

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

C i t i z e n s f o r Cr o wl e y

I MPORTANT : I n d i c a t e b y # t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :0( 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 Co 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 e

CANDI DATE COMamI TTEES I ,

Ca nd i d a t e NameI A k l ' r4. r ~

.

a

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Co r y Cr o wl e y

O f f i c e So u g h t

1 0 / 2 6 / 0 4I AM F I L I NG A

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

S t a t e Re p r e s e n t a t i v e

.

/ A, ~ hSI GI ATURE OF PERSON F I L I NG REPORT

CHECK I F AMENDMENT TO REPORT DATED1 0 / 2 4 / 0 4

E l Ch 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 DR- 3 .

( Y ou mus 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 . )

SUBTRACT TOTAL MONEY SPENT T HI S PERI OD

Re p u b l i c an

D i s t r i c t ( i f Se n a t e o r H o u s e )

3 6

3 / 9 - 3 G d d - o k - yTE L EPHONE

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

I n d i c a t e b y #

ST ATE MENT 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 o t a l o f a l l f u n d s h e l d b y t h e

c o mmi t t e e . T h i s amou n t MUS T b e t h e s ame as t h e c a s h o n h an d a t t h e e n 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD TOTAL MONEY TAKEN I N T HI S PERI OD

Sc 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) . . . . . . . . .

Sc h e d 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 e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sc h e d u 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 d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H ap p l i e s t o Ca nd i d a t e s ' Co mmi t t e e s Owl

Sc h e d u l e B : Ex p e nd 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 ) ( * * a l s o s e e d e bt s an d l o an s b e l o w) . . . .

Sc h e d u l e F : L o a n Re p a yme 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 al a nc e mus t

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * UNPAI D BI L L S ( F r o m Sc h ed u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * OUTSTANDI NG L OANS ( F r o m Sc h ed u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

CANDI DATE COMMI TT EES ONLY :

CONSUL TANT BRE AKDOWN ( Sc h ed u l e G A t t a c h e d? )

VAL UE OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h e d u l e H)

FORM

DR- 2( Re v . 0 7 / 2 0 0 4)

DI SCL OSURE

REPORT

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

Co mm. #

L o g g e d I n

Scanned

Compu t e r

A 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 m i 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 n

Co un 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

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

2 1 . 7 9

1 2 , 2 6 4 . 0 0

0 . 0 0

0 . 0 0

SUB- TOTAL . . . . . $ 1 2 , 2 8 5 . 7 9

4 , 6 5 8 . 1 5

0 . 0 0

4 - 4 8 1 . 5 2

7 , 8 3 1 . 0 0

0 . 0 0

$ 0 . 0 0

i - 1 ULDATE SI GNED

YES NO




COMMI TTEE NAME ( M u 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 )


Rese t F o r m

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 )

SCHEDULE

E I I N KI ND

( Re v 0 6 / 9 7 ) CONTRI BUTI ONS

0CHECK THI S BOX I F

AMENDI NG FORM

' 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 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 n i n k i n d c o n t r i b u t i o n t o t h e Page 1 o f 1

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

b y ma r r i a g e ) . ( S e e 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 s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 .

DATERECEI VED( MM/ DD( YR)

NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI PTOCANDI DATE

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

DESCRI PTI ONOF I N KI ND

CONTRI BUTI ON

ESTI MATEDF AI R MARKET

VAL UE

J I F FOR

FUND- RAI SERCONTRI BUTI ON

1 0 / 1 9 / 0 4

Campa i g n o f On e

PO Bo x 8 8 7

Ame s , I A 5 0 0 1 0

Su p p o r t e r Ma i l i n g 3 3 1 . 0 0

1 0 / 2 0 / 0 4

Re p u b l i c a n P a r t y o f I o wa

6 21 Ea s t 9 t hDe s Mo i n e s , I A 5 2 3 0 9

P r i n t i n g 3 , 7 5 0 . 0 0

F

1 0 / 2 0 / 0 4

Re p u b l i c a n P a r t y o f I o wa

6 21 Ea s t 9 t hDe s Mo i n e s , I A 5 2 3 0 9

Po s t a g e 3 , 7 5 0 . 0 0 F

F- 1

VA hN 2 6 3 -2 0 0- 5-

F - 1

0




DI SCLOSURE SUMMARY PAGE

COMMI TT EE NAME ( Mu s t b e s ame as o n St a t eme n 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 b y # t y p e o f c o mm i 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 / 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 mm i 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 ) Sc h o o l B o a r d o r Ot 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 l

S 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 e


Ca nd i d a t e Name 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 )

~ o r y Cr o wl e y R e p u b l i c a n

Of f i c e So u g h t D i s t r i c t ( i f Se n a t e o r H o u s e )

S t a t e R e p r e s e n t a t i v e 3 6

0SI GNAT E OFPR~NREPORT

I AM F I L I NG A1 0 / 2 6 / 0 4

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

EI CHECK I F AMENDMENT TO REPORT DATED

3 i ~ - . ( V- 2 R, 2TE L EPHONE

Ch 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 an 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 .

( Yo u mu s t c o nt 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- EL ECT I ON YEAR.

I n d i c a t e b y #

ST ATEMENT OF CASH ON HAND

1 3

CASH ON HAND a t t h e b eg i n ni 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 amou n t MUS T b e t h e s ame as 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD TOTALMONEY TAKEN I N T HI S PERI OD

Sc h e d u 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 ) ( * a l s o s e e i n - k i n d b e l o w) . . . . . . . . . .

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

Sc h e d u 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 d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

SUBTOTAL . . . . . $ 1 2 , 2 8 5 . 7 9

SUBTRACT TOTAL MONEY SPENT T HI S PERI OD

Sc h e d u l e B : Ex p e nd 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 ) ( * * a l s o s e e d eb t s an d b a n s b e l o w) . . . . 4 , 6 5 8 . 1 5

Sc h e d u l e F : L o a n Re p a yme n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0

* * UNPAI D BI L L S ( F r o m Sc h ed u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ , . . , $

* I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * OUTSTANDI NG L OANS ( F r o m Sc h ed u l e F - At t ac h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $


CONSUL TANT BRE AKDOWN ( Sc h e d ul e G At t a ch e d ? )

VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - At t a ch Sc h e d u l e H)

FORM

DR- 2( Re v . 0 7 1 2 0 0 4 )

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

Co mm # k ! ! -a- ' / 0L o g g e b.~~

Scanned

Compu t e r

A u d i t e d

L a t e r e p o r t s ar e s u b j e c t t o

p o s s i b l e c i v i l an d c r i m i 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 n

Co u n t y B L o c a l C o mmi t t e e s , e n t e r Co 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

2 1 . 7 9

1 2 6 4 . 0 0

0 . 0 0

0 . 0 0

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 nc e mus t7 , 6 2 7 . 6 4

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

$ 0 . 0 0

$ 4 , 4 8 1 . 5 2

0 . 0 0

0 . 0 0

DI SCL OSURE

REPORT

t o a p - 4DATE SI GNED

YES NO



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 m

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 T TEE NAME ( Mu s t b e s ame a s o n St a t emen t o f O r g a n i z a t i o n )


Re se t F o r m

STATE CANDI DATES NOTE : I F A C ON T RI BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL A CT I ON COMMI TTEE) , L I ST THE PAC I DENT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS 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 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 .

SUB- TOTAL1 2 , 2 6 4 . 0 0

TOTAL ( 1 1 f l a s t p a g e o f t h i s s c h ed u l e )1 2 , 2 6 4 . 0 0

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 mu 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 P a g ef 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 .

1 1o f _

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

SCHEDULE

A MONETARY

( R e v . 0 7 / 0 3 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F F ORECE I VED f r f a p p l i c a b l e ) TO CAN D I 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#J a n e t S u l l i v a n

1 0 / 1 5 / 0 4CK# 2 2 1 0 2 7 t h S t . $ 5 0 . 0 0

Ma r i o n , I A 5 2 3 0 2

I D#Ri c ha r d F e t t e r

1 0 / 1 5 / 0 4 CK# 2 6 2 6 I n d i a n H i l l Rd . SE 1 5 0 . 0 0

Ce d a r Ra p i d s , I A 5 2 4 0 3

I D#J o s h u a L i n e be r g e r

1 0 / 2 1 / 0 4 CK# 1 3 7 5 Do mi n i o n Ri d ge L an e 1 0 0 . 0 0 ElHemdo n , VA 2 0 1 7 0I D#

9 6 1 3 L i n n Co u n t y Re pu b l i c an Wo me n1 0 / 2 1 / 0 4 CK# 5 0 1 5 5 t h S t . 2 0 0 . 0 0 E ~ l1 7 0 0

L i s b o n , I A 5 2 2 5 3

I D#9 6 3 7 L i n n E ag l e s

1 0 / 2 1 / 0 4 CK# 3 2 0 Cr e s c e n t S t . SE 3 , 0 0 0 . 0 01 5 3 0

Ce d a r Ra p i d s , I A 5 2 4 0 3

I D#1 5 1 0 Th e H a w k e y e PAC

1 0 / 2 3 / 0 4 CK# 3 4 0 0 Wo o d l a n d L an e 8 , 7 5 0 . 0 01 1 0 9 A l e x a n d r i a , VA 2 2 3 0 9

I D# T o t a l Un i t e mi z e d C o n t r i b u t i o n s

CK# 1 4 . 0 0

I D#

CK#

I D#

CK#

I D#

CK#



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 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 m i z e d o nS c h e d u l e Gb 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 l f o f t h e c a n d i d a t e ' s c o mmi 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 Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

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

FOR I NSTRUCT I ONS , SEE BACKOF FORM Re s e t Fo r mSCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT

( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DESI GNATEDCOLUMNAND THE F E ] 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 .

COMMI TTEE NAME ( M u 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 )


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

EXPENDED C r 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 PAC

CHECK

NUMBER

I D#RARM, I n c . Re t u r n o f c o r p o r a t e c o n t r i b u t i o n

1 0 / 1 5 / 0 4CK#588

1 7 7 5 7 t h Av e .$

5 0 . 0 0Ma r i o n , 1 A 5 2 3 0 2

I D# S P o s t Of f i c e Po s t a g e &e n v e l o p e t o ma i l 1 0 / 1 9 / 0 41 0 / 1 9 / 0 4

CKi f W1 6 1 s t Av e . r e p o r t 3 . 0 1e d a r Ra p i d s , I A 5 2 3 4 9

I D # o wa F a r m Bu r e a u Sp o k e s ma n Ca mp a i g n a d1 0 / 2 1 / 0 4

CK#5890Box 6 7 0 3 7 8 . 5 4o wa F a l l s , I A 5 0 1 2 3

D#i n n GOP Co nt r i b ut i o n t o L i n n GOP

1 0 / 2 1 / 0 4CK#590

1 8 3 r d Av e . SE 1 , 1 0 0 . 0 0e d a r Ra p i d s , 1 A 5 2 4 0 1

I D#C o r y Cr o wl e y Re i mb u r s e me n t t o c a n d i d a t e f o r

1 0 / 2 5 / 0 4CK#591

1 1 3 5 El m S t . p a y m e n t o f p r i n t i n g f o r c a mp a i g n 1 8 0 . 6 0Ma r i o n , I A 5 2 4 0 3 l e t t e r

I D #Ma i d Ri t e Ca mp a i g n l u n c h

1 0 / 2 6 / 0 4CKAI S92

0 0 0 7 t hAv e

.3 5 . 0 0Ma r i o n , I A 5 2 3 0 2

I D# S P o s t Of f i c e Po s t a g e t o ma i l c a mp a i g n l e t t e r1 0 / 2 6 / 0 4

CK#5935 1 6 1 s t Av e .

1 1 1 . 0 0Ce d a r Ra p i d s , I A 5 2 3 1 9

I D #e L a m a r Co mp a n i e s B i l l b o a r d s

1 0 / 2 6 / 0 4CK#597

O Box 9 6 0 3 0 1 , 8 0 0 . 0 0a t o n Ro u g e , LA 7 0 8 9 6

SUB- TOTAL $ 4 , 6 5 8 . 1 5

TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ $ 4 , 6 5 8 . 1 5



FORI NSTRUCTI ONS. SEEBACK OF FORM

COMMI TTEE NAME ( Mu s t b e s ame 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 )


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 m a 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 sS 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 ns i n c u r r e d i n t h i s p e r i o d

DEBTS/ OBLI GATI ONS REMAI NI NG T HI S REPORTI NG PERI OD

( DONOT I NCLUDE LOANS - - SHOWLOANS ON SCHEDULE F )

' I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i ma t e d " b e s i d e t h e f i g u r e .

SCHEDULE

D I NCURRED

( Re v 0 8 1 9 8 ) 1 I NDEBTEDNESS

CHECK THI S BOXI F AMENDI NG

FORM

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 e

e 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 an i n v o i c eh a s been r e c e i v e d .

P a g e I o f I

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

CANDI DATE COMMI TTEES NOTE :

' I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r t o n l e n t i t y w i t h wh om t h e c a n d i d a t e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e . E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e ms s u c h a s 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 i n g , ma n a g i n g , o ro r g a n ¢ i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i ma t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

DATE DESCRI PTI ON OF GOODS OR BALANCE OWED ATI NCURRED NAMEAND ADDRESS OF PERSON SERVI CES PROVI DED OR CLOSE OF( MM/ DDNR) TOWHOMDEBTOROBLI GATI ON I S OWED PURCHASED REPORTI NG

PERI OD'

1 0 / 1 5 / 0 4F i n e L i n e P r i n t i n g P r i n t i n g o f c amp a i g n p os t c a r d s1 0 7 5 Hawke ye Dr . 9 2 8 . 5 2

Hi a wa t h a , I A 5 2 2 3 3

On Sc r ee n P l u s , L C L ar g e c amp a i g n y a r d s i g n s1 0 / 1 8 / 0 4

2 1 2 9 No r t h Towne Lan e S t e . A 9 1 3 . 5 0

Cedar Ra p i d s , I A 5 2 4 0 2

B i g l e r t e k Campa i g n we bs i t e h os t i n g1 0 / 2 5 / 0 4

2 0 5 Ma i n S t . NE t h r o ug h 1 2 / 3 1 / 0 4 5 9 . 8 5

S h e l l s b u r g , I A 5 2 3 3 2

1 0 / 2 0 / 0 4E i l e e n Cr o wl e y Po s t a g e p u r c h a s ed f o r mai l i n g

1 2 1 Ro l l i n g wo o d Dr . v a r i o u s c amp a i g n l i t d r o p p i e c e s 2 , 1 3 0 . 6 0

Cedar R a p i d s , I A 5 2 4 0 5

1 0 / 2 1 / 0 4J an Cr o wl e y P os t a g e an d o f f i c e s u p p l i e s2 4 0 S . B l a i r s f e r r y Cr o s s i n g p u r c h as e d f o r c amp a i g n l e t t e r 4 4 9 . 0 5

Hi a wa t h a , I A 5 2 2 3 3

SUB- TOTAL $

4 , 4 8 1 . 5 2

TOTAL DEBTS OWED BY COMMI TTEE AT THE END OF T HI S REPORTI NGPERI OD $4 , 4 8 1 . 5 2

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