Carstensen Zach - 1252 - Scanned

FOR l,'JSTRUCTIONS.
SEE BACK OF
DISCLOSURE
DISCLOSURE SUMMARY PAG REPORT
IMPORTANT: Indicate type of committee you are reporting for: FLI

( t )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate
( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee
She ZSupport Slate 9SA;andidates
SURER (or person filing this report) TELEPHONE
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :
I AM FILING A IZ fil C7/

(report date)
`~ REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR.
Indicate one 19
[]CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election
(] Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed .)
STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period. (This is the total
of all monies held by the committee . This amount MUST be the
same as the cash on hand at the end of the last reporting period,
or must be zero if this is first report filed .) ....... ........... . ..... ............ .................... ........... .. .......$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ... .... .. .......... ..... ........... ..... .. ..... ..
Schedule F: Loans Received total (Attach Schedule F) ... .... .. ...... .......... ................ ..... .. ..... ..
Schedule H : Total Sales of Campaign Property (Attach Schedule H) .... ................ ..............
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL......S 97-3 -1-75
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) . ...... ...... .. .. .. .... ...... . . ......... ....... ...... ...... 3 .5,-,7c 1
Schedule F: Loan Repayments total (Attach Schedule F) ..... .. .. .............. ......... ....... .. .... ......
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . .... ... .. . .. .. .. . . . ... .. ......... .. .. . . ..... .. ... ... .. ......... . .. .. .. .. .. .. ..... .. ..... .. ..... .. .. . .... .$ 6991 173,
UNPAID BILLS (From Schedule D - Attach Schedule D) . ....... ... ....... ........ . . .... . . ...... ............ .. ...... .. .. .. .$
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) ........ .. .. .. . . . ... .. .. ... ....... .. .. .. .. .. .. .. .$
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) .. .. ..... ... .. .. .. . . . ..... .. ... .. ..... .. .... .. .. .. .. .$
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $

FORYNS~TRUCTIONS, SEE BACK OF F I SCHEDULE
B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. o9M7) EXPENDITURES
STATE PAC COMWTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES. LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 0 CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A UST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .
COMMITTEE NAME (Must be same as on Statement of Organization)

U
M M~ _~
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if appliomMo) (Disbwsernent) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
/ 0, ID# 5~,y
CK# ?? 0. Sox zoo ,-, $
-I,4 /UO nor
ID#
' .i'u l ,c.c.J PIZ.f-0y1 r"r
11. 161 ~~ 52rS .7 s-)1

c~c _~sc_ AJ n ,Lc G~f r l . 1-~ 73 , o c1
ID#
CK#
ID#
CK#
` ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $ 3 Uc1
TOTAL (N last page o1 this schedule) $ %3 rJC1
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions.)
E zpenditures to peratrts/entities Providing consulting, advertising, fundraising, poNng, managing, organizing services must also be delall itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the perswently on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
Page / of ___Z
(for Schedule B)

Carstensen Zach - 1252 - Scanned

Uploaded by

Copyright:

Available Formats

Carstensen Zach - 1252 - Scanned

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Carstensen Zach - 1252 - Scanned

Uploaded by

Copyright:

Available Formats

FOR l,'JSTRUCTIONS.

IMPORTANT: Indicate type of committee you are reporting for: FLI

SURER (or person filing this report) TELEPHONE

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :

I AM FILING A IZ fil C7/

STATEMENT OF CASH ON HAND

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $

COMMITTEE NAME (Must be same as on Statement of Organization)

11. 161 ~~ 52rS .7 s-)1

TOTAL (N last page o1 this schedule) $ %3 rJC1

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

You might also like