District Union 431 UFCW Political Action Account6028scanned

8/7/2019 District Union 431 UFCW Political Action Account__6028__scanned

1/3

OCT - 1 9 - 0 4 TUE 11 02 AM UFCW43 1 FAX NO, 5 6 3 3 2 3 8 7 6 3 P . 0 1

FORI NSTRUCPONS, SE. FRACKOFFORM

CC) MMI TTV=~ : NAM. ( I l r 1 t I J ( I ) C s a r r l e a s o n S t a t e r n en t o f Or g an i z a t i o n)D i s t r i c t Un i o n 4 31 , L J F C , ; W, P o l i t i c a l A c ' t _ i o n Ac c o u n to r :I MP QI i 1 ' A NT : I s t d j C . j t , : t y p + . o f c ommi t t e e y o u a r e r e p o r t i n g f Comp u t e r

( t ) 8 l a t o w l d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) 5 1 a l e w i d e PAC ( 3 ) S t a t e P a r t y ( b ) 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 . ; ( G ) B A l l o 1 l a s u c l l = r a n c h i c e Co 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( i l El ms o f C a l u t i d a l e + - , _ . r . _ . ,

TUBE F TREASUC~ER` - a ~ c r s o n f i l i n g t h i s r e p or t )SI GNA ~~ { t V p TELEPHONE DATE SI GNED1 7 c ~ n a l t i e s Du e Fo r L at e F i l e d Re p or t s R a n g e f r o m $ 10 t o $400

5 1 E l N 5 T ~ t L I C T I t ~ NS ON SACK AND COMPL ETE 7 , y ~ F S ~ ? l , L ;

( r . : p o r t d a t e )n c F i r c K i t A h n r N r ? a ~ n e N ~ r r o F i i ' r ~ o r ~ r DATED

~ . ) 1 S G1 ~~ ) S URE SUMMARYPAGE

[ ] Ghoc : k i f l l - r i s i " f } n ~ ~ 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 " c c o f Di s s o l u t i o n Fo r m DR- 3 .( Yo u n - r c t s t c n n t i r l t ~ i , t o f i l e f e p o r t s u n t i l a No t i c e o f Di s s o l u t i o n i s f i l e d . )

STATEMENT OF CASMONHANDCASN OI J 1 - I A N f 7 r t t I I t E b e g i n r t i r t t l o f t i r 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 L o t a l

o f a l l t Y l U r i i B " J ms l d v y t h e c ommi t t e e . Th i s a m o u n t MUST b e t h e~. ~ a n ~ t ~ : ; a : , t h r : c : a r s h o n f t a n d a l t h e a n d o f t h a l a s t r e p o r t i n g p e r i o d ,o r mu s t l a o z c ; r o i f t h i s ; i ~ ~ f i r , t r e p o r t f i l e d . ) . . . . . . . . _ . _ . . . . . . . . . . . _ . . . . . . . . . . . _ _ _ _ _ . . . . _ . . . . . . _ _ . . _ . . . . . . . . . . . . . . . . . $A I ) C ' ' f C ) ~ 1 " A L . f 4 i C 3 NC Y TA i ~ > = N I N T HI S PERI ODS c i t r : c t l r l a A : C : r ~ h C o n t r i k ~ t a t i o n s t o t a l ( A t t a c h S ch e du l e A) . . . . . _ . . . . . . . . - - - _ . _ _ _ _ _ . _ . . _ _ _ _ _ _ _ _ _ . _ _ _ - _ _ _ . _ _ .S c f t r ; c F u l o G : F = a n a l - r ~ i . i n g l r v c n t s t o t a l ( A t t a c h S c he d ul e C) . - . . . . . _ , . . . . _ . . . . _ . _ _ . . . . . . . . _ . . . . . . . . , . . . , . . . .S r h n dUl v : h : I , . a an s f ~ i e c e i v e : d t a t : ~ l ( A t t a c h S ch e du l e F ) _ . _ . . . . _ . _ . . . . _ . . . . . . . . . . . . , . . , . . . . . . . . . , . . , . . . . . . . . . .Sc ; h c du l o h l : Tot . v l S; s l ~ s o f Ca mp a i g n Pr o pe r t y ( A t t a c h S ch e du l e H ) . . . . , . . . . . . . . . . . , . . . . . . , . . . . . . . . .

_ ~ i l e c f l a l o k l a p p l i a s t o C a n d i d a t + ? s ' Co mmi t t e e s On l rSUf 3 - TOTAL , . . . . $

S l 1 f 3 T R l 1 C : T l ' 1 ; } 1 ' A h . MC) NE' Y SPENT THI S PERI ODS c } t ~ : c h . r l e L ~ : E " x n c ~ i ~ d i t u r e s t o t a l ( A t t a c h S ch e du l e f 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . - _ . _ - - . . . . . .S c h e ~ c l : r h ; } " ~ : l . o ; ~ n ( t c : p a y me n t s t o t a l ( A t t a c h S c he d u l e F ) _ _ _ _ _ _ . . . . . . . . . . . _ . . . _ _ _ _ . . . . . . . . . . _ _ . . . . . . . . . . . , . ,

( ; A S H C) N I 1 A ND a l t h r , 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 ce mu s t

UNPAI C~ f f l L , l . . S ( F r c ~ r r t : y c l t e d l l l e t 1 _ At t a ch S c he d u l e D) . . . . . . . . . . . , . . . . . . . . . . . . . - . . . . . . . . _ _ . . _ _ _ . . . . . . _ . . . . . _ _ _ _ _ _ . . _ . . _ . $I N K I ND CONTR113 UTI C4~ S ( i - r o m S c he d u l e a E - At t a ch S ch e du l e E ) . _ _ _ . _ . _ . . _ . . . . _ . _ _ _ _ . . _ _ . . . . . _ . _ _ _ . _ _ _ _ . . . . . _ . . . $OUTSTANDI NG LOAN: " . , ( F r o r r i S ch e du l e F - A t t a c h S c he d ul e F ) . _ _ . _ _ . . . . . . . . . . . . . . . . . . _ . . . . . . _ _ . _ . _ . . . . . , . . . . . . . . . . $CANDI DATE CUMMf " f 1 " EE: ONLY :CONSUI . Y A N ' f ' f c RE: AKf 30WN ( S c he d ul e G A t t a c h e d ? )VA I . . UE Of ' CAMPAI GN P t ~ R O F f ; ? R TY ( F r o m S c he d ul e F I - At t a ch S c he d u l e H)

FORMDR-2( R EV . 02196 )

Fo r Of f c e Us e n l ~/Comm. #I n d e x e dA u d i t e d

1 0 / 1 9/ 0 4

8900. 0 0

1 600. 0 0

10500. 0 0

10000. 0 0

ol s c LOSUR~REPORT

/ A ( 1 ) ELECTI ON I ( 2 ) ~ ON- EL E CT I ON YEAR .I I n d i c a t e o n e

L o c a l C o r n m i t t e s , e n t o r Da t e o f E l e c t i o n

Cou n t y & l o c a l Co mml t i e e s , e n t e r Cou n t y i nwh i c h E l e c t i o n h h e l d

500. 0 0

YES NO


2/3

OCT- 1 9- 0 4 TUE 1 1 ; 0 2 AM UFCW431 FAX N 0 , 5 6 3 3 2 3 8 7 6 3 P . 02For I n st r u c t i on s, See Back o f For mCONTRI BUTI ONS- - MONEYTAKEN I N

( I n c i 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! ( mi s t t ) e s a n l e as on St at ement o f O r g a n i z a t i o n )D i s t r i c t Un i o n 4 , 31 , UFCW, P o l i t i c a l Ac t i o n A c c o u n t

SCHEDULEA I MONETARY( Re v . 0 2 / 9 6 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANUI UAf I : . r + NGTh : I f A C C7 Nf I + I L 1 U f I ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I D EN T I F I C A T I O NNUMBER AND' r l I l l. PAC;CHECK NUMNF_R I N THE pESI GNATEO COLI I MN- A L I ST OF I D NUMBERS I S AVA I L AB L E FROMTHE I OWA ETHI CS ANDCAMPAI GNp I SCLOSL I RI . GOARU .CAUTI ON; Se c t i o n BOL 3 . " s 2 A ( r ) , 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 ma t i o n c o pi e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r any c o r n r r m r c i , a l I s u r n o s e b y An y p a 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 .

` L 1 1 s r 1 o s u r e I 1 1 W r 0 1 1 1 1 1 1 3 c U o d i J a l r , : c o r n r r r i l l c e s t o d i : : c l o a o 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 i c o n t r i b u t i o n t o t h ec o r n r n i u c c , W - t a l i o n s ; f l i p r r r u c l L c shown t o t h e t h i r d d e gr e e o f c o n sa ng ui 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 1ma r t l a p e ) ( ; t e e P i i y -s 2 o f f o r ms p a c k e t . ) . I f sur name o f c o n t r i b u t o r 1 s t h e s ame a s c a n di d at e , b u t t h e r e i s n o p a g e o f _f a mi l i a l ml a t i a n s h i l l , e : n t r : 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 Sc h e d u l e A)

DATE r ' A O I h NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNTRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED( MMI DDI Y r t ) AND PAC CHECK ( i f a p p l i c a b l e )NUMBER0 3 / 3 1 / ( ) ' W# UFCW D i s t r i c t L o c a l 43 1 Tr an s mi t t a l Ac c 1 6 0 0 . 00$

CKf t

I DY

C K1 1

CI Qr 1

CKf f

-

C I ` 1 F

- _r . _ - __ I l e f t

C I G 1

C l o t

CK#

C I < J 1

C I : ' 1 tSUB- TOTAL $

TOTAL ( i f l a s t pa g e o f t h i s s c h e du l e ) 1 6 0 0 . 00


3/3

OCT - 1 9 - 0 4 TUE 1 1 : 03 AM UFCW43 1

FOR I NSTRUCTI ONS, SCE BACK OF FORVEXPENDI TURE : ) - - MONEY SPENT FROMCOMMI TTEE ACCOUNTPACCOMMI TT EES : NOTE : FOR CQP ( T R I B Lf f I ONS MADE TO STATEWI DE OR L EGI S L A TI VE

DI DATES . L I ST THECANDI DATE I DE NT I F I CA T I ON NUMBER I N THE DESI GNATED COLUMN AND THECHECK NUM13F r , R F 4 . J R EAr , H EXPENDI TURE . AL I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWAI CS i s CAMPAI GN DI SCLOSURE : BOARD .MMI TTE: E -~AME ( A Q u ; : t b e same a s o n St a t eme n t o f O r g a n i z a t i o n )D i s t r i c L Un i o n 4 3 1 , UFCW, P o l i t i c a l A c t i o n A c c o u n t

1 , 5 f 3 o~ AFPLI ES - TA - CANDI DATES' COMMI TT EES ONLY :ampa i g n f u n ds may b e . u s e d o n l y t q r) Eampa i g n p u r p o y e s .c o n s t i t u e n c y e x p e n s e s , an d) v d u c a t i o n a l an d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .I c a w i n s e r t t r i o a p p l i c a b l e n u m b ~ ~ r i n t h e p u r p o s e c o l u mn f o r e a c h e x p e n d i t u r e .

FAX NO . 5 6 3 3 2 3 8 7 6 3

SUBTOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )

u r c h a s w s o f c o r t am c a mp a i g n p r o pe r t y c o s t i n r d 5 5 0 0 o r mo r e mu s t a l s o b P 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 n . ) e t i o n s . )

P , 03

C4 t o p e r s w i s l e n f t i L $ 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 , manag i n g , o r g a n i z i n g s e r v i c e s mu st a l s o b e d e t a i l i t e mi z e d o nG b y t h e a r ' V I O U n t , p u r p o s e , an 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 mad 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 oG I n . ; r u c t i , ~ r l Y n , ) d l o wo Co d e 5 6 . f i ( 3 ) ( i ) . )Page o f

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

SCHEDULEE3 MONETARY

( R e v , 0 2 1 9 6 ) EXPENDI TURESE ] CHECK THI S 13OX I FAMENDI NG FORM

C AN 0 I 0 A ~ 1~E NAMEANDADDRESS TOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( Di s b u r s e me n t ) WASMADE ( CANDI DATES SEE EXPENDEDPEN( ) E 1 ) ( i f p p t i s : i ! ; 4 ~ : ) BELOW& ENTERWDDI YR) ANDPAC; 1 , 2 , 3 )

CFI F: ; t ; , 1 < NUMBERS7 3 1 6 . 1 b # , o c I s l an d o W) em n t r Comm c o n t r i b 0 1 1 A 0 1 0P O Bo x 3 1 2 8C , K ( ) 5: i i i 1 Rock I s l a n d I L 01204

C E j ;

CK ; t ( )

CK 1 , `

CKi d

CK#

G, K~ ( ( )

Documents

District Union 431 UFCW Political Action Account__6028__scanned

District Union 431 UFCW Political Action Account6028scanned