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FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI 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" r E

I 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 :( 1 ) S t a t e w l d e r t 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 l e PAC ( 3 ) S t a t e P a t 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 ( B ) C i t y C a n d i d a t e ( 7 ) S , cP 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 ( B ) C o u n t y PAC ( 9 ) C i t y PAC ( 1 0 ) S c h o o l B o d r i " F ' 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 ONLY :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 f 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 Ho u s e )

SI GNATURE OF PERSON FI L I NG I f E PORT

AM FI L I NG A U ~ . ~ .

[ ] CHECK I F AMENDMENT TO REPORT DATED

s l - _ S 6 s :TEL EPHONE

0 C h 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 Fo r m DR- 3( Y o 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 . )

STATEMENTOF CASHONHANOI

ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A - C a 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 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 Camp a 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 a p 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 )

" UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . , . $' I N K I ND CONTRI BUTI ONS ( F r o m Sc he d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . $- OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - At t a ch Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . , . . . . . . . , . . . $CANDI DATE COMMI TTEES ONLY :CONSUL TANT BREAKDOWN ( Sc h ed u l e G A t t a c h e d? )VALUE OF CAMPAI GN PROPERTY ( Fr o m Sc h e d u l e H - A t t a c h Sc h e d u l e H) $

FORMDR- 2( Ve v . 0 7 1 20 0 4 )

L o g g e d I n~ e a n n c d -, . . , _C o mp u t e rA u d i t e d

; 2 _ 0 GREPORT FOR ( 1 ) ELECT I ON 1 ( 2 ) NON- E LECT I ON YEAR( r e p o r t d a t e ) I n d i c a t e b y # F2 3 .

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 ec o mmi t t e e T hi s a m o u n t MUST b e t h e s a m e a s t h e c a s h o n h a n d a t t h e e n d 3 S7 , 3o 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 mus 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . $

SUB- TOTAL . . . . . S / y O/ 3SUBTRACT TOTAL MONEY SPENT THI S PERI OD 0Sc 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 Sc 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 ce m u s t - ] 4 - / ,b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . $ _ . _ . . , . .

DI SCLOSUREREPORTA'F d r 'O f f t e o Us e On l y ~~Co f r n m . # ( i CJ

L a t e r e po r t s a r e s u b j e c t t opo s s i b l e c i v i l a n d c r i m i n a lp en al t i e s .

Y - / ? zDA SI NED

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

Co u n t y R L o c a l C o mm i t t e e s , e n t e r C o u n t y i nwh i c h E l e c t i o n i s H e l d

YES F - 1 NO

2 u a

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For I n st r u c t i on s, SeeBack of Form

CONTRIBUTI ONS - - MONEYTAKENI N( I n c l u d i n g c an di d a t e ' s p er s o na l f u n ds )

COMMI TTEENAME ( Mus t b e s ame as on St # f emen t o f Or g an i z a t i o n )Nke. u At -A- Ge- Cr r

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 COMMI TTEE) , L I STTHE PAC I DENTI FI CATI ONNUMBER ANDT HEPACCHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM 7 1 4 E I OWA ETHI CS AND CAMPAI GNDI SCLOSUr E BOARD,CAUTI ON : Se c t i o n 658 . 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 ma t i o n c o p i 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 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 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 e s

8U 8 - TOTALTOTAL ( i f l a s t page 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 mmi 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 . 1 c o n t r i b u t i o n t o t h ec o mmi t t e e . R e i a Go n s h i p mu s t b e Shown t o t h e t h i r d d e g r o c 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 d t f i n l l y ( r e l a t i v c s b yma r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a nd i d a t e . b u t t h e r e i s n o Page o ff a mi 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 Sc h e d u l e A)

SCHEDUL EA MONETARY( Re v 0 7 1 0 ) RECEI PTSQCHECK THI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - 4 I F FORRECEI VED ( i f a p p l i c a b l e ) ' l ' OCANDI DATE' RECEI VED FUND-( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEo ' / a r~D

I D#CK# ~ - - I 1 L J ( , r - ~SkI D# ( ' k , r l e I I - q.

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Fo r I n s t r u c t i o n s , Se e Ba 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 TT EENAME ( Mu s t b e s ame a s o n St a t e me nt o f O r g a n i z a t i o n )

STATECANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBER AND THE PACCHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD,CAUTI ON : Se c t i o n 6 8B 3 2 A ( 6 ) , I o wa Cod e , 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 a nd s t a t e me nt 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 ny c o mme r c i a l p u r p o s e b y a n 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 o mmi t t e e s .

D i s c l o s u r e I 3 w r e q u i r e s c a n d i d a t e c o r n ml t t o 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 any r e l a t i v e mak i n q a c o n t r i b u t i o n t o t h ec o mm i t t e e , R e l a t i o n s h i p must b e s h own 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 nd 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 same a s c a n d i d a t e , b u t a t o r c i s nof 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 umn , ( f o r Sc h e d ul e A )Pag e O" ' o f

SCHEDUL EA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS0CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELAT I 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-( MMI DDi YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEGj I D#

0( r t " S, l o S CK#I D # C ~ , a . r L a r - c Taut .

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THI S BOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :Pu r c h a s e s o f c c r t a l 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 s ! 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 p e nd i t u r e s t o p e r s o n s i e n l 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 m i z e d o nS c h e d u e G b y t h e a mo u r f l . 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 en d i t u r e ma d e b y t h e p e r s o n t e n t i l 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 c f o 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 Co d e 6 8 A , 4 0 2 ( 3 ) ( I ) . )

Page Z-o f - , j

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

200

FOR I NSTRUCTI ONS, SEE BACK OF FORM Rec e t . B ' u ~ f n ; -TSCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE: FORCONTRI BUTI ONSMADE TO ST A' r r WI n F OR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THL DLSI GNATED COLUMN ANDTHE CHECKTHI S BOXI FPACCHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF 1 0 NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI 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 Pa n i z a t i o n )a ~ ~ ~ . ~ ~

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE 1 0 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 s mo n l ) WAS MADE

( MM/ DDI YR) AND PACCHECKNUMBER

I D#US - CK# ,