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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 Co mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co mmi t t e e( 8) S u p p o r t S l a t e o f C a n d i d a t e s

TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNEDURo u t i n e Pe na l t i e s Due Fo r L a t e F i l e d Re p o r t s Range f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCT I ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :I AM FI L I NGA I 6 0 SPORTFORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR .

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OC h e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a nd 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 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 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 CASHON HANDCASH ON HAND a t t h e b e g 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 lo f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s amoun t MUST b e t h es ame a s t h e c a s h o n h a n d a t t h e e nd o f t h e l a s t r e p o r t i n g p e r i o d , l ~ go 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADDTOTAL MONEYTAKEN I N THI S PERI OD 4( 0Sc h e d ul 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 ) . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d ul 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 ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d ul 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( S c h e d 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 )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d ul 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 ul e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASHON HAND a t t h e e nd 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 c e mus tb 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 e d ul e D - A t t a c h Sc h e d ul e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I 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 ul e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( Fr o m Sc h e du l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d ul e H - A t t a c h Sc h e d u l e H )

FORMDR- 2 I DI SCLOSURE( Re v . 0 1 / 9 8 ) REPORT

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C0 1 4 MI T T E E NAME ( Mu ; ( b e s ame a s o n S t a t e M I p n t o f O r p a r l i z s t i o n )

STATE C N DA T ES NOT E I F A C ON T R I B U T I O N I S R EC E I V D F DM A S T A T E P A C ( P O L I T I C A L A C T I ON C OM MI T T E E ) , L I S T T HE P A C I D E N T I F I C A T I O NNUMBER AND T H E P A C C H E C K NUMBER I N T H E D E S I G N A T E D C O L U M N A L I S T O F I D N U M B E R S I S A V A I L A B L E FROM T H E I O WA E T H I C S A N D C A M P A I G ND I S C L O S UR E B O A R DCAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o 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 a n 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 a n y c o m m e 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 m m i t t e e s

SUB - TOTALTOTAL ( i f l a s t p a g e o f t h i ss 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 mm i t t e e s t o d i s c l o s e t h a 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 m a k k 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" ( r e l a t i v e s b ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) I f s u mame o f c o n f r b u t o r i s t h e s a m e 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 ( f o r S c h e d u l e A )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) R ECE I PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR R E L A T I ONSHI P AMOUNT - 4 I FR ECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE ' R ECE I VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AINUMBER I NC

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( I n c l u d i n q c a n d i d a t e ' s p e r s o n a l f u r W s )

S C H E D U L EA MONETARY( R e v . 0 6 / 9 7 ) I RECEI PTSQCHECK T HI S BOX I FAMENDI NG FORMCOMMI TTEE NAME ( Mu s t 6 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 )

~a on5 oh 6k4eSTATE CANDI DATES NOTE : I F A C ON T RI B U T I O N I S RECE D FROMA S T A T E PAC ( P O L I T I C A L A CT I O N C O MM I T T E E ) . L I S T T HE PAC I D EN T I F I C A T I O NNUMBER AND THE PACCHECK NUMBER I N THE D E S I G NA T E D COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 8 . 3 2 A ( 6 ) , 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 m a t i o n c o p i e d f r o m r e p o r t s a nd 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 a n y c o m m e 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 m m i t t e e s .

S U B - T O T AL I $ _ q t l z d _ I g ooT O T A L ( ! f l a s t p a g e o f t h i ss c h e d u l e ) $ 1 j 3D 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 makkq 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 m u s t b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a r p u i n i t y ( b l o o d r e l a t i v e s ) a n da" ( r e l a t i v e s b y , , 2ma r r i a g e ) ( S e e P a g e 2 o f f o r m p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s f t s ame a s c a n d i d a t e , b u t t h e m i s n o P a g e o ff a m i l i a l r l a t a 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 m n . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NC

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T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :Pu 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 mus t a l s o b e i n v e n t o r i e d o n Sc h ed 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 . )Ex 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 nSc h e d u l e G b 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 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 5 6 . 6 ( 3 ) ( 1 ) . )

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

FORI NSTRUCTI ONS, SEEBACK OFF' ' M SCHEDULEEXPENDI TURES B- MONEY SPENT FROM COMMI TTEE ACCOUNT MONETARY( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE O CHECK T HI SCANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE BOX I FPAC CHECK NUMBER FOREACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( M s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n )44. ~or n s ~ ' a e r c 5 e n - ~ - i V C

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE 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 m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI N 1 0 5 4 R ~ p u b % l c a n P l l e

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T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :P ur 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 mus t a l s o b e i n v e n t o r i e d o n Sc h ed 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 . )Ex 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 mus t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e a mo u n t , p u r p o s e , a nd 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 oSc h e d u l e G I n s t r u c t i o n s a nd I o wa Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

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

t - u H 1N57 RUCTI ONS, SEE BACK OF F " M SCHEDULEEXPENDI TURES - MONEY SPENT FROM COMMI TT EE ACCOUNT B MONETARY[ Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EGI SL ATI V ECANDI DATES , L I ST THE CANDI DATE I D ENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBERFOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NGFORMETHI CS 3 CAMPAI GN DI SCL OSURE BOARD .COMMI TTEE NAME ( M 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 )4a honS r " tae r c 5 c x ) - E a - ~ i v e

CANDI DATE NAME AND ADDRl =SS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I 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 m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI Nc K# ! U~3 , a"- r~ . . o g38 ~ospa y aoI D#

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