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F , OR I NSTRuCTt ONS. SEEBACKO 3RM

DI SCLOSURE SUMMARY PAGCOMMI TTE NAME ( Mu s t b e s am a s o n S t a t en o f

I MPORTANT : I n d i c a t e 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.

O I S ( 3 i , + 0 E i E l BOARJ AN 2 4 2 0 0 2

j f l 1 - 22

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

FORM

F o r O f f i c e Us e O n l yComm . # -_

SI GNATUREOF TREASURE ( 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 S I GNEDRo u t i n e Pen al t i e s Du e Fo r L a t e F i l e d Rep o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONSONBACK AND COMPL ETE THE FOLL OWI NG SENTENCE :

DR- 2 DI SCLOSURE( Re v . 0 1 / 9 1 3 ) REPORT

I n d e x e dA u d i t e d _q44Compu t e r

I AM F I L I NG A ~OUZ REPORT FOR AN/ A ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR .( r e p o r t d a t e ) I n d i c a t e o n e V1 1 - I

OCHECK I F AMENDMENT TO REPORT DATED

E l Check 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 mDR- 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 CASH ONHANDCASH ONHAND 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 mon i e s h e l d b y t h e c ommi 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 nd a t t h e en 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 must 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 . . . . . . $SUBTRACTTOTAL MONEY SPENT THI S PERI ODS c he 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 S c h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he d ul e F : L o a n Re p a y men t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UNPA I D BI L L S ( F r o mS c he d ul 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 S c he d ul e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m S c he d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATECOMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S ch ed u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m S c h e d u l e H - A t t a c h Sc h e d u l e H ) $

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 nC o u n 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 nw h i c h E l e c t i o n i s h e l d

l - 5 y sv . . ~ -;/ADD TOTAL MONEY TAKEN I N THI S PERI OD ,S c he 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 S c he d ul e A )S c he d ul e F : L o a n 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . - - - . .S c he d ul 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 a pp l i es t o Ca n d i d a t e s ' Commi t t e e s On l y )

/ Dy y 3S

CASH ONHAND a t t h e en 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 c e mus t %b e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ go .

YES - / NO

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r o r i n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKENI N

( I MAXNq Ca n d Wl a ' s p e r s o n a l l a n d s )COMMI TTEE NAM! OWat be s ame a s o n S t a t e me n t o f o r g a r u z a d a r y

- - T.STATE CANDI DATES NOTE I F A CONTRI BUTI ON I S RECSAb FROMA STATEWK ; Wxswl . ACTI ON mWo M mI x 7 r e E n L I S T THE PAC I D E NT I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DERWW" 1 8 1 ) COLUMN . A L I S T OF 0MASUI S I S AWARABUE FROMTHE KMAEI NW8 AND C A M M & P A N I O G NDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 6 6 8 . 3 2 A( 6 ) . I o wa 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 pi e d f r o m r e p o r t s a n d 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 an s t a t u t o r y pAbud

' DWAMM I NN 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 f t 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 e0 Wn f f 1 f t * - R e l a t i o n s h i p a u n t b e s h ow n 0Me t h i n g d e g r e e o f c o n s a n q u i n i l y ( b l o o d v e l a d v e s ) a n dWay ( r e l a t m e s b Vn am a g e l ( S e e Pa g e 2 0 f o r m s poop. 0 s u r n a me o f c o n t r i b u t o r 4 Me s am 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 d wWW, 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 )

SCHEDULEA I MONETARY( Re v .Owl RECEI PTS

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DATE PAC1 0 NUMBER NAMEANDADDRESSOF CONTRI BUTI ONR RELATI ONSHI P AMOUNT v I F FRECEI VED W TOCANDI DATE' RECE I VED FUN( MWOOM) ANDPACCHECK Qf a pp l i c a bl e ) RAI SUWASER I NCOU3#

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T H I S BOX A P P L I E S TO C A ND I D A T E S ' 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 S 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 S c he 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 n d i t u r e s t o p e r s o n s l 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 amo 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 Ne n i 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 C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

P a g e

FORI NS Th u c T I ONS . SEEBACK OF FURM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEEACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES: NOTE : FOR CONTRI BUT I ONS MADE T O STATEWI DE OR L E GI S L AT I V E OCHECK T HI S BOX I FCANDI DATES . L I ST T HE CANDI DATE I DE NT I FI CAT I ON NUMBER I N T HE DE S I G NA T ED COLUMNAND T HEPAC CHECK NUMBER FOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROMT HE I OWA AMENDI NG FORME THI C S & CAMPA I G N DI S C LOSURE BOARD.COMMI TTEENAME ( Mu s t be s ame a s o n S t a t e me n t o f Or g an i z a t i o n)

CAND I DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DE S CR I B E TRANSACT I 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 PACCHECKNUMBER

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T HI S BOX APP L I E S TO CANDI DATES ' COMMI T T EES ONLY :P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g S 5 0 0 o r mo r e m u 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 f 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 m u 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 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 made b y t h e p e r s o N e n i 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 Code 5 6 . 6 ( 3 ) ( 1 ) . )

FORWSYRUCTI ONS, SEE BACK OFPuRM SCHEDULEEXPENDI TURES B MONET ARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PACCOMMI TT EES : NOT E : FORCONTRI BUTI ONS MADE TO STATEWI DE OR L E G I S L A T I V ECANDI DATES . L I S T T HE CANDI DATE I D E N T I F I C A T I O N NUMBER I N T HE DESI GNATED COLUMN AND T HE OCHECK T HI S 60X I FPAC CHECK NUMBER FOREACH EXPENDI TURE . A UST OF I D NUMBERS I S A VA I L A B L E FROM T HE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD.COMMI TTEENAME ( Mu s t b e s a m e 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 )

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