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FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGE

CANDI DATE COMMI TT EES ONLY :Ca n d i d a t e Name P o l i t i c a l P a r t yr J Q : d ~ 6 a i ) c / & , AO f f i c e S o u g h t D i s t r i c t ( i f Se n a t e o r H o u s e )

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I GNATURE OF TREASURER r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE

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( - 1 Ch 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 F or m DR- 3 .( Yo 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 ON HANDCASH 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 h i s i s t h e t o t a l o f a l l mo n i e s h e l db y t h e c o mmi t t e e . T h i s am o u n t MUST b e t h e s am e a s t h e c a s h o n h a n d a t t h e e n 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI 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 he d u l e H s i mi l e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e d u l e B : Ex 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 ee 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 mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 DI SCLOSUREORT

/ 0- / a - a eDATE SI GNED

L a t e f i l e d r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l and c r i mi n a l p e n a l t i e s .SEE I NSTRUCT I ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :I AM F I L I NG A 7r / S-~ - f 0 - / -D: y REPORT FOR AN/ A ( 1 ) ELECT I ON / ( 2 ) NON- E L ECT I ON YEAR

( r e p o r t d a t e )CCHECK I F AMENDMENT TO REPORT DATED L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

C o u n t y & L o c a l C o mm i t t e e s , e n t e r C o u n t yw h i c h E l e c t i o n i s h e l d

d 35 7- - - - - - - -

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> , Y5a - 59' 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ #_&~~ - - - - - - - -1N KI 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 u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ - - - - - -- OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES ONLY :CONSULTANT BREAKDOWN ( Sc he 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 u l e H - A t t a c h Sc h e d u l e H) $ - - - - - - - - - - -

1 - 11 - 1 YES NO

COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e m e n t o f O r g a n i z a t i o n )5 ' a - } - o r A 4 1 4. , C' - 0 F / 5 e474 f - " i 1 ~S( Re v . 0 7 / 2 0 0 3 )F o r O f f i c e Us e On l yComm #

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I MPORTANT : I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r : L o g g e dS c a n n e d( 1 ) S t a t e w i d e / L e g i s l a t i v e Ca 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 mm i t t e e ( 7 ) C ou n t y / C i t y C e n t r a l C o mm i t t e e Co mp u t e r _ __A u d i t e_


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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 F o r mCONTRI BUTI ONS - - MONEYTAKEN 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 same as o n St a t eme n t o f Or g a n i z a t i o n). . 7Cand~ 4, - 04 t - 5 , 4 0 4 2 0 4 : r$

Rese t Fo rmMONETARYRECEI PTS

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( Re v . 0 7 / 0 3 )QCHECK THI S BOX I FAMENDI NG FORMSTATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I ST THE PAC I DENTI F I CATI ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use 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 an d s t a t e me n t s f o r s o l i c i t i n g c o nt r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y a ny p e r s o n o t h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTAL

TOTAL ( i f l a st 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 any r e l a t i v e mak i ng a c o n t r i b u t i o n t o t h ec ommi 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 ) and a f f i n i t y ( r e l a t i v e s b yma 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 as c a n d i d a t e , b ut t h e r e i s no Page - - - - - - -f a m i l i a l

o fr 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)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI 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-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D#$ 10 6 . 00

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t o o E~]9-3-611 CK# g . , V / o Z ' / ' OO .OdR- d r e . L -I D# R a y - i ) C h r - . ` s ~~h s E ; n E~]g _3_ ar ~ CK# 1107 5ugr-67. -Vv 4 / 0 / / - f r o . ot ov _I D# v , -

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Fo r I n s t r u c t i o n s, See Back o f Fo rmCONTRI BUTI ONS- MONEYTAKENI 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 EE NAME ( Mu s t b e same 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 )bandG t - I r ocLSG n i l " 5g-nAf . l 1 eS

STATE CANDI DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E PAC ( P O L I T I C A L A C T I O N C OMMI T T E E ) , L I S T T HE P AC I D EN T I F I C AT I O NNUMBER AND T H E P A C CHECK NUMBER I N T HE D E S I GN A T E D COL UMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I O WA E T H I C S AND C A MP A I G ND I S C L O S UR E BOARD .CAUTI 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 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 .

SUB- TOTALTOTAL ( i f l a s t p a g e 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 a 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 l a t i o n s h i p m u 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 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 a me o f c o n t r i b u t o r i s t h e 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 o P a g e ! _ o ff 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 7 / 0 3 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

DATE P AC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F F ORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM / D D / Y R ) AND PA C CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME

S _ 3 _ a v CK# 60~. / W4Z , ,hAd.. , , .Z' , f L - 1 5 ~v403I D# A " d r e c z n a a " i 5~r8 - 3 ~ 5 1 CK# az57 _ s~W . S ) ' o - 5o . o d r s5 ' 0 t - 6 - 3I D# , e 0 ~ a a i - ' , Bar nef ~CK# ` y 95 uJ ~ ` f L l / i f AAr .U~ o~D. Ohwes . r C _I D# SuyncS LG~i / . S c ~ r ~ fCK# 13 q: ~ NW %b . 2 - v Q l ' Lawe, SD. vdc u & . r w . 5 0 3 5~ , B n " 9 : f A ~ f ~ l L ~1 ~, 7 1/ J w

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Fo t I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN 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 TTEENAME ( Mu s t b e same a s o n S t a t e me n t o f Or g an i z a t i o n)Sand - f o r ^ous . ~F~~ ~~ QA' dSTATECANDI DATES NOTE: I F ACONTRI BUT I ON I S RECEI VED FROMA STATE PAC( P OL I T I CA L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CA TI ONNUMBERANDTHEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . AL I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i on 68B . 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 mat i on c op i e d f r o m r e p o r t s a n d 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 any c omme r c i a l p u r p o s e by any p er s o n o t h e r t h an 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 .

TOTAL ( i f l as t page o f t h i s s c h e du l e )* D i s c l o s u r e l aw r e q u i r e s c a n d i d a t e c ommi t t e es 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 a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p mus t be s h o w n t o t h e t h i r d d e gr 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 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 a me o f c o n t r i b u t o r i s t h e s ame 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 .

SUB- TOTAL

Page 0- _ o f( f o r Sc h e d u l e A )

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

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F o r I n s t r u c t i o n s , Se e B a 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 TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)

R e s e t Fo rmMONETARYRECEI PTS

SCHEDULEA( Re v . 0 7 / 0 3 )

CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE I F ACONTRI BUTI ON I S RECEI VED FROM ASTATE PAC( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PACI DENT I F I CATI ONNUMBER AND THE PACCHECKNUMBER I N THE DESI GNATED COLUMN AL I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B. 3 2 A ( 6 ) , I o wa C od e , p r o h i b i t s t h e us e o f i nf 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 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 any c o mme r c i a l p ur p o s e b y an y p e r s o n o t h e r t h an 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 .

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i s s c h e d ul 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 ny 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 ec o mmi t t e e . R e l a t i o n s h i p must 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 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 byma 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 same a s c a n d i d a t e , b ut t h e r e i s no Pag e - . o ff 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 f S c he d ul e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI 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-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D # S2cg 4 f l , * 4 e 3 JCG/eM&h $ 0 0J - / / D4 CK# d r r e c + ~ a . St . r J 0 i /. Z ' o _8 - / l - Df G

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- l / - D CK # f Z S U; l c f l . ' h n . ` c : . K p r - , OE3 S o a t i f ~ J l Er/ &4 & 4, 4 d p L ' Z ' , ~ 5 r ~ o aI D #CK# e a - ' Sh 4 ( o n a ' f ' , ` o n s 4' r o , n j 7~ p t )d iD # S t t Z u n n e - An d e r 6 o n sC K # 9 2 8 0 S t r a f - . f o r d 1 0 r ~5 r Ca r J ' o n X, + " 5 ' 2 3 , 6 2I D # P o r e + A y P C ) , _ V p r 5 y$ - . 3 c - o " , CK# I 6 r 7 . + e - _ -,0 4 - Soov3I D # o r i 5 O' u f q na hS v / A l " 1 3 * A 5t " / o oCK# , 4 d e w - 4 . : 7 " ' A J ` rE' OI D # ~ - c C P 4 My er 6CK# . 3 0# f 9 o 0 ' 4 z o l y ' ' h s f r l e~ 50 ~

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Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN 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 TTEE NAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n )

R e s e t F or m f

STATE CAND I DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A S TA TE PA C ( P OL I T I C A L A C T I ON C OMMI T T E E ) , L I S T T HE PA C I D EN T I F I C A T I ONNUMBER AND THE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 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 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 .

SUB- TOTAL

TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )

MONETARYRECEI PTS

SCHEDULEA( R e v . 0 7 / 0 3 )0CHECK T HI S BOX I FAMENDI NG FORM

' 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 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 m a k i n g 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 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 f f i n i t y ( r e l a t i v e s b yma 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 s ame a s c a n d i d a t e , b u t t h e r e i s n o Page o ff 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 )

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR R E L AT I ON SH I 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-( MM/ D D/ Y R) AND PACCHECK ( i f a p p l i c a b l e ) R AI S E R

NUMBER I NCOMEI D# 4y v A J L L / ~uec~~ ; - - c , o8 _ 30 _ 0 5 CK# : 2 0_ 5 F , ' / t / , s ~ . P v . B c n , ~ 6g^LU r h ' R 5 55I D# c har / e t i e - , ~ ol ~ c >n s c ~ n $ oQCK# z2v 4 ,

Aoes+ L i " FA- .I D# goane Co Oe i 7 7 , Gr u 7f " ' C ~ as ~ ' f h t L B 00 ! ? 1 e c o .

y ~ ~ l - Ca CK# I 3 od Cd .n r _ , . ~ >V 0e o g & Ae - MOCr W7 / " C ; 50 ~~i f Ae I - - - a r t . L C ' - i J L r - L ' C ! ,I D# A 4 y ~ . , F . wa rdCK# ~` / S5 5. k J d l l a e L AP . , wt De- 5 /ha. ' r Jc5ZS~2G6 /

_ _I D# , E ' t c h a x - d 6- t - , - -/ t , o f t9 - 2 - - o 11 CK# B0x 50; z : 1 0 - 7 77 7 0 -I D# aa t - o / e . e cQ~ - . ~ J ! Of L CK# a 7 9, y ' ~r ~~ . ~ Sam. . dA- d ~~ , ' t om ~~ea . ~

I D# &h3~ L c n ; / ed S c r - ~- l Uc ~ J - eJ ' S d , - ^ A . 4 Pf i Y~ ' ' Of t9- ~ CK# ast o ' ~ o c ~ 4 31oi a~- v w , 8 r a 4dc~y ~Oc ~Ol d , 9 2

CK# 12 . Z6 8Wsf . 5 a:f v . % i o6 P, q -G 7l ~8~ t de s t pas i r ~ r ~ n r _ s 1~a6. ~I D# papas c o a a n + y Aemocrat S Pa ! / a 5 Co s

7 r - 2 5 4 - 0 / CK# Z o 3 r / 4de 4 . Z~_A t o - Mo c , f I d s + 900I D# 60 i ` fGuAI - OC- 4 4 7/ o2 - Po / ; ~ca. L s a a9= 2 f l - o p CK# 36/ 2 s a t 4 - / h 5 7 1% l a o: 5 85 ' t 7 Ps t ha t # . - s :A


7/12

Fo r I n s t r u c t i o n s , Se e Back 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 TTEENAME ( Mu 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 )a J t : Z- l 4e , ' o r - J5i ~ h~Se~7~Q7 ~ e

Res e t Fo r m SCHEDULEA( Rev . 0 7 / 0 3 )

MONETARYRECEI PTS0CHECK T HI S BOX I FAMENDI NG FORM

STATECANDI DATES NOTE : I F ACONTRI BUT I ON I S RECEI VED FROMA STATE PAC( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PACI DENT I F I CA TI ONNUMBERANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN . AL I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Sec t i o n 68B . 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 mat i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i bu t i o n s o rf o r a n y c o mmer c i a l p u r p o s e by a n y p e r s o n o t h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTAL

TOTAL ( 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 nd i d a t e c ommi t t e es 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 an 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 ec o mmi t t e e . R e l a t i o n s h i p mus t be 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 ) an d a f f i n i t y ( r e l a t i v e s byma 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 ame as c a n d i d a t e , b u t t h e r e i s n o ~Pa ge _ _ _ _ o f _~_-f 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 Sc h e d u l e A)

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELA T 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-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

I D# : 50 / 4 ( ~" ' ~ o c v C_- 7e ` Q t Co r n Q:. l e t _ ,L t = 6 CVt t ) e t r d I r a / 5 N- h d r Oe r / 1 QS Cr n9 - 3 0 - - 6 1 t CK# r

I D#~i o na ~- ~ ~n t v ~ e ~ c t i l e c ~ r t , rd > t 7oCK# C.~5h - ~ r r o r ~u r 9 I - a i 5t : Y

I D# / 2 t s ' F f I F~' a dr e ; / / YCK# 5R& ' d o 43 f h s

a ~ ,AdeC. . Z7o u l . a ~f i c 9 d 3I D# ~~l _ r Y , t 3 ~ ~ . ~d Ja i s Q$

f t ) CK# d e< . 7 t f + X0003I D# Al a r y , Bt t Sf ADCK# ~ l a 5 . / , a n a5 ' . o di 0 0 0 C 1We '. 50 7

! 6/ - 0 0 CK# 10 -1 3 - 6 7 1 125 15- Al i ' - t a 5 h , h n o I D# , e c . y e 1a . r x

/ 0 - y - 0 y CK# 1 3 -9 57 , B e - / 4 " ! - / o vA zr o - CK# I l 6 S G. ~ - p ~ , ~ ~ J L 7 7 f lI D # _

CK#I D#CK#


8/12

FOR I N ST RUC T I ON S, SEE BACK OF FORM R e s e t F o r mEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI S LA TI V ECANDI DATES, L I S T THE CANDI DATE I DENT I F I CA TI ON NUMBER I N THE DES I GNATED COLUMN AND THEPAC CHECK NUMBER FOREACH EXPENDI TURE . A L I S TOF I D NUMBERS I S AVAI L ABL E FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD

THI S BOX APPL I ES TOCANDI DATES' COMMI TT EES ONLY :

SCHEDULEB

( Re v . 0 7 / 0 3 )

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 mu s t a l s o b e i n v e n t o r i e d o n S c he d ul e H . ( R e f e r t o S c h ed u l e H i n s t r u c t i o n s . )

MONETARYEXPENDI TURES

CHECKTHI S BOXI FAMENDI NG FORM

Ex p en 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 mi z e d o nS c he d ul 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 en 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 ha 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 he d ul e G i n s t r u c t i o n s a n d I o wa C o d e 68A. 4 0 2 ( 3 ) ( i ) . ) -

( f o r S c he d u l e B)

COMMI TTE E NAME ( Mu s t b e s ame a o n S t a t e me n t o f O r g a n i z a t i o n )SQLhq r WA 1 0 56 W14? / / / ) 0 - ! : )CANDI DATE NAME AND ADDRESS TOWHAM PURPOSE AMOUNT

DATE 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 D # A d e c . pCS~ l Tk t S f e Y Orj { ~ge ~ ~, - %n r l i l r ' ~ 9

l ~ 7 - 1 6 . . p CK# / / 0 2 .5 $I~GL ~ ~' ~ ~f b0~I D # . 4 de t - h e, &p aS- l e I - oQg f

6 7 - Zt - o f - CK# t e 3 n c t a u x c r d _I D # Rde- 4. - Pk ' 5/ J 7 7 d 5 A ? - w' l e , , i / 5 > r r s r n/ 05 ` 3 o aCK# h o , g . 7 Ad s L . . Z ; q ~ - d s N~ ~ . ey 51 D # ~CK# l 02~ 7~~~d 5 f ~ l " 4 n g l A - C J ~ . / r 2 ~~ / a 5 ~ ~ . yp os ~ . _ _I D # m e r l e i / d i d E l n f x r i u r y l 3~ sj l Z ~eQ/ 5 ~~c ' . ~d s

1 - D - - O # CK # ' P o t - 4 - u 4 i d T4 0 s r r 764" Odl ~ Z i 4 o ! c ~ L , . ~ o a v , 9I D # F ~ ? c ,k" Eaa- d t t - y Pa. ~ Ve r

O8 , / / _ p CK # 1 0 . 2 . 6 1 ( 4 n : d V _ e s ; 1 y ) 7 4 Z l ` a q ( ~ Cl a d t ' J J a v ~ ~ l ~ ~ l 3t o el : d e . I ' c ~, yI D #5 1 _ / Z _ p y CK # Zd f A 5 - j r , 73D S r n o . n . - t t y - a ~ r 61 D # 0 0 1 1 4 - - Y 1 3 4 y0S" oq CK# 19 , --

SUB- TOTAL $ r t , rTOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $


9/12

FOR I NSTRUCTI ONS, SEE BACK OF FORM

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :

Re s e t Fo r mEXPENDI TURES - - MONEYSPENT FROMCOMMI TTEEACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEB I MONETARY( R e v . 0 7 1 0 3 ) EXPENDI TURES

CHECK T HI S BOX I FAMENDI NG FORM

P u 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 mor 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 i 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 mi 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 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 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 6 8 A . 4 0 2 ( 3 ) ( i ) . )

( f o r S c h e d u l e B )

COMMI TTEE NAME ( Mu s t b e s ame a s on St a t eme n t o f O r g a n i z a t i o n )

' 6 a n q l - o - o r ' / a 5 ' - 4 ~~%? t ' , e - Se r e ~ JCANDI DATE NAME ANDADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WAS MADE( MM/ DD/ YR) ANDPACCHECKNUMBERI D# n ~nq( Cecan - i v y 416

O$ - Z / - 4 * CK# / 0 3 c ( , J c ~ f 1 L Y Cdk1 . YGl ~ X, 4 / Se - / / Sr t u r C~ , y t i "an

~I D# ~a. c , c b o + . v i l o. - ~ 4 A~

o b ' - 3 / - o f c . CK# ~' e . u r t i e ~ , e " , r ~n

a4d - h ar 7 d / , ` n . e rD# 7 ~ y % a - ~ V~ L ? at e d y - - r e r - Pa r - = z p l y . / b . 3dCK# i ' / 0 5 S 4 i y - s l1 0 13 - 3

I D#a 9 - u i - o CK# t o : ~ ~ r u. > I : v ~r s ; y / h a : l >h~ 330. 7. ' ; -/ 03, 5 Cl ~ a t o k 1 3z 5I D # QGFi c; / h a - " 1 ~ Aa , 6 e %5 - - r e r~ 9D c ~ un oUe~S : f 5 / 7g` 7

j b 3 , 4 5 e, 2 . ' b 5-I D# ROI L J " a Sf , * 7 a 5 7 ( - -~ Pe5 - l a e -

/ D- Dl - Df i CK# ~ d e L , . ~ , q ; 5 e : wo _ 3 ' 7 9 0 , / 3/ 03I D# pal l a s Cou , . ~ l ' S , a ~ ' o r , pa pe r - r

/ 0 - - d l - D3 i CK# - 7 - mc " ' hl 6 3 Ad- i _ , rA 5 o v oI D# ~} ~, ~ . ` ~ - f 1 ~B~u r r aM e r r - i Dc c r

/ o - D. f - O CK# / 3 / z o r c ha r d J P r s S La . ` ~ ~ z ~~ . ~a o " 6 r


10/12

T HI S BOX A PP L I E S T O CANDI DATES ' COMMr i TEES ONL Y :P u 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 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 / 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 Gb 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 m a d e b y t h e p e r s o n l 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 mm i 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 Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

( f o r S c h e d u l e B )

FOR I N S TRUC T I ON S , SEEBACK OF FORM Res e t Fo r m SCHEDULEEXPENDI TURES B MONETARY- - MONE Y SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 7 1 0 3 ) EXPENDI TURES

S TA TE PAC COMMI TT EES : NOTE : FOR C ON T RI B UT I ON S MADE T O STATEWI DE OR L E G I S L A T I V EC A ND I D A T E S , L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N T HE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA AMEND I NG FORME T H I C S & CAMPAI GN D I S C L O S UR E BOARD .COMMI TT EE NAME ( Mu s t b e s ame on S t a t eme n t o f O r g a n i z a t i o n )

CAND I D ATE NAME AND ADDRESS TO WHOM 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 / D D/ Y R ) AND PACCHECKNUMBER

I D # Pama ~~ . N- e t c h , q c , rCK # 7 , 4. ` n l 3 b " : 5 c 7

r i ve-, P, 0 . 0 h i p/ , 0 6 S, 0 CK # 1 7 3 1 7 ~a5t 6 - t % 1 4 4 AL k . 8 . 5

PS I z : ~. p!I D #CK #I D #CK #1 D #CK #1 D #CK #I D#CK #

SUB - TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ 3 i 1 3


11/12

FORI NSTRUCTI ONS, SEEBACK OF FORMCOMMI TTEE NAME ( M u s t b 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 )vQ/ JC~ , e ` t - pr OuS

NOTE: D e b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p a i d mu s t b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a ny n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

DEBTS/ OBL I GAT I ONS REMAI NI NG THI S REPORTI NG PERI OD( DO NOT I NCL UDE L OANS - SHOWL OANS ON SCHEDUL E F )

* I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i ma t e d " b e s i d e t h e f i g u r e .

An " i n c u r r e d d e b t * i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f w h e t h e r a n i n v o i c eh a s b e e n r e c e i v e d .

Pag e / O f _ _ _ _ Z( f o r S c h e d u l e D)CANDI DATE COMMI TTEES NOTE :* I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h whom t h e c a n d i d a t e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e . E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s 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 ro r g a n i z i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i ma t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

SCHEDULED I NCURRED( R e v . 0 8 / 9 8 ) I NDEBTEDNESSL / CHECK THI S BOXI F AMENDI NGFORM

DATEI NCURRED( MM/ DDNR) NAME AND ADDRESS OF PERSONTO WHOMDEBT OR OBLI GATI ON I S OWEDDESCRI PTI ON OF GOODS ORSERVI CES PROVI DED ORPURCHASED

BALANCE OWED ATCLOSE OFREPORTI NGPERI OD*

l 0 - 1 - 0 9 Oar f e r - P r1 -73q FasA- I rr ' n 7 F01d / 4 v - e - p o ~ _ , A Lpa r d sf or t o , a 2 o o $

SUB- TOTAL $ ~ `

TOTAL DEBTS OWED BY COMMI TTEE AT THE ENDOF THI S REPORTI NG PERI OD $ D ~ ~


12/12

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