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FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURESUMMARYPAGE

AM F I L I N G A

I ] 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( Yo 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 D R- 3 i s f i l e d . )

COMMI TT EE NAME ( Mu s t b e s am 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 )

~I e - WVa n Pat H~- r o ( _-SWa S~+e St j ~ ~ t e _I MPORTANT : I n d i c a t e b y # t y p e o f c o m m i 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 i d e / L 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 t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP 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 ( 8 ) C o u n t y PAC ( 9 ) C i t y M - ? ~ ) S c h o o l B o a r d o r O t h e r P 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 e

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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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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2/9

F o r I n s t r u c t i o n s , Se e B a c k o f F o r mCONTRI BUT I 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 ( M u s t b e s a m e 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 )N( ' K Vc - n 06+f en f o r : , ~ )Wa 6i x e

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SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) I

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CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DA TES NOTE : I F A CONTRI BUT I ON I S RECE I V ED FROM A S TAT E P AC ( P O L I T I C A L ACT I ON C O MMI T T E E ) , L I S T THE PA C I D EN T I F I C A T I O NNUMBER ANDTHE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARDNOTE ANY PERSON, OTHER T HA N A N I N D I V I D U A L , THAT CONTR I BUTES MORE THAN $ 7 5 0 T O YOUR CAMPAI GN MAY HAVE F I L I N GRESPONS I B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT T HE BOARD .C AU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 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 r f o r a n yc o mme 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 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 .

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAMEAND ADDRESS OF CON TR I B U TOR REL A T I ONSH I PT O CANDI DATE* AMOUNTRECE I VED I F F ORFUND-( MM/ DD/ YR) AND PAC CHECKNUMBER ( i f a p p l i c a b l e ) R AI S ERI NCOMEI D# DaVI d L ( 4 ( 6 01 9

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I D# ; h r 5 - t n e T r v i n e -o 5 F o 5 - f i e r Dr - I V eI 0CK# 5 R 0 0 I b 0ne s 5 0 3 1 aI D# I - - I n c i G t Ne S b r f -CK# bg36 4 1 5 4 5 4 4 1 S t d50u 5 _ T / 4 - , I - ~ 5 0 3I D# Chl i dt 5 e


3/9

Fo r I n s t r u c t i on s , Se e Ba c k 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 a s on S t a t e me n t o f O r g a n i z a t i o n )Nt , cKVc u i Pa+t en 4-; r T-wa5&t e " Sc r l c - l e

SCHEDULEA

I MONETARY( R e v . 0 7 / 0 3 )

RECEI PTS


STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A S T AT E PAC ( P O L I T I C A L AC T I ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER THAN AN I N D I V I D U A L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI BI L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD.CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 r f o r a n yc 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 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 .

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE' AMOUNTRECEI VED J I F FORFUND-( MM/ DD/ YR) AND PAC CHECKNUMBER ( i f a p p l i c a b l e ) RAI SERI NCOMEI D# BI l l i e k G1v.

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4/9

F o 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 - - 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 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 )NI ~_I KVan f a+f en - ~ ) r 11~W0, 6t -&h- Serer e

SCHEDULEA

~ MONETARY( Re v 0 7 / 0 3 )

RECEI PTS

FI CHECK THI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A ST AT E PAC ( P O L I T I C A L AC T I ON C OMMI T T E E ) , L I S T T HE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC 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 THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER THAN AN I N D I V I D U A L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONS I B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 r f o r a n yc o mme 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 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 .

S U B - T O T A L T O T A L ( 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 m m 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 e c o m m 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 y m a r r i a g e ) . I f s u r n a m e 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 n d i d a t e , b u t t h e r e i s n o 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 m n . ( f o r S c h e d u l e A )

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE* AMOUNTRECEI VED J I F F ORFUND-( MM/ DDNR) AND PAC CHECKNUMBER ( i f a p p l i c a b l e ) RAI SERI NCOME

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5/9

FOR I N S TRUCT I ONS, SEE BACK OF FORM R e s e t F or m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI T TEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTE E S : NOTE : FOR CONTRI BUT I 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 EN T I F I C A T I ON NUMBER I N THE DES I GNATED COL UMN AND THE D CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e Sam a s on S t a t e me n t o f O r g a n i z a t i o n )N ~ C . K v a n Pmt en - t o r J l gwa5- 1 z t e 5en a- ~ e

CANDI DATE NAME AND ADDRESS T O WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DE S CRI BE 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

1 1 1 j o bI D# 3 5&a , - y l e n

_ 6 1 N A w l ~ - e e b 05 1 1 t + r i p F~ . 51 0 CK# 10g5 De s A 4 o i r l e 5 , ~1 50315 ~. i ~ ~ r ' , 5 $ 6I o i a _; 5 1 U P CK# 109 , 5ov5~hl . l a - i ~ PI E . Co~Sul - hn j F - e e 5 ( ~ ( ~ UD

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6/9

FORI NSTRUCTI ONS, SEE BACK OF FORMCOMMI TT EENAME ( M u s t b e s am e 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 )N i ( - k

P a 4 f e - n

r

e Se n a - f e r

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 m u 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 n y 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 T HI S REPORTI NG PERI OD( DO NOT I NCLUDE L OANS - - SHOWL OANS ON SCHEDULE F )

R e s e t F o r m

SCHEDULED I NCURRED( R e v 0 8 1 9 8 ) 1 I NDEBTEDNESSCHECK T HI S BOXI F AMENDI NGFORM

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 .DATEI NCURRED( M M I D D I Y R ) NAME AND ADDRESS OF PERSONTO WHOM DEBT OR OBLI GATI ON I S OWEDDESCRI PTI ON OF GOODS ORSERVI CES PROVI DED ORPURCHASED

BALANCE OWED ATCLOSE OFREPORTI NGPERI OD'

q 1 , 9 , 9 1 0 / 6N I r . h o l a 5 C ~ - Ur n P a t f e nb a a a S w . ~ ' V l e k ~ In AVe,De s Mo i n e 5 , - - 1 r - - A , 6 f e y6b3a i

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i b l i q j b b I b i 5 a r i dM6 5 - Mi d w ~ + 5 u 5 i n e 5 5? n u eMb ~ n e S , T~ 5 o : ~4L f - U 5 e n n t ra n d 0 - o pf - i P ~ a r ' ~o b 3


7/9

FOR I NSTRUCT I ONS , SE E BACK OF FORMCOMMI TT EE NAME( Mus 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 )N c _ K v an Pa i t e n _ b ( __Dwa S f i ~~. t e Sn l a t eNOTE T h i s s c h e d u l e r e p o r t s money l o a n e d t o t h e c o mm i t t e e w h i c h i s d e p o s i t e d i n t h e c o mmi t t e e a c c o u n tTOTAL UNPA I D LOANS FROM LAST REPORT I NG PERI OD $SOm, ODPART - MONETARY LOANS RECEI VED T HI S REPORT I NG PERI OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , m u s t b e s h ow n i f a t h i r d p a r t y i si n v o l v e d I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

TOTAL ( P AR T/ )

* 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 ema k i n g a c o n t r i b u t i o n t o t h e c 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 ow n t o t h e t h i r d d e g r e e o fc 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 y ma 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 st h e same a s c a n d i d a t e , b u t t h e r e i s n o 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 er e l a t i o n s h i p c o l u mn when i t a p p l i e s

R e s e t F o n n

PART I I - MONETARY LOAN REPAYMENTS MADE T HI S REPORT I NG PER I OD( L o a n s f o r g i v e n m u s t b e r e p o r t e d o n S c h e d u l e E - I n - k i n d C on t r i b u t i o n s . )

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

SCHEDULEF LOANS( R e v 0 7 / 0 3 ) RECEI VED& REPAI D[ : ] CHECK T HI S BOX I F

AMENDI NG FORM

DATERECEI VEDMM/ DDI YRNAME AND ADDRESS OF LENDER( I n c l u d e E n d o r s e r ' s N a m e , I f A p p l i c a b l e ) RELAT I ONSH I PT O CANDI DATE

I f A l i c a b l e *AMOUNTOF LOAN DATE PAI D( MM/ DD/ YR) NAME ANDADDRESS OF LENDER( I n c l u d e E n do r s e r ' s Name, I f A p p l i c a b l e ) RELAT I ONSH I PTO CANDI DATE *I f A p p l i c a b l e )

AMOUNTREPAI D$

TOTAL CASH REPAYMENTS ( PART 1 1 ) $ -Fr o m S c h e d u l e E - - TOTAL LOANS FORGI VEN $ -

T O T AL OUT S T AND I N G LOANS ENDOF REPORT PERI OD $ 9 00 0 , 0 0


8/9

FOR I NSTRUCT I ONS , SEEBACK OF FORM

COMMI TT EE NAME( Mus t b e same a s o n S t a t e m e n t o f Or g a n i z a t i o n )N c K %- n P~ - t ` f e n - f Dr Sv wa 5- b t e mat e

PART I I - I T EMI ZED BREAKDOWN OF UNREI MBURSED EXPENSES PAI D BYCONSULTANTTO OTHERS I N PERFORMI NG SERV I CES OF CONTRACT ( T h e s e e x p e n s e s s h ou l d NO T b ePART I - NAME ANDADDRESS OF CONSULTANT

r e p o r t e d o n Sc h ed u l e B , a s t h e y a r e d i r e c t p a ym e n t f r o m t h e c o n s u l t a n t . )

Name o f C o n s u l t a n t&-- r - I j a . me n 3 1 6 { ' t o pM a i l i n g Ad d r e s s3 5 0 0 S . V J . l at h PUeE

C i t y~5 M o i e t i e s

EST I MATES OF PERF ORMANCE

S t a t e

Z i p C o d e

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SCHEDULEG BREAKDOWNOF MONETARY( R e v 0 2 / 9 6 ) EXPENDI TURESBY CONSULTANT


DATEEXPENDEDMM/ DD / YR NAME ANDADDRESS T O WHOM EXPENDI TURED i s b u r s e me n t WAS MADE PURPOSE AMOUNTEXPENDED$

SUB-TOTAL $

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


9/9

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