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A FORM04DI SCLOSURE SUMMARY PAGE I " l H~, Ap DR- 2SC

F OR STATEWI DE AND GENERAL ASSEMBLY CA4DI D 2 4 2 0 0 2CANDI DATE' S COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e m

CANDI DATEF o r o f f i c e u s e o nl yComm. No .I n d e x ed aAu d i t e dC h e c k e d -Comp u t e r

ATURE - 6F 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 GNEDCAUTI ON : Pe na l t i e s . D u e _ F o r La t e F i l e d Re po r t s Range F r o m $ 1 0 t o $ 4 0 0

ELECTI ON YEAR REPORTI NGDATESRe p o r t Due Co v e r e d P e r i o d - I n c l u s i v eOMa y 2 0 , 1 9 J a n . 1 - Ma y 1 5 ,

F r i d a y p r e c e d i n g p r i m a r y Ma y 1 6 - T u e s d a y p r e c e d i n g( S e e N o t e ) p r i m a r y0 J u l y 2 0 , 1 9 Ma y 1 6 o r Wedn e s d a y p r e c e d i n gp r i m a r y - J u l y 1 5 , 19-0 Oc t . 2 0 , 1 9 J u l y 1 6 - Oc t . 1 5 , 1 90 F r i d a y p r e c e d i n g g e n e r a l Oc t . 1 6 - T u e s d a y( S e e N o t e ) - p r e c e d i n g g e n e r a l

J a n . 2 0 , Oc t . 1 6 o r Wedn e s d a y p r e c e d i n gg e n e r a l - D e c . 3 1 , 19-

0 Che c k i f f i n a l ( t e r m i n a t i o n ) r e p o r t . ( A t t a c h No t i c e o f D i s s o l u t i o n F o r m DR- 3 )STATEMENT OF CASH ON HAND

CASH ON HAND a t t h e b eg 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 l o f a l lmo n i e s h e l d b y t h e c o mmi t t e e . T h i s amo u n t MUST b e t h e s am e a s t h e c a s ho 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 mu s t b e z e r o i f t h i s I s f i r s tr 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: Ca 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) . . . . . . . . . . . . . . . . . . . . -Sc h e d u l e C: F u n d r a l s i n g Ev e n t s t o t a l ( A t t a c h Sc h e d u l e C) . . . . . . . . . . . . . . . . . . . . -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 e d u l e H) . . . . . . . . . . . .

VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a ch Sc h e d u l e H)

SPECI AL ELECTI ON REPORTI NGDATESDATE OF ELECTI ON 19-

Co v e r e d Pe r i o d - I n c l u s i v eRe p o r t Du e1 4 t h d a y p r i o r t o e l e c t i o n. 19-

0 F r i d a y p r e c e d i n g e l e c t i o n( S e e N o t e ) , 1 9

C u r r e n t t h r u 1 9 d a y s p r i o rt o e l e c t i o n1 8 t h d a y p r e c e d i n g e l e c t i o nt h r u T u e s d a y p r e c e d i n ge l e c t i o n

NONELECTI ONYEAR REPORT I NG DATESR e p o r t Du e C o v e r e d P e r i o d - i n c l u s i v eOc t . 1 6 - De c . 3 1 ,o rT u e s . P r e c e d i n g E l e c t i o n t h r uDec . 3 1 , o rJ a n . 1 - De c . 3 1 , 0

NOTE : T h e s e s u p p l e me n t a l r e p o r t s a r e r e q u i r e d I f c o n t r i b u t i o n s r e c e l wi d I n t 1 w c c r e d Pe r i o d e qu a l t t o , o o o o r mo r e f o r g o v e mo r $ 5, 0 0 0 o r mo r e f o r o1M r S t a t e w i d e c a n d l d Ne e$ 1 , 0 0 0 o r mo r e f o r g e n e r a l a s s emb l y c an d i d a t e &Che c k I f Amen dme n t t o r e p o r t d a t e d 1 9

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' SUB- TOTAL I 3WO7 . c 7 ( oSUBTRACT TOTAL MONEYSPENT T HI S P ER I ODSc h e d u l e B : Ex p en 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n R e pa 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 c e mu s t b e z e r o )( A t t a c h DR - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .UNPAI D BI L LS ( 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 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 NGLOANS ( F r o m Sc he d u l e F - At t a ch Sc h e d u l e F )CONSULTANT BREAKDOWN ( Sc he d u l e Ga t t a c h e d ? ) e 7

' REMI NDER : Th e l a w p l a c e s r e s p o n s i b i l i t y s o l e l y u p o n t h e c a n d i d a t e f o r t h e t i m e l i n e s s a n d a c c u r a c y o f r e p o r t s f i l e d b y t h e c o mmi t t e et r e a s u r e r . 140 . 0 0 3 A/ CPK- 0 20 5 2 2 ( R e v . 1 9 9 3 )


2/18

L - 0 5 8 2 8 1 1 4 o - 0 0 5 4 - L / ( R e v . 1 9 9 3 )

CONTRI 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 )

CANDI DATE ' S COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n l z a t l o n )y & - Cr Y\

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A PAC ( P OL I T I CAL ACT I ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLE AT NO COST FROM THE ETHI CS AND CAMPAI GN DI SCL OSURE BOARD.

SCHEDUL EMONETARSTATE RECE I P T SCANDI DATE

F o r o f f i c e u s e o n l y

S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co de , 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 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 y c o mme rp 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 l a w r e q u i r e s c a n d i d a t 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 e c o mmi t t e e . R e l a t i o n s h i p muss 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 ) .P a g e_I o f I ! ~ )( f o r S c h e d u l e A )

DATERECD PAC I . D . NUMBER( i f a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR( I f p r o c e e d s f r o m f u n d r a i s e r , s h o w f u n d r a l s e r s p o n s o r ) RELATI ONSHI PTO CANDI DATE'i f a p p l i c a b l e )AMOUNTRECEI VED

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3/18

CANDI DATE' S COMMI TT EE NA - 0 C ( Mu s t b e e a s o n St a t e me n t o f Or g a ni z a t i o n)

CONTRI BUT I ONS - MONEY TAKEN I N( i n c l u d i n g c a nd i d a t e ' s p er s o n a l f u nd s )

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CA TI ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D. NUMBERSI S AVAI LABLE AT NO COST FROM THE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEMONETARYSTATE RECEI PTSCANDI DATE

Fo r o f f i c e u s e o n l y

Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C od e , p r o h i b i t s t h e u s e o f i n f or ma t i on 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 ont r i bu t i ons o r f o r a ny c o mme r cp u r p o s e b y a ny pe r s on ot 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 es .

' Di s c l os ur e l a w r e q u i r e s c a nd i d at 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 ont r i bu t i on t o t h e c o mmi t t e e . Re l a t i ons h i p m u s tt o t h e t h i r d d e g r e e o f c ons a ng ui n i t y ( b l o od 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) .. 1 9 9 3 )

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

DATERECD PA C I . D . NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( I f p r o c e e d s f r o m f u n d r a l s e r , s h o w f u nd r a l s er s p on s o r ) RELATI ONSHI PTO CANDI DATE'I f a l i c a b l sAMOUNTRECEI VEDn

W17 r y k a " : ~ j o z y 2 - 6 - -: . . 4A. A) EI~ G V / I Smr r s w~ 3 s _4 : . A1E CAL D i r: ' . . Al e ~ - ~ -

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4/18

CONTRBUTONS-MONEYTAKENIN( i n c l u d i n g c an d i d a t e ' s p e r s o n a l f u nd s )

CAND' r T E ' S COMMI TTEE NAME ( 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)z e S y- Q " A- 1 1 CA 11S- e

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( P OL I TI CA L ACT I ON COMMI TTEE) , L I STTHE PAC I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN. L I S T OF I . D . NUMBERSI S AVA I L A BL E AT NO COST FROMTHE ETHI CS ANDCAMPAI GNDI SCL OSURE BOARD.

L - 0 5 6 28 / 1 4 0 - 0 0 5 1- L / ( R e v . 1 9 93 )

SCHEDULEMONETAR

STATE I RECEI PTSCANDI DATEFo r of f i c e u s e o nl y

S e c 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 m a t i o n f r o m r e p o r t s an 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 y commer cp u r pose b y an 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 l a w r e q u i r e s c a n d i d a t 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 e c ommi t t e e . R e l a t i o n s h i p muss hown 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 ) .( f o r S c h e d u l e A )

DATERECD

PA C I . D . NUMBER( i t a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR( i t p r o c e e d s f r o m f u n d r a l s e r , s h ow f u nd r a l s e r s p o ns o r ) RELAT I ONSHI PTO CANDI DATE'I I a pp l i c a bl e )AMOUNTRECEI VED

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5/18

L - 0 5 8 2 8 / 1 4 0 - 0 0 5 4 - L / ( R e v . 1 9 9 3 )

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

CANDI DATE' S COMMI TTEE NAME ( 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)

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CA TI ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLE AT NOCOST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEMONETARYSTATE RECEI PTSCANDI DATE


Se c t i o n 6 8 B . 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 ma t i on 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 on t r i bu t i on s or f o r a n y c o mme r cp ur po se 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 p o l i t i c a l c o mmi t t e e s .

' Di s c l os ur e l a w r e q u i r e s c a nd i d at 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 on t r i bu t i on t o t h e c o mmi t t e e . Re l a t i on sh i p musts h o w n t o t h e t h i r d d e gr e e o f c on s an gu i n i t y ( b l ood 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 by ma r r i a ge ) .Page -4- o f( f o r Sc h e d u l e A )

DATERECD PAC I . D . NUMBER( i f a p p l i c a b l e ) , NAME AND ADDRESS OF CONTRI BUTOR( I f p r o c e e d s f r o m f u n d r a l s e r , s h ow f u nd r a i s e r s p o ns o r ) RELATI ONSHI PTOCANDI DATE'I f a pp l i c a bl e )AMOUNTRECEI VED

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6/18

L - 0 5 8 2 8 / 1 6 0 - 0 0 5 4- U ( R ev . 1 9 93 )

CONTRI BUTI ONS - - MONEY TAKEN I N( i n c l u d i n g c an d i d a t e ' s p e r s o n a l f u nd s )

CANDI DAT ' S COMMI TT EE NAME ( Mu s t b e s ame a s on St a t e me n t o f Or g an i z a t i on )

NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLEAT NO COST FROM THE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEA MONETSTATE RECEICANDI DATE IF o r o f f i c e u s e on e

Se c t i on 6 8 B . 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 ma t i on 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 on t r i bu t i on s o r f o r a ny c o mmpu r p os e b y a n y p e r s o n ot 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 ommi t t e e s .

' Di s c l o s ur e l a w r e q u i r e s c a nd i d at 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 on t r i bu t i on t o t h e c o mmi t t e e . Re l a t i on sh i p mushown t o t h e t h i r d d e g r e e o f c o ns a ng ui n i t y ( b l o od 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 by ma r r i a ge ) .

Page _ . Z_ o f -10( f o r Sc h e d ul e A)

DATERECD PAC I . D . NUMBER( i t a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( i f p r o c e e ds f r o m f u n d r a l s e r , sh ow f u nd r a i s e r s p on s o r )RELATI ONSHI PTO CANDI DATE'l i t a p p l i c a b l e )

AMOUNTRECEI VED

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


7/18

CONTRI 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 )

CANDI DATE ' S COMMI TTEENAME ( Mu s t b e s a me 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 )r - J i C- f t ( ~ ~~ -ar ~d ~4 , 2 ~L , ~ ~NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T

THEPAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I S T OF I . D . NUMBERSI S AVAI LABLE AT NOCOST FROMTHE ETHI CS ANDCAMPAI GN DI SCL OSURE BOARD.

SCHEDULEMONETARYSTATE R EC E I P T SCANDI DATE

F o r o f f i c e us e o n l y

S e c t i o n 6 8 B . 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 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 y c omme r cp 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 l a w r e q u i r e s c a n d i d a t 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 e c o mmi t t e e . R e l a t i o n s h i p m u s ts 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 ma r r i a g e ) .L - 0 5 6 2 8 / 1 4 0 - 0 0 5 4 - U ( R e v . 1 9 9 3 ) P a g e - 4 p - o f / 0( f o r S c h e d u l e A )

DATERECD PAC I . D . NUMBER( i t a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR( i f p r o c e e d s f r o m f u n d r a i s e r , s h o w f u n d r a l s e r s p o n s o r ) RELATI ONSHI PTO CANDI DATE'( i t a l i c e b l e

AMOUNTRECEI VEDm. .

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8/18

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S A VA I L A BL E AT NO COST FROMTHE ETHI CS ANDCAMPAI GN DI SCLOSURE BOARD .

L - 0 5 8 28 / 1 4 0 - 0 0 5 4- L / ( Re v . 1 9 9 3 )

CONTRI 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 er s o n a l f u n ds )

CAN~I DA TE' S COMMI TT EE NAME ( Mu s t 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 )

SCHEDUL EMONETARSTATE I RECEI PTSCANDI DATE


S e c t i o n 6 8B. 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 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 y c omme r cp 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 l a w r e q u i r e s c a n d i d a t 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 e c o mmi t t e e . R e l a t i o n s h i p mu s ts 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 ma r r i a g e ) .( f o r S c h e d u l e A )

DATERECD PA C I . D . NUMBER( i t a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( ! f p r o c e e d s f r o m f u n d r a l s e r , s how f u n d r a i s er s p o ns o r ) RELAT I ONSH I PTO CANDI DATE'I f a l i c a b l eAMOUNTRECEI VED

2 1 . . " . . - _ . ~ . _ k . c - 5 6

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9/18

, CANDI DATE ' S COMMI TTEE NAME ( Mu s t b e s ame a s on St a t e me n t o f Or g a ni z a t i on )1__J1p. ny i ' 8 t i ~~f O-k " f e r n SCHEDULE I N- K I N DE CONTRI BUTI ONSCANDI DATE


' Di s c l o su r e l a w r e q u i r e s c a nd i d a t e s t o d i s c l os 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 n i n k i n d c on t r i b u t i o n t o t h e c o mmi t t e e .Re l a t i ons h i p must b e s h ow n t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o od 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 ge ) .L - 0 5 8 2 5 / 1 4 0 - 0 0 5 8 / ( R e v . 1 9 9 3 )

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

DATERECEI VED NAMEAND ADDRESSOF CONTRI BUTORRELATI ONSHI PTO CANDI DATE'I f A l i c e b l e

DESCRI PTI ON OFI N- K I ND CONTRI BUTI ON ESTI MATED FA I RMARKET VALUEMo L ' GL I Y~ I ? t ~ . ~i C U. t ! _ ~ ' I ' r T i ~ ff ~ d ~9 / eX 1~

, , _S r m res ~~l L t T4 . . G l c . . ~a o7 e?Sp o. S b3~ q Zs ~l

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10/18

. 1 0 / 1 2 / 2 0 0 1 s e p t 2 5 e v e n tP e r 0 +t , Q- V i t s C , i 0 4 k ~ - , E ?p

O " n umbe r A d d r e s s AMTL a w p a c 6 0 7 0 5 2 1 E . L o c u s t , 3 r d F l , DM 5 0 3 0 9 1 0 0Qwes t I PA C 6 1 0 7 9 2 5 Hi g h S t 9 s 9 DM, I A 5 0 3 0 9 5 0 0

MCCO PACT f o r Res p . S t a t e Go v 6 0 3 3 7 1 7 Mu l b e r r y S t DM, I A 5 0 3 0 9 1 0 0( I P A C 6 0 6 9 9 0 4 Wa l n u t , S t e 1 0 0 , DM, I A 5 0 3 0 9 2 5 0Ma r k Do u g l a s 4 8 0 4 C e d a r D r i v e , WDM, I A 5 0 2 6 6 1 0 0

i a n t f o r Good S t a t e Govt 6 4 3 3 2 0 0 F i r s t S t r e e t , SE, Ce d a r R a p i d s , I A 5 2 4 0 1 2 0 0wa H o s p i t a l i t y A s s n PAC 6 4 0 0 3 8 0 0 M e r l e Ha y R d , S u i t e 6 0 6 , DM I A 5 0 3 1 0 1 0 0Wma n d B a r b a r a F i t z g e r a l d 6 8 1 N 5 7 t h S t Omaha , NE 6 8 1 3 2 5 0 0

J am e s / Co n n i e B l i e t z 2 1 1 Wi l d w oo d Rd CB , I A 5 1 5 0 3 7 5D e n t a l A s s n PAC 6 0 6 3 5 0 5 5 t h Av e , S t e 3 3 3 , DM, I A 5 0 3 0 9 2 0 0- M a n u f a c t u r e d Ho u s i n g PAC 6 0 9 6 1 4 0 0 Dean A v e DM, I A 5 0 3 1 6 2 5 0

" T e l e c o mmu n i c a t i o n s A s s n PAC - 6 9 8 r - 1 6 0 1 2 2 n d S t . S t e 2 0 9 , WDM, I A 5 0 2 6 6 2 5 0J o h n S c h a c h t e r l e 3 1 7 6 t h A v e , s u i t e 7 4 0 , DM, I A 5 0 3 0 9 1 0 0C r a i g Wa l t e r 1 4 8 6 2 L a k ev i e w Dr . , C l i v e , I A 5 0 3 2 5 1 0 0i om I n d e p . Ba n k e r s PAC 6 1 6 0 1 6 0 3 2 2 n d S t . , S t e 2 0 2 , WDM, I A 5 0 2 6 6 1 0 0A s s o c G e n e r a l C o n t r a c t o r s PAC 6 0 0 4 ' POBo x 7 5 7 , DM, I A 5 0 3 0 3 1 5 0i o wa Co mmi t t e e o f A ut o R e t a i l e r s 6 0 5 9 1 1 1 1 O f f i c e P a r t k Rd , WDM, I A 5 0 2 6 5 3 0 0e p I n s u r a n c e A g en t s o f I A PAC 6 0 5 2 4 0 0 0 We s t o wn P k w y , St e 2 0 0 , WDM, I A 5 0 2 6 5 5 0 0O p t o m e t r i c A s s n PA C 6 1 1 8 1 4 5 4 3 0 t h S t . S t e 2 0 4 , WDM, I A 5 0 2 6 6 2 0 0S t e p h e n / Dawn R o b e r t s T h e F i n a n c i a l C e n t e r , 6 6 6 Wa l n u t St . S t e 2 5 0 0 DM 5 0 3 0 9 5 0wa N u r s e s A s s n PA C , ? S 1 5 0 1 4 2 n d S t S t e 4 7 1 , WDM, I A 5 0 2 6 6 1 0 0f o wa Me d i c a l PA C 6 0 7 3 1 0 0 1 Gr a n d A v e WDM, I A 5 0 2 6 5 2 5 0o wa H o s p i t a l A s s n PA C 6 2 9 1 1 0 0 E Gr a n d , S u i t e 1 0 0 7 5 0

FORE PAC 6 0 6 4 8 5 2 5 Do u g l a s A v e , S t e 4 8 , DM, I A 5 0 3 2 2 1 0 0P h a r ma c y PAC 6 0 7 7 8 5 1 5 Do u l a s S t . , St e 1 6 , DM, I A 5 0 3 0 9 1 5 0b r C a r r i e r s PAC 6 1 0 1 POBOX 6 1 2 1 , E a s t DM S t a t i o n , DM I A 5 0 3 0 9 1 0 0I o wa PA C 6 4 1 1 7 0 7 1 7 t h S t . , S u i t e 3 6 0 0 D e n v e r , CO 8 0 2 0 2 - 3 4 3 6 2 0 0

Dr P h i l i p a n d J a n e Meye r 3 4 1 Wo o d l a n d Dr . , CB , I A 5 1 5 0 3 1 0 0De e r e PA C I o wa 6 0 2 7 6 6 6 Gr a n d A v e . , S u i t e 1 7 0 7 , DM, I A 5 0 3 0 9 - 2 5 0 7 2 5 0C l a r e n c e / L y nn Ho f f ma n PO Bo x 8 3 , C h a r t e r O a k , I A , 5 1 4 3 9 1 0 0

= r s U n i t e i n L e g i s l a t i v e D e c i s i o n s PA C _ , # ' , 4 1 8 6 t h A v e . , # 4 3 0 , DM, I A 5 0 3 0 9 1 5 0 0B r i a n J o h n s o n _ A dd r e s s _ a n o n - t }_ 5 0: a w e - L i f e I n s u r a n c e I n d u s t r y PAC 6 0 7 1 5 7 0 0 We s t o w n P k w y , Wes t DM, I A 5 0 2 6 6 - 8 2 2 1 2 5 0U S t a t e PA C " ' ?C) q 1 8 1 5 C a p i t o l Av e , Oma h a , NE 6 8 1 0 2 1 0 08 1 2 5


11/18

CAND A E' S COMMI TTEE NAME ( M u s t b e s ame a s o n S t a, t ~ m^ e n t o f O r g a n i z a t i o n )r~

NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA PAC ( POL I T I CAL ACTI ONCOMMI TTEE) , L I S TTHE PAC I DE NT I F I CA TI ON NUMBER I N THE DESI GNATEDCOLUMN . L I S T OF I . D . NUMBERSI S AVAI LABLEAT NOCOST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD.Se c t i o n 6 8 B . 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 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 ut i o ns o r f o r a n y c o mme r cp ur 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 .

' Di s c l o s u r e l a w r e q u i r e s c a n di d at 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 e c o mmi t t e e . Re l a t i o n s h i p mu ss 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 gu i n i t y ( b l o od 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 ge ) .L - 0 5 8 2 8 11 4 0 - 0 0 5 4- L / ( R a v . 1 9 93 )

CONTRI 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 ds )

SCHEDULEMONETARYSTATE RECEI PTS

CANDI DATEFor o f f i c e u s e o n l y

Page ko f 10( f o r Sc h e d ul e A)

DATEREC' D PAC I . D . NUMBER( i t a p p l i c a b l e ) NAMEANDADDRESS OF CONTRI BUTOR( i f p r o c e e ds f r o m f u n d r a i s e r , s h ow f u n d r a l s e r s p o n s o r ) RELATI ONSHI PTO CANDI DATE'1 1 a p p l i c a b l e )AMOUNTRECEI VED

~ r t a vI t ~ ~ : : GUr a , s a -S 7o z

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S ~ ~. "w7MWI 1 .( ( ' ~ h 0 ( e ~ ' #. f i r: . , n . O, . . . JA. 4 . s a_ Q

~ t l ~ ~ o 7 2 # , . , Zo mom. s ~ s

SUB- TOTAL $TOTAL ( I f l a s t p a g e o f t h i s s c h e d ul e ) $


12/18

CONTRIBUTI ONS-MONEYTAKENI N( i n c l u d i n g c an d i d a t e ' s p e r s o n a l f u n d s )

CANDI DAT ' S COMMI TTEE NA ( Mu s t b _ e- ss ame a s o n St a en t o f Or g an i z a t i on )+ = ~ C p l 2

L - 0 5 8 2 8 / 1 4 0 - 0 0 5 4 - L / ( R ev . 1 9 93 )

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLEAT NO COST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD.

SCHEDULEMONETARSTATE I RECE I P T SCANDI DATE


Se c t i o n 6 8 B . 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 ma t i on 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 on t r i b ut i on s o r f o r a ny c omme rp ur po se b y a n y p e r s o n ot 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 es .

' Di s c l os ur e l a w r e q u i r e s c a nd i d at 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 on t r i b u t i on t o t h e c ommi t t e e . Re l a t i on sh i p mu ss h o w n t o t h e t h i r d d e gr e e o f c on s an gu i n i t y ( b l ood 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 ge ) .Page - - ~ Lo f i ' v( f o r Sc h e d u l e A)

DATERECD PAC I . D . NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( I f p r o c e e d s f r o m f u n d r a i s e r , s how f u n d r a i s e r s p o ns o r ) RELATI ONSHI PTO CANDI DATE'( i t a p p l i c a b l e )AMOUNTRECEI VED

f U f r v ~ e . _I l Ti

1 1 l e i 1 Q 1 7 9 " S " 7 1 k ' -- ( w f -. ) J - 3 O dam- ~00_ . ~ : ~ 30 9AA' W1 ' L ' N- RO

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v l p L I , _r m - ~UI ~ t . 4 Zt

rSUB- TOTAL $

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


13/18

CONTRI 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 )

CANDI DATE' S COMMI TTEE NAME ( 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 )

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DEN TI F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D. NUMBERSI S AVAI LABLEAT NO COST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .Se c t i o n 68 B . 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 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 on t r i bu t i o n s o r f o r a n y c o mme rp u r p o s e by 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 .

L - 0 5 8 2 8 / 1 4 0 - 0 0 5 4 - U ( R s v . 1 9 9 3 )

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

s CHEDULEIMONETARSTATE R E CE I P T SCANDI DATE


/ l . a Ze S ' . / S-* Di 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 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 on t r i b u t i o n t o t h e c o mmi t t e e . Re l a t i o ns h i p mu ss h o w n t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o od 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 by ma r r i a g e) .( f o r Sc h e d u l e A)

DATERECD PAC I . D . NUMBER( i f a p p l i c a b l e ) NAMEAND ADDRESS OF CONTRI BUTOR( I f p r o c e e d s f r o m f u n d r a i s e r , s h ow f u n d r a l s e r s p o n s o r ) RELATI ONSHI PTO CANDI DATE'I f a p p l i c a b l e )AMOUNTRECEI VED

2 6 0 1' -

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14/18

EXPENDI TURES - MONEYSPENT

CANDI ATE' S COMMI TTEE NAME ( Mu s t e s ame a s on St a t e me n t o f Or g a ni z a t i on )

SCHEDULE 1 MONETARYB wwomma sCANDI DATEF o r 4 ( I mm" 4 s &

Camp a i g n f u nd s may be u s e d o nl y f o r c a mp a i g n p ur po se s, c on st i t u en cy e x pe nd i t u r e s a n d e d uc a t i o na l a n d o t h e r e x p e n s e s a s so ci a t e dwi t h d u t i e s o f o f f i c e .P ur c h a s e s o f c a mp a i g n p r o pe r t y must a l s o b e I nv e nt o r i ed on Sc h e d ul e H.Ex p en di t u r e s t o c o ns ul t a nt s ( p e r s o n s / e n t i t l e s pr o v i d i n g c o ha 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 an i z i ng s er v i c es .e t c . ) must a l s o b e d e t a i l I t e mi z e d o n Sc h e d ul e f 3 b y t h e amoun 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 pe nd i t u r e mad e b y t h ennnasoHan# nn h ah a l f o f t h e n a n d i t f a t a ' a c o mmi t t e e . Se e manua l f o r mo r e s De c i f i c I n s t r u c t i o n s .

DATEEXPENDED NAMEANDADDRESS T O WHOMEXPENDI TURE( D i s b u r s e m e n t ) WASMADE01 5

PURPOSEAMOUNTEXPENDED

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SUB- TOTAL S mmS ZZZTOTAL ( I t l a s t Ps " o f t h i s s c h e d u l e ) $


15/18

EXPENDI TURES - MONEY SPENT

CANDI DATE' S COMMI 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 )

SCHEDULECANDI DATE

F o r a t l a s we o n h r

Camp a i g n f u nd s may b e u s e d o nl y f o r c a mp a i g n pu r po s es , c on s t i t u en c y e x pe nd i t u r e s a nd e d uc a t i o n al a n d o Eh e r e x p e n s e s a s s oc i a t e dwi t h d u t i e s o f o t f i c e .Pu r c h a s e s o f c a mp a i g n p r o p er t y mu s t a l s o b e i n v e n t o r i e d o n Sc h e du l e H .Ex p end i t u r e s t o c ons u l t a nt s ( pe r s o n s e n t i t l e s pr o v i d i ng c o hs u l t i n g , a d v e r t i s i n g , t u n d r a l s i n g , p o l l i n g , ma n a g i n g , o r g an i z i ng s e r v i c e s ,e t c . ) mu s t a l s o b e d e t a i l i t e mi z e d o n Sc h e du l e G b y t h e a mo u n t , p u r p o s e , a n d d at e o f e a c h t y pe o f e x pe nd i t u r e made b y t h ewnns Nen f n n hehn l f n1 f l o w r a n d i t l e t w ' s c o mmi t t e e . Se e manu a l f o r mo r e s p e c i f i c I n s t r u c t i o n s .

GATEEXPENDED NAMEAND ADDRESS TOWHOM EXPENDI TURE( D i s b u r s e me n t ) WAS MADEr PURPOSE AMOUNTEXPENDEDt f . G- aa

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16/18

C A N D I D A T E ' S C OMMI T T E E 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 )

C a m p a i g n f u n d s ma y b e u s e d o n l y f o r c a m p a i g n p u r p o s e s , c o n s t i t u e n c y e x p e n d i t u r e s a n d e d u c a t i o n a l a n d o i h e r e x p e n s e s a s s o c i a t e dw i t h d u t i e s o f o f f i c e

E X P E N D I T U R E S - MONEY S P E N TS C H E D U L E E 1 n E I ~ D r t t ~ sC A N D I D A T EF o r o f f e w e o n l y

P u r c h a s e s o f c a m p a i g n p r o p e r t y 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 3E x p e n d i t u r e s t o c o n s u l t a n t s ( 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 , m a n a g i n g , o r g a n i z i n g s e r v i c e s ,e t c . ) 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 n S c h e d u l e G b y t h e a m o 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- n e e s H a n f n n h e h n l f o f f h o n n n d i d a t e ' s c o m m i t t e e . S e e m a n u a l f o r m o r e s p e c i f i c I n s t r u c t i o n s

DATEEXPENDED NAME AND ADDRESS TO( Di s b u r s e me n t ) WHOM EXPENDI TUREWAS MADE - PURPOSEAMOUNTEXPENDED

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' ~GnSs ~77l l l l s l ~ , . o 1 -Z - 7 - ~. . ~ . . . ~ Gy1 S/ L 1 . LQ ~ 5 y/ 1 / Oow= 1 3 s / 7 Q1 6 , 5 - 7

~ L . S l / O7 r ,- 3 ( V

L / i a m / m n f , l e, . . ; . a c s .. ~3_ _a r e r , , t L ` ~ p h

Cam~G. ~ C l ~ 1 ' ~ y ^ q . U B - T OT A L S aT 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 ) Z


17/18

EXPENDI TURES- MONEYSPENT

CANDI DATE' S COMMI TTEE NAME( Mu s t b e s ame a s on S t a t eme n t o f Or g an i z a t i o n)WC) 7 - 7

SCHEDULE MONETARY

CANDI DATEF o r o M 1 0 e we o n h r

Camp a i g n f u nd s may be u s e d o nl y f o r c a mp a i g n p u r p o s e s , c on st i t uen cy e x pen di t u r es a n d e d uc a t i o n al a n d o c h e r e x p e n s e s a ss o c i a t e dwi t h d ut i e s o f o f f i c eP ur c h a s e s o f c a mp a i g n pr o pe r t y must a l s o be I n v e n t o r i e d o n Sc h e d ul e H ,Ex p en d i t u r e s t o c o ns ul t a nt s ( p e r s o n s / e n t i t l e s pr o v i d i n g c o hs u l t i n g , a d v e r t i s i n g , f u n d r a l s i n g , p o l l i n g , ma n a g i n g , o r g an i z i ng s e r v i c e s ,e t c . ) must a l s o be d e t a i l i t emi z ed o n Sc h e d u l e G by t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y pe o f e x pe nd i t u r e mad e by t h ew- n ei s l t n f n n h s h a t f o f t h o n a n e l i e t a t e ' s c o mmi t t e e . Se e manua l f o r mo r e s p e c i f i c I n s t r u c t i o n s .

DATEEXPENDEDNAMEANDADDRESSTOWHOMEXPENDI TUAE( D l s u r s e me n t ) WASMADE PURPOSE

AMOUNTEXPENDED$

~ i T o ~m ~-93s / ?AotL- 3 . ~ l . P. 4 7

tea ' S2 r c " " = " ~. t ! o " o O

SUB- TOTAL STOTAL( I f l a s t page o f t h i s s c h ed u l e ) Z


18/18

CANDI DA E ' S COMMI TTEE NAME ( M u s t b e s a 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 )uw ~- Rr o ec 5 - e l ' l

PART NAME AND ADDRESS OF CONSULTANTName o f Co n s u l t a n t

Ma i l i n g A F f i r e s s.yke3; &v 1 1CA- r -

C i t y S t a t e Z i p CodevA i - ~ - ~4 -T-0-a- 4 4

CONTRACT PERI OD TOTAL ANT I CI PATED COMPENSAT I ON FOR PERFORMANCEF r o mt o

ESTI MATES OF PERFORMANCE ( Us e back o f f o r m I f n e e d e d )7 - C . t . r d r ~ t t t " '

SCHEDULE I BREAKDOWN OFMONETARYEXPENDI TURESBY CONSULT ANTFo r o f f i c e u s e o n ew 01- 0 Eb ) Ok

PART I I I T E MI Z E D BREAKDOWN OF UNREI MBURSED EXPENSES OF CONSULTANT I N PERFORMI NG S E RV I C ES OF CONTRACTDATEEXPENDED NAME AND ADDRESS TOWHOM EXPENDI TURE( D i s b u r s e m e n t ) WAS MADE PURPOSE AMOUNTEXPENDED

P a g e - I - o f SUB- TOTAL $( f o r S c h e d u l e G )L o s e 2 7 n a ao os o i ( Re v . 1 9 9 3) TOTAL ( i f f a s t p a g e o f t h i s s c h e d u l e ) $

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