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' ° FOR I NSTRUCT I ONS, SEE BACK OF FORM

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 )

S ~ r G f G ' ( f For 5P/ La

I MPORTAN ~ I n d i c a t e b y # 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 :( 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 C o mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 8 ) 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

PAC ( 1 0 ) 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

C ONLY :

C a n d i d a t e Name

L a t e 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 a n dt h e c a n d k t a t e , f o r a c a n d i d a t e ' s c o mmi t t e e , a

I r e s p o n s i b l e f o r f i l i n g t i me l y an d

I AMF I L I N G A v h e

DI SCLOSURE SUMMARY PAGE

( r e p o r t d a t e )

QCHECl ( F ANETCMEI NT TOREPORT DATED

[ ] Chec 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 an 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 .( Y o 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 DR- 3 i s f i l e d . )

u r s u a n t t o I o wa Code s e c t i o n 6 8 B . 3 2 A ( 7 )( r p e r s o n , f o r a n y o t h e r t y p e o f c o mmi t t e e , i s t h e

c u r a t e r e p o r t s .

3 1 , 9 - 3 ~K' - l 9 / ' , 7 ( / ' - / - o?- -TELEPHONE DATE SI GNED

REPORT F OR ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR.

I n d i c a t e b y # I Z I

STATEMENT OF CASH ON HAND

CASH 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 o t a l o f a l l f u n d s h e l d b y t h e

c o mmi t t e e . T h i s amou nt MUST b e t h e same a s t h e c a s h o n h a n d a t t h e e n do 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 st 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 OD

S c h e d u l 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 h e du l e A ) ( ' a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . . . . . .

S c h e d u l e F : Loa n s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .

S c h e d u e H : T o t a l S a l e s o f Campa i g n P r o p e r t y ( A t t a c h S c h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l v t

SUB - TOTAL . . . . . . . . . . . . . . . . . . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PER I OD

S c h e d u l 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 ) ( " a l s o s ee d e b t s an d l o a n s b e l o w ) . . . . . . . . . . . . . . . . . .

S c h ed u l e F : Loan Re pa ymen t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 mu stb e z e r o ) ( A t t a c h D R- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

" UNPAI D BI L L S ( F r o m S c h e d u l e D - A t t a c h S c he d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . $

` I N KI NDCONTRI BUT I ONS ( F r o m S c h e d u l 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 h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )CANDI DATE

COMMI TTEES ONLY,

VALUE OF CAMPA I GN PROPERTY ( F r o m S c h e d u l e H - A t t a c h S c h e d u l e H ) $

STATE COMMI T7F ES : S u b mi t a r e c o n d l e d c ampa i g n a c c o u n t b a n k s t a t e m e n t i n J a n u a r y o f e a c h y e a r .

FORM

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( Re v . 1 2 1 2 0 0 5 ) REPORT

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F ax : 5 1 5 - 2 8 1 - 3 7 0 1

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 n

C o u n t y & L o c a l C o mmi t t e e s , e n t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

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Fo r I n s t r u c t i o n s , Se e B a c k o f F o r m

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 )

COMMI TT EE NAME ( M u s t b e s ame a s o n 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

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 O MMI T T E E ) . L I S T T Hg PA C I D E N T I F I C A T I O NNUMBER AND TH E P A C CHECK NUMBER I N T HE D E S I G NA T E D 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 O WA E ' r H i c S AND C A MP A I G N

D I S C L O S U RE BOARD.

NOTE : A NY PERSON, OTHER THAN AN I N DI V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GR E S P ON S I B I L I T I E S AND SHOUL D I MMEDI ATELY CONTACT THE BOARD .

CAUTI 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 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 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 e

c 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 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 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 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 .

SCHEDULE

A MONETARY( R e v . 0 7 / 0 3 ) RECEI PTS

CHECK T H I S BOX I F

AMENDI NG FORM

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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 )

COMMI TT EE NAME ( M u s t b e same a s o n 5 t q t e me n t o f O r g a n i z a t i o n )

C~ -11

R e s e t F o n r n SCHEDULE

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CHECK T H I S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I ST THEPAC I DENT I F I CATI ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATEDCOLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .

NOTE ANY PERSON, OTHER THAN AN I N D I V I D UA L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GR ES P O NS I B I L I T I E S AND SHOULD I MMEDI ATELYCONTACT THE BOARD .CAUTI 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 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 mm i t t e e s .

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 )

' 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 ma k i n 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 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 m e o f c o n t r i b u t o r i s t h e s a me 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 m n . ( f o r S c h e d u l e A )

DATE PAC-1 1 3 1 4 1 L I W A -M 2 1 6 1 1 0 2 a l e . ? 73 ~. u t T « i l ~ I L > j t L ~ . : a UNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D I Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER

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Fo r I n s t r u c t i o n s , Se e B a c k o f F o r m

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 )

COMMI TTEE NAME ( Mu s t b e s ame a s o n 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

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 OMM I T T E E ) , L I S T T HE P AC I D E N T I F I C A T I O NNUMBER AND T H E P ACCHECK NUMBER I N T HE D E S I G N 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

NOTE:ANY PERSON, OTHER THAN AN I N DI V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GR E S P O N S I B I L I T I E S A ND SHOUL D I MMEDI ATELY CONTACT TH E BOARD .

CAUTI 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 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 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 e

c 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 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 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 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 $

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

P a g e o f -( f o r S c h e d u l e A )

SCHEDUL E

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AMENDI NG FORM

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RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( M M/ D D 1 Y R) A ND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

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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 F o r m

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

i COMMI TT EE NAME ( Mu s t b e s ame 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 )CHECK T H I S BOX I F

AMENDI NG FORM

SCHEDULE

A MONETARY( R e v . 0 7 / 0 3 ) RECEI PTS

S T A T E CANI XDATES NDTE : I F A C ON T R I B U T I ON I S R E CE I V E D FROM A S T A T E PAC ( 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 AC I D E NT I F I C AT I O NNUMBER AND T H E PAC CHECK NUMBER I N T HE D E S I G N AT E D COLUMN A L I S T OF I D NUMBERS I S A VA I L A B L E FROMT HE I O WA E T HI C S AND C A MP A I G ND I S C L O SU R E BOARD.

NOTE : ANY PERSON, OTHER THAN AN I N DI V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GNMAYHAVE F I L I N GR E S PON S I B I L I T I E S AND SHOULD I MMEDI ATELY CONTACT THE BOARD .

CAUTI 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 o mm 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 .

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

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STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE 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 THE PAC I D EN T I F I C A T I O N

NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: 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 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 o n t r i b u t i o n s o rf o r an y commer c i a l p u r p o s e 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 t 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 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 t t 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 paw 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 ns h i p c o l u mn . ( S c h e d u l e A)

SCHEDULE

A MONETARY

( Re v . 0 7 / 0 3 ) RECE I PTS

QCHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT 4 I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DD/ YR ) AND PAC CHECK ( I f a p p l i c a b l e ) RAI S ER

NUMBER I NCOME

I D#

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s / z 3 / c Y C

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ce,

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Fo r I n s t r u c t i o n s , Se e Bac k o f F o r m

CONTRI BUTI ONS - MONEYTAKEN I N

( I n c l u d i n g c a n d i d e t W a p e r s o n a l f u n d s )

COMMI T I J EE NAME ( Mu 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 )

STATE CAND I 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 FROM A S T A T E PAC ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C AT I O N

NUMBER ANDT HE PAC CHECK NUMBER I N T HE D E S I G NA T E D COLUMN.

A L I S T OF I D NUMBERS I S A V AI L A B L E FROMTH E I OWA E T H I C S AND C A MP A I G ND I S C L O S UR E B O AR D ,

CAUT I ON : S e c t i o n B8 B. 3 2 A ( 8 ) , 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 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 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 .

' 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 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 M 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 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 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 m a r n e 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 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

SCHEDULE

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

0 CHECK T H I S BOX I FAMEND I NG FORM

DATE PAC I D NUMBER NAME A ND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CAND I DATE ' RECEI V ED FUND-( MM/ DDYR ) A ND P A CCHECK ( i f a p p l i c a b l e ) R AI S E R

NUMBER I NCOME

I N A J

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F o r I n s b v c t i o n s , Se e B a c k o f Fo r m

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 )

COMMI TTEE NAME ( Mu s t b e s ame 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 )

STATE CANDI DATES NOTE . I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON C OMMI T T E E ) , UST THE PAC I DENT I F I CAT I ON

NUMBER 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 FROMTHE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUT I ON : 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 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 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 a n y c omme r c i a l p u r p o s e by 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 .

SUB- TOTAL

77r <TOTAL ( I f l a s t page o f t h i s s c h ed 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 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 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 l M y ( r e l a t i v e s b ym a r r I e 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 a s c a n d i d a t e , b u t t h e m e i s n of a m#W r e l a t i o n s h i p , e r g e r ' n o t a p p l i c a b l e " i n t h e P c o l u mn .

SCHEDULE

A MONETARY

( Re v . 0 7 1 0 3 ) RECEI PTS

Q CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT 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/ DDYR) AND PACCHECK ( I f a p p l i c " ) RAI SER

NUMBER I NCOME

I D#

s 4 ~ ( o D~ c K#5o~. + G S

I D#Q

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F o r I n s t r u c t i o n s , Sa e B a c k o f Fo r m

CONTWBUTI 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 TT EE NAME ( Mu 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 )

GG f r ~ ~ ~ ~-nY~~ . ~

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) . L I S T THEPAC I D EN T I F I C A T I ON

NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C SAND CAMPAI GNDI SCLOSURE BOARD .

CAUT I ON : S e 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 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 ny 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 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 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 ma k i n 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 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 mame 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 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 . ( &e d ul eA~

SCHEDULE

A MONET ARY

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

QCHECKTH I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p b c a b i 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 SER

NUMBER I NCOME

I D# . - y

c K# ~5 65 f ~

CK#

CK#

e l l r - m a r t

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T HI S BOX APPL I ES TO CANDI DATES ' COMMTI TEES ONLY :

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 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 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 r 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 er 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 l 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 l y o n b e h a l f o f f t c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o

S 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 de 6 8 A . 4 0 2 ( 3 ) ( 1 ) . )

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

FOR I NSTRUCT I ONS , SEE BACKOF FORM SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI T T EE ACCOUNT

( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PA C COMMI TT EES : 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 N T I F I C A T I O N NUMBER I N THE DESI GNATED COL UMN 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 AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e s am e 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 )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE

( MM/ DD/ YR) AND PACCHECK

NUMBER

I D # ~ / e t v r r l ~ , 2 ' h / + ~ . . , , k

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T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES ONLY :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 mu 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 R 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 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 ma 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 o

S 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 wa C o d e 6 6 A . 4 0 2 ( 3 ) ( i ) . ) _ _

P a g e o f

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

FOR I NSTRUCTI ONS, SEE BACK OF FORM Ae* . F o r m SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTE E ACCOUNT

( R e v . 0 7 / 0 3 ) EXPEND I TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L AT I V E -CANDI DATES, L I S T THE CAND I DATE I D E N T I F I C A T I O N NUMBER I N THE DESI GNATED COL UMN AND THE or CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI L ABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN D I SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e s ame 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 )

I I I ~ ~ , t ~ri. ~

CAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPEND I TURE ( D ESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( I f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE

( MMI DDI YR) AND PACCHECK

NUMBERI

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T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES 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 l 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 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 ) ( 1 ) . )

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

F OR I NSTRUCTI ONS, SE E BACK OF FORM R '- SCHEDULE

EXPENDI TURES B MONETARY- - MONEYSPENT F R O M COMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CON TRI BU T I ON S MADE TO 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 C AND I D A T E I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND THE D CHECK THI S BOX I FPA C CHECK NUMBER FOR EACH EXPENDI TURE . A UST OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMENDI NG FORME T H I C S & CAMPAI GN D I SC LOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e same 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 )

< V

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE "i AMOUNTDATE I D NUMBER EXPENDI TURE ( D ES CR I B E T R AN S A CT I p , I EXPENDED

EXPENDED ( 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 I D D/ Y R ) AND PAC

CHECKNUMBER

I D#

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T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES ONL Y :

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 a t i n g 5 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 l e n t i t l a 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 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 mm i t t e e . ( R e f e r t oS c h e d u l e Gi 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 ) ( 1 ) . )

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

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EXPEND I TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTE ES : NOTE : FOR CON T RI B U T I ON S MADE T O STATEWI DE OR L E G I S L A T I V EC A N DI D A T E S , L I S T THE CAND I DATE I D E N T I F I C A T I O N NUMBER I N THE DES I GNATED COLUMNAND THE CHECK THI S BOX I FPAC CHECK NUMBER FOREACH EXPENDI TURE. A US T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMEND I NG FORME T H I C S 3 CAMPAI GN D I SCLOSURE BOARD .

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