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' ` OR' I YSTRUCT I ONS . SEE BACKOF FORM

DI SCLOSURE SUMMARY PAG I u R E e o r w D -2 3 2 0 0 7COMMI TTE NAME Mus t b e s a s o t a t e me n t I Or a a b o n )

I MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r : I Z I1 1 ( S t a t e w i d e / L e g i s l a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l Ca n d i d a t e( 5 ) C ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e( u p p o r t S I o f Ca n d i d a t e s

S) eAATURE OF 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 GNEDRo ut i n e P e n a l t i e s Du e F o r L a t e F i l e d Rep o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK ANDCOMPLETE THE FOL LOWI NG SENTENCE :I AM F I L I NG A C I Qhuo l - y Z Z , . 2 0 0 , 9 - , REPORT FORAWA ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR .

( r e p o r t d a t e )CHECK I F AMENDMENT TO REPORT DATED

0 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 o r m DR - 3 .( Y o u must 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 HAND

I n d i c a t e o n e

CASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a lo f a l l mo n i e s h e l d by t h e c o mmi t t e e . T h i s amoun t MUST be t h es a m e a s t h e c a s h o n h a n d a t t h e en d o f t h e l a s t r e p o r t i n g p e r i o d ,o r must b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL 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 ul 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 S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l S a l e s o f Ca mp 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 h ed u l e p l i e s t o Ca n d i d a t e s ' Commi t t e esOnlSUB - TOTAL . . . . . . S

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc 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 Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d ul e F : L o a n R ep a y me n t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND 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 m u s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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

DI SCLOSUREREPORTFORMDR - 2( Re v 0 1 / 9 8 )

F o r O f f i c e Us e O n l yComm . #I n d e x e dA u d i t e dC o m p u t e r

L o c a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y b L o c a l C o mmi t t e e s , e n t e r C o u n t y iw h i c h E l e c t i o n i s h e l d


2/14

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 )COMMITTEENAME ( Mu s t b e s ame a s o n St a t e me nt o f Or g a ni 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 OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE 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 .CAUTION: Se c t i o n 68 B . 3 2A( 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 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 nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c o mme r c i a l p u r p o s e 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 es .

SUB-TOTAL

TOTAL ( i f l a s t page o f t h i ss c h ed u l e ) L$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 mm i t t e e . R e l a t i o n s h i p mu s t b e s 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 ym a r n a g e ) ( S e e Pa ge 2 o f f o r m s p a c k e t . ) . 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 r e i s no P a g e 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 umn . ( o r Sc h e d ul e A)

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

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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 - - 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 TTEE NAME ( Mu s t b e s ame a s on S t a t e me n t o f Or g a ni z a t i on )

fSTATE CANDI DATES NOTE: I F A CONTR I BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE PACCHECK 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: S e c t i o n 68 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 op i e d f r o m r e p o r t s a nd s t a t emen 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 c omme r 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 es .

' 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 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 m u s t 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 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 ) ( S e e Pa ge 2 o f f o r ms p a c k e t . ) . 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 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 .

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) I RECE I PTSCHECK T HI S BOX I FAMENDI NG FORM

SUB- TOTALTOTAL ( i f l a s t page o f t h i s

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' F o r I n s t r u c t i o n s , s ee 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 S t a t e me o f O r g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A C ON T RI B UT I ON I S R E CE I V E D FROM A STATE PAC ( P OL I T I CA L A C T I O N C OMMI T T E E ) , L I S T T HE P AC I DE NT I F I C A T I ONNUMBER AND THEPAC CHECK NUMBER I N THE DES I 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 .CAU T I ON : S e c t i o n 8 8 8 . 3 2 A ( t 3 ) , 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 an y c 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 m m i t t e e s .

S U B - TOTA LTOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e ) ~$

$ J - 2 21 -

D i s c l o s u r e t 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 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 ( h 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 ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . 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 o Page ~ ~~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 )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI P TS

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5/14

F o r l n s t r u c t i o n s , Se e Ba 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 ( 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 )~oOa~WEknu4c . -

S T A T E CAN NOTE I F A C ON T RI B U T I O N I S R E CE I V E D FROM A S T A T E P A C ( P O L I T I C A L A CT I O N C O MMI T T E E) , L I S T T H E P A C I D EN T I F I C AT I O NN U M B E R A ND T HE P AC CHECK NUMBER I N T H E D E S I G N AT E D COLUMN . A L I S T OF I D N U M B E R S I S A VA I L A B L E FROM T HE I O WA E T HI C S AND C A MP A I G ND I S C L O S UR E BOARDCAUTI 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- TOTAL $ V K , "6. d eTOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e ) 1 $' 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 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 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 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 ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . 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 P a g e _O f_0f 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 )

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

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F o 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 S t a t eme n t o f O r g a n i z a t i o n )P~P ~ 2 ( t Ni ~, ~ N)ug--

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) 1 RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

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 FROM A STATEPAC ( P OL I T I C A L A C T I O N C OM MI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBERAND THEPAC CHECK NUMBER I N THE DES I GNATED COL UMN . 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 HI C S AND CAMPAI GND I SCLOSURE BOARD .CAUT I 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 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 rf o r an y c o m m e r 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 mm i 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 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 n a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . 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 o P a g e 11 ~-_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 m n . ( f o r S c h e d u l e A )

DATERECE I VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI PTO CANDI DATE' AMOUNTRECE I VED 4 IFU( MM/ DD/ YR) AND PAC CHECKNUMBER ( i f a p p l i c a b l e ) RAI NCI D#

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7/14

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 S t a t eme n t o f O r g a n i z a t i o n )

[ ~2 t f e ( t ~ au~huSTATE 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 AT E P AC ( P O L I T I C A L A CT I O N C OMMI T T EE ) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THEPAC CHECK NUMBER I N THE DES I GNATED COL UMN . 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 HI C S AND CAMPAI GND I SCLOSURE BOARD .CAU T I 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 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 rf o r an y c o m m e r 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 mm i t t e e s .

1 SUB - TOT A LTOTAL ( i f l a s t p a g e o f t h i ss c h e du 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 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 ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . 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 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 . P a g e o f( f o r S c h e d u l e A )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) R EC EI P T S

CHECK T HI S BOX I FAMENDI NG FORM

DATE P AC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR R EL A T I ON S HI P AMOUNT 4 I FRECEI V ED( MMI D D/ Y R) ( i f a p p l i c a b l e )AND PACCHECK TO CAND I D AT E '( i f a p p l i c a b l e ) RECEI VE D FURA INUMBER I NCu ~ ~ t r S er kCK# Z q 1 1 02 Wf ' n $

I Z/ ' / D

I D# b o u q A r t t r , _' ` hMd e ~n c t , A J c i c L I nf r . - -CK# I , ~ ~ j 7 2 Z y I n 5+ . o x 32q. " UI D# / 4 ~ r . d ~r 5 , I D h h A 6a p- )U I c K# 120 2301

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8/14

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

( I 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 Or g a n i z a t i on )

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE 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 c t i o n 6 8B . 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 c op i e d f r om r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c omme r c i a l p u r p o se 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 page o f t h i s

s c h e d ul e ) L$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 mm i 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 y ~nma r r i a g e ) ( Se e Pa ge 2 o f f o r m s p a c k e t . ) . 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 umn . ( f o r Sc h e d ul e A)

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATERECE I VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESSOF CONTRI BUTOR RELAT I ONSHI PTO CANDI DATE' AMOUNTRECE I VED 4 IFU( MM/ DD/ YR) AND PACCHECKNUMBER ( i f a p p l i c a b l e ) RAII NI D# Ehour J16er

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I D # a u r / ~~ s J-e a n n e - O r ' ' t k )CK# ~~y~ 3 g 0 5+ ~~c?cI D # Sf hCl - 2 Low-i 2 _ /

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9/14

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

( I 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 S t a t e me n t o f Or g a n i z a t i on )k' _CO' - i f or t ~kAmt,

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON: S e c t i o n 68 B . 3 2 A ( 6 ) , I o wa Cod 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 op i e d f r om r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c omme r c i a l p ur p os 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- TOTAL1$ ~o

TOTAL ( i f l a s t page of t h i ss c h ed u l e )L' 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 mm i 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 yma r r i a g e ) ( S e e Pa g e 2 o f f o r m s p a c k e t . ) . 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 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 . P a g e o f( f o r S c he d u l e A )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS0CHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESSOF CONTRI BUTOR REL A TI ONSHI PTOCANDI DATE' AMOUNTRECE I VED v I FFU( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# FI ) Ef ~ J C )C~~CK# y ~ ~ -J ~ '

3C- S ' ( I C c X I I S of t~kL t 1

$ 1 =~ ( ~cF V 1 r 6 1 6 6 1 ,

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~ Zl ~

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P, 0, t 3 ox 35~~ 50- .Cu r ~ ~ ~ t ~ ur 5~~~~I

I D* Wat wa Rt I l e r + - s Tr u s+ - ~Ot ~e. : ; ~ _I cK# CJO ` ~ q ~ f , , t

+( + . & ( arm~t nagri mi +- G"4' 2Do0 05c ) - 00, McUGQa ,V5vzo1D# Wman a n dM. r ~ doer c t n d& y a r n p

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10/14

F o r I n s t r u c t i d 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 nd i d a t e ' s p e r s o n a l f u n ds )CO" . 1 " : 1 1 T TE " ` LAME ( Mus t be s ame a s on St a t ement o f Or g an i z a t i o n )ySTATE_ CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THEPAC I DENT I F I CATI ONNAG, - . _ - ANC THE PACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L A B LE 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 Cod e, p r oh 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 po 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 b u t i o nsf o r a n y c omme r 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 es .

' 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 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 . Re l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c on s a ng 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) ( Se e P a g e 2 o f f o r ms p a c k e t . ) . I f su r name o f c on 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 pp l i c ab l e " i n t h e r e l a t i o n s h i p c o l u mn

SCHEDULEA MONET AR

( Re v 0 2 / 9 6 ) RECEI PTI ] CHECK THI S BOX

AMENDI NG FORM

DATERECEI VED( MMI DDI YR)

PAC I D NUMBER( i f a pp l i c a b l e )

ANDPACCHECKNAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P

TO CANDI DATE'( i f a pp l i c ab l e )

AMOUNRECEI V

NUMBERI D#

I z - LZ- 0 / CK#. . / y . . ~~ CK# me J07fI D# ~

t t CK# 10C4 9r . .I D# f i r , IY

XI L CK# 7g-7 vf 'l . . l yn ~ CK# y 7 c ~ ~d- ~Uf

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I D# i ~l" , ~ c e - Z , t I O~Cs .

i D# W1 ~ , ~ ; aK#

I D# +CK# d )I D# hCK#

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 )


11/14

F o r I n s t r u & a o n s , Se e B a c k o T Fo r mC%NTRI B l 9 T I CNS - - MCNEY 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 7TEE AME ( Mu s t b e s ame o n St a t e me n t o f O r g a n i z a t i o n )

SCHEDULEA( R e v . 0 6 1 9 7 ) MCNE- APYRECEI PTS

CHECK T HI S BOX i FAMENDI NC- FORM

STATE CANDI DATE= NOTE : I F ACONTR I BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACT I ON CCMMI T TEE} , L I ST THE PAC I DENT I F I C AT I ONNUMBERANDTHE PACCHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUT I ON : S e c t i o n 6 8 8 . 3 2 4 ( 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 m m i t t e e s .

SUB- TOTAL 1 10TOTAL . ( i f l a s t , p a g e o f t h i ss 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 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 ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t ) . 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 u t t h e r e i s n o P a g e _D 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 m n . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I Ft RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MMI DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# ~J u~% v hi ( S ' ~ J? ' c ~ , A ,

I D# 1 5 c vCK#I D# / ~ 7^ / l / ~ l s ~ ~ ~ Q~ e ~a vCK# 1ZI D# ~ f -CK# o i C / f GMMEJ3" r ~f t

qU

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I D#CK#


12/14

T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEE S ONLY :P u r c h a s e s o f c e r t a i n c a m p a i g n p r o p e r t y c o s t i n g $ 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 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 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 C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

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

t - UK I NS I KUG I / U NS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( R e v . 0 9 / 9 7 ) EXPENDI TURESSTATE PA C COMMI TTEE S : NOTE : FOR CON TRI 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 CAND I DATE I D E NT I F I C AT 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 A V A I L A B L E FROM THE I OWA AMEND I NG FORME T H I C S & CAMPAI GN D I SCLOSURE BOARD . -

COMMI TTEE NAME ( Mu s t b e s ame a s o a t e me n t o f O r g a n i z a t i o n )f t ~CANDI DATE NAME AND ADDRESS Tb 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 me n t ) WAS MADE( MM / D DI Y R ) AND PACCHECKNUMBER

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13/14

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 st i n g $ 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n S c he d u l e H. ( Re f e r t o S c he d u l e H i n s t r u c t i o n s . )Ex p e nd i t u r e s t o p e r s o n s t 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 u l e G b y 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 p e o f e x pe n d i t u r e made b y t h e p e r s o n l e n t i t y o n b e ha l f o f t h e c a n d i d at e ' s c o mmi t t e e . ( Re f e r t oS c he d u l e Gi n s t r u c t i o n s a n d I o wa C o d e 5 6 . 6 ( 3 ) ( i ) . )

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

1 - C ) H uv s TRUCTI ONS, SEEBACK OF FORM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PACCOMMI TTEES : NOTE : FORCONTR I BUT I ONS MADE TO STATEWI DEOR L E GI S L A TI VECAND I DATES , L I ST THE CANDI DATE I D EN TI F I C AT I ON NUMBER I N THE 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 VA I L A B L E FROMTHE I OWA AMEND I NG FORME T HI C S &CAMPAI GN DI SCLOSURE BOARD. _COMMI TT NAME ( Mu s t b e e a s o n S t a t e me n t a n i z a t i o n )

l - 0 _ ~ l J t ; ~ r l ~ or ` Y o " L6CANDI DATE NAME AND ADDRESSTO 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 ) WASMADE( MM/ D DI Y R) ANDPACCHECKNUMBER

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14/14

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 m o 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 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 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 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 C o d e 5 6 . 6 ( 3 ) ( i ) . )

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

FOR I N STRUCT I ONS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PA C COMMI TTEES : NOTE : FORCON TRI B UT 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 CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COL UMN AND THE I ~ CHECKTHI 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 THE I OWA AMEND I NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD . _COMMI TTE, 9A4 ME ( M u s t b e s am e t a t e me n t o f O r g a n i z a o n )we r ~ ) Z : A , 4 ~ l j l e ?CANDI DATE 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( M M / D D / Y R ) ANDPACCHECKNUMBER

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