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  • 8/7/2019 McKinley Paul__1269__scanned

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    FOR I NSTRUCTI ONS, SEE BACK OF, l M

    DI SCLOSURE SUMMARY PAGECOMMI 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 )McKi nl e y f or St a t e Se na t eI 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 :( 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 C an d i d a t e( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o 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( 8 ) S u p p o r t S l a t e o f C a n d i d a t e sSI GNATURE 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 ) TEL EPHONE DATE SI GNED

    Ro u t i n e P e n a l t i e s Du e Fo r L a t e F i l e d Re po r t s Ra n g e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ON BACK AND COMPL ETE THE FOLLOWI NG SENTENCE :- I ' - iI AM FI L I NG A Ja n 1 , 20 0 1 t o De c 3 1 , 2 0 R 1PORT FORAN/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

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

    CHECK I F AMENDMENT TO REPORT DATED

    Ch e c 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 a n d a t t a c h No t i c e o f D i s s o l u t i o n Fo r m DR- 3 .( Yo u mu s t c o nt i n u e t o f i l e r e p o r t s u n t i l a No 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 eL 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 mm i t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

    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 lo f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s a m o u n t MUST b e t h es ame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a s t r e p o r t i n g p e r i o d ,o r m u s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 719 . 96ADD TOTAL MONEY TAKEN I N THI S PERI OD FSc h e d u l e A : C a s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h ed u l e A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 , 2 5 0 . 0 0Sc 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 -Sc h e d u l e H : T o t a l Sa 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 -

    ( Sc h ed u l e H a pp l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )

    l J - " T . - r f

    OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e du l e F ) . . . . . . . . . . . r . . . . . 6 ~? . . t . . ~ 1 . . ~ J. . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l e G At t a c h e d ?) YES X NOVALUE OF CAMPAI GN PROPERTY ( Fr o m Sc h e d u l e H - At t a ch Sc h e d u l e H) $ - 0 -

    C~

    SUB- TOTAL . . . . . . $ 4 , 96 9 . 96SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B : Ex p e n di t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 0 3 . 4 9Sc h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 -

    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 tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4 , 76 6 . 4 7

    UNPAI D BI L L S ( Fr o m Sc h ed u l e D - At t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ - 0 -I N KI ND CONTRI BUTI ONS ( Fr o m Sc he d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 2 0 9 . 18

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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 Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e s am e a s o n S t a t e m e n t o f O r g a n i z a t i o n )

    Mc Ki n l e y f o r St a t e Se n a t eSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P O L I T I C A L 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 AVA I LABLE F ROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : 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 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 os e 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 .

    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 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 yma 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 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 1 o f 3f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A )

    SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e )

    SCHEDUL EA MONETARY( Re v . 0 6 1 9 7 ) RECE I PTSQCHECK T HI S BOX I FAMENDI NG FORM

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 4 I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECE I VED FUN( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI D# t 2 - g 1 I o wa Ho s p i t a l A s s o c , PAC10 / 1 9/ 0 1 CK#1780 100 E Gr a n d Av e 5 00 . 00De s Mo i n e s , I A 5 0 3 0 9I D# 6071 I o wa L i f e I n s . I n d u s t r y , PAC1 0 / 1 9 / 01 5 700 We s t o wn Pkw yCK# 3078 We s t De s Mo i n e s , I A 5 0 2 6 6 100 . 0I D# 6 0 9 6 Ma nu f a c t u r e d Ho u s i n g PAC1 0/ 1 ' 9 / 01 CK# 1 430 1 4 00 Dea n Av eDe s Mo i n e s , I A 5 0 3 1 6 300 . 0I D# 6 0 6 9 I o wa I n d u s t r y , PAC0 / 1 9 / 0 1 CK#1833 9 5 4 Wa l n u t St Su i t e 100De s Mo i n e s , I A 5 0 3 0 9 5 00 . 0I D# J o h n Humph r ey10 / 2 0/ 0 1 Ce n t e r v i l l e , I A 5 2 5 4 4CK# Ca s h 50 0I D# St e p h en Ro b e r t s10 / 2 0/ 0 1 866 Wa l n u t StCK#6726 De s Mo i n e s , I A 5 0 3 0 9 1 0 0 . 0I D# 6 4 3 0 I A Ru r a l Wa t e r St a t e PAC1 0 / 1 1/ 0 1 4221 So u t h 2 2 n d Av e E

    _ CK#1 . 1 8 2 Ne w t o n , I A 5 0 2 0 8 1 0 0 . 0I D# - J o h n Gl e n n10 / 1 1/ 0 1 2 2 8 9 0 1 3 0 t h Av eCK# C a s h Ce n t e r v i l l e , I A 5 2 5 4 4 5 0 . 0 0I D# 6 1 1 8 I A Op t o me t r i c As s o c PAC0 / 1 9 / 0 1 CK# 1736 1 0 5 4 - 5 0 t h St St e 204We s t De s Mo i n e s , I A 5 0 2 6 6 15 0 . 00

    0 / 1 9 / 0 1 I D# 6 0 8 7 I A Te l e c ommu n i c a t i o n s A s s n PACK# 1 1 23 1 60 1 - 2 2 n d St St e 209We s t De s Mo i n e s , I A 5 0 2 6 6 1 5 0 . 0 0

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

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( 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)McKi n l ey f or St at e Se n at e

    CAUTI ON : Se 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 c o p i ed 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 c o mme r c i a l p u r p os e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

    SCHEDULE-( R ev . 0 6 / 9 7 ) MONETARYRECE I PTS

    [ ] CHECK T HI S BOX I FAMENDI NG FORM

    STATE CANDI DATES NOTE: I F A CONTR I BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER ANDTHE 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 .

    SUB- TOTAL $ 1 9 0 0 . 0TOTAL ( i f l a s t page o f t h i s

    s c h e d ul e ) $D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma l t 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 be s h ow 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 Page 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 same a s c a n d i d a t e , b u t t h e r e i s n o Page 2 o f 3f a mi l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A )

    DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR REL A T I ONSHI P AMOUNT J I F FRECEI V ED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI SNUMBER I NCO1 0 / 1 9 / 0 1 I D# 6 0 5 9 I A Comm o f Au t omot i v e Re t a i l e sCK# 2 1 0 4 1 1 1 1 Of f i c e Pa r k Ro a d $Wes t De s Mo i n es , I A 5 0 2 6 5 1 0 0 . 0ID::- Hu l t ma n ' - C om p a n y '1 0 / 1 9 / 0 1 1 20 0- 5 7t h StCK# 4 4 4 2 Wes t De s Mo i n es , I A 5 0 2 6 5 1 0 0 . 01 0 / 1 9 / 0 1 I D# 6 2 3 4 I FBF PACCK#3725 5 4 0 0 Un i v er s i t y AVeWes t De s Mo i n es , I A 5 0 2 6 6 2 5 0 . 0

    I D# 6 0 7 0 ` 2 A Lawpac1 0 / 1 9 / 0 1 CK# 2 5 2 8 521 E Locus t ' S tDes Mo i n e s , . I A 5 0 3 0 9 1 0 0 . 01 0 / 1 9 / 0 1 I D# . 6 0 5 6 Ba n k e r s Un i t e I n Leg i s l at i v e e c i : s i On s -CK# 251 6 4 1 , 8 6 t h ` , Av e . S t e ; 430 .De s Mo i n e s , I A 5 0 3 0 9 2 0 0 . 0

    I D# 6 0 2 7 Deer e PAC I A9 / 1 5/ 0 1CK# 1 8 3 5 6 8 8 Gr and Av eDe s Mo i n e s , I A 5 0 3 0 9 5 0 0 . 0

    1 0 / 1 9 / 0 1 I D# 6 0 6 3 I A De n t a l As s oc .CK# 1 4 4 9 5 0 5 5 t h Av e S t e 3 3 3De s Mo i n e s , I A 5 0 3 0 9 1 0 0 . 01 0 / 1 9 / 0 1 I D# 6 0 2 1 Cr e d i t Un i on PACCK# 1 4 3 7 3 7 3 7 Wes t own PkwyWest De s Mo i n e s I A 5 0 2 6 5 25 0 . 01 0 / 1 9 / 0 1 I D# 6 1 2 5 I A Re a l t o r s PACCK# 1 8 7 2 9 9 9 Oak r i d ge DrDe s Mo i n e s , I A 5 0 3 1 4 1 0 0 . 01 0 / 1 9 / 0 1

    1 D # 6 1 4 6 Ho me bu i l d e r s ASSOC PACCK# 1 3 1 7 9 0 0 1 f . Hi c k man j - Rd_ St e 2 1 ' 0 2 0 0 . 0 1 )Des Mo i n e s , I A 5 0 3 2 2

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    Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

    ( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( M u s t b e s am e a s o n S t a t e m e n t o f O r g a n i z a t i o n )

    McKi nl e y f o r St a t e Se na t e

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

    STATE CANDI DATES NOTE : I F A CON TRI B UT I ON I S R E CE I V E D FROMA 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 T HE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC 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 FROMTHE I OWA E T H I C S ANDCAMPAI GND I SCLOSURE BOARD .CAUTI 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 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 rf o r a n y c o m me 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 350 . 0 0'TOTAL ( i f l a s t p a g e o f t h i s 2 5 0 , 0 0s 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 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 l 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 ) ( 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 3 o f3f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

    DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI D# 6004 ' As s o c Gene r a l Co nt r a c t o r s " PAC10 / 25 / 0 1 $CK# 3804 PO Bo x 757De s Mo i ne s , I A 50303 250 . 00

    10 / 25 / 0 1 I D# : . ' 6 05 9 - - I A Commi t t e e o f Aut omo t i v e Re t a i l e r sCK# ' 1111 Of f i c e Pa r k Ro a d2118 We s t De s Mo i ne s , I A 50265 100 . 00I D#CK#I D# ;CK#

    CK#I D# , .CK#

    I D#CK#

    CK#I D#CK#

    I D#CK#

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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 m o 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 m a d e 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 PAC COMMI TTEES : NOTE : FOR C ON T R I B UT I ON S MADE T O S T A T EWI D E 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 A ND I D A T E I D E NT I F I C A T I ON NUMBER I N T H E D ES I GN AT E D COLUMN AND T HE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH E X P E ND I T U RE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA AMEND I NG FORME T H I C S & CAMPAI GN D I S C L O S UR E BOARD .COMMI TTEE NAME ( Mu s t b e same as o n S t a t e me n t o f O r g a n i z a t i o n )

    Mc Ki n l e y f o r St a t e S e n a t eCANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DE SCRI B E TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ D D/ Y R ) AND PACCHECKNUMBER

    I D# Mc Ki n l e y I n c Re t u r n A d d r e s s9 - 2 1 - 0 1 CK# 5 5 8 3 1 9 S 7 t h ST En v e l o p e s $ 2 0 3 . 4 9Ch ar i t o n I A 5 0 0 4 Co un t y F a i r L o g o sI D#CK#I D#CK#

    CK#I D#CK#I D#CK#I D#CK#I D#CK#

    SUB- TOTAL $TOTAL ( i f l a s t pag e o f t h i s s c h e du l e ) $ 2 0 3 . 4 9

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    FOR I NSTRUCTI ONS, SEE BACK OF FORMCOMMI TTEE 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 )

    Mc Ki n l e y f o r St a t e Se n a t e

    SUB- TOTAL

    TOTAL ( i f l a s tp a g e o f t h i s

    s c h ed u l e )

    SCHEDUL EE I N K I ND( Re v . 0 6 / 9 7 ) CONTRI BUTI ONS

    El CHECK T HI S BOX I FAMENDI NG FORM

    ' D i s c l o s u r e l aw r e q u i r e s c an 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 an y r e l a t i v e ma k i n g a n i n k i n d c o n t r i b u t i o n t o t h e Page 1 o f _ 1 -c o mmi t t e e . Re l a t i o n s h i p mus 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 on s an gu i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s ( f o r Sc h e du l e E )b y ma r r i a ge ) . ( Se e Page 2 o f f o r ms p ac 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 as c a n d i d a t e , b ut 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 .

    DATERECEI VED( MM/ DD/ YR) NAME AND ADDRESSOF CONTRI BUTORRELATI ONSHI PTO CANDI DATE

    ' ( i f a p p l i c a b l e )DESCRI PTI ONOF I N K I ND

    CONTRI BUTI ONESTI MATEDF AI R MARKET

    VALUE4 I F FOR

    FUND- RAI SERCONTRI BUTI ON

    0 9/ 2 8 / 0 1Mot or Ca r r i e r s PAC 6 10PO Bo x 6121De s Mo i n e s , I A 5 0 3 0 9

    F o o d a n dI A - Mot orMot orAt r i um2 09 " 18

    9