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FOR I NSTRUCTI ONS,. SEE BACK OFF ' M

CANDI DATE COMMI TT EES ONLY :Ca n d i d a t eName _ C) P r -a .C t f -0- Z ~T Lp o l i t i c a lP a r t y

O f f i c eSou g h t D i s t r i c t( i fSe n a t e o r Ho u s e )

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Z/ 1 Z 5 ? ' '- c S ` 7 c c .

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Fo r l r a s F r u c: 1 c r I l s ,Se e Back o f Fo r m

CCNTRI BUTI CNS - - MCNE' l TAKEN I N( I n c l u d i n gc an d i d a t e ` s p e r so n alf u n d s )

COMM1r EE NAME ( Mu s t b es ame a s on S t a t eme n t o f Or g a n i z a t i o n )

c- -t ~- r 5 / 57-

SCHEDULE

( R e v. 0 6 1 5 7 )

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STATE CANDI DA TES ~+ l OTE: I FA CONTRI BUTI ONI SRECE I V EDFROM A STATE PAC ( POL I T I CALACTI ONCCMMr TTE_9,L I S TTHE PAC I DENT I F I CAT I ONNUMBER AND THEPAC CHECKNUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROM 11 1 1 EI OWAETHNCSANDCAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: S e c t i o n6 8 B. 3 2 A ( t 3 ) ,I o wa Co d e,p r o h i b i t st h eu s e o f i n f o r m a t i o nc o p i e df r o mr e p o r t san d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i oof o ra n yc o mme r c i a lp u r p o s e b y an y p e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e e s.

D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st o d i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pm u s tb e s hownt o t h et h i r dd e g r e eo fc o n sa n gu i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e )( S e e P a g e2 o ff o r m sp a c k e t ). I f s u r n ameo f c o n t r i b u t o ri s t h es ame a s c an d i d a t e ,b u tt h e r ei sn o Page - o ff a m i l i a lr e l a t i o n s h i p ,e n t e r" n o ta p p l i c a b l e "i n t h er e l a t i o n s h i pc o l u mn. ( f o rS c h e d u l eA )

DATE PAC I DNUMBER NAMEAND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT v FRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FU( MA A l D D / Y R)AND PAC CHECK ( i fa p p l i c a b l e ) RA

NUMBER I N/ , ` I D# FL ~ 'Z FI L k ~~ ~ q~ .

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T H I SBOXA PP L I E STOCAND I DATE S 'COMMI TTEE SONLY:

P ur c h a s e s o f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o r mo r e must a l s ob e i n v e n t o r i e do n S c h ed u l e H . ( R e f e rt o S c h ed u l e H i n s t r u c t i o n s. )

E x pe nd i t u r e st o p e r s o n s l e n t i t i e sp r o v i d i n gc o n s u l t i n g ,a d ve 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 n gs e r v i c e smust a l s ob e d e t a i li t e mi z e donS c h ed u l e G b y t h eamo u n t , p u r p o s e , a nd d at e o f e a c h t y p eo f e x pe nd i t u r emade b y t h e p e r s o n / e n t i t yo n b e h a l fo f t h e c an di d at e ' sc o mmi t t e e. ( R e f e rt oS c h ed u l e G i n s t r u c t i o n sa n d I o wa Code 5 6 . 6 ( 3 ) ( 1 ). )

( f o rS c h ed u l e B)

FOR I NSTRUCT I ONS ,SEE BACK OF FORM SCHEDULE

EXPENDI TURES B- - MONEY SPENT FROM COMMI TTEE ACCOUNT MONET ARY( Re v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TT EES : NOTE : FOR CONTRI BUT I ONSMADE TO STATEWI DE OR L EGI S LAT I V ECANDI DATES,L I S TTHE CANDI DATE I DENT I F I CAT I ONNUMBER I NTHE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S TOF I DNUMBERS I SAVA I LABLEFROMTHE I OWA AMENDI NG FORMETHI CS& CAMPAI GN DI SCLOSURE BOARD . -

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f Or g a n i z a t i o n )

/ T-

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( i fa p p l i c a b l e ) ( D i s b u r s e me n t )WAS MADE( MM/ DDI YR) AND PAC

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THI SBOXAPPL I E STO CANDI DATES 'COMMI TTEES ONLY:

P u r c h a s e so fc e r t a i nc a mp a i g np r o p e r t y c o s t i n g$ 5 0 0o rmo r emu s ta l s ob e i n v e n t o r i e do nS c he d u l eH. ( R e f e rt oS c h e d u l eH i n s t r u c t i o n s. )

E x p e n d i t u r e st op e r s o n s / e n t i t i e sp r o v i d i n gc 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 gs e r v i c e smu s ta l s ob ed e t a i li t e m i z e d oS c he d u l eG b yt h ea mo u n t ,p u r p o s e ,a n dd a t e o fe a c ht y p eo fe x p e n d i t u r emadeb yt h ep e r s o n / e n t i t yo nb e h a l fo ft h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c he d u l eG i n s t r u c t i o n sa n dI o w aCode5 6. 6 ( 3 ) ( i ). )

( f o rS c he d u l eB )

FOR I NSTRUCTI ONS ,SEE BACK OF FORM SCHEDUL E

B MONETARYEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATEPAC COMMI TTEES: NOTE: FORCONTRI BUTI ONSMADETO STATEWI DEOR L E GI S L ATI V ECAND I DATE S ,L I S TTHE CANDI DATEI DENT I F I CAT I ONNUMBERI NTHEDESI GNATEDCOLUMNAND THE 0 CHECK THI S BOX I FPACCHECKNUMBERFOREACH EXPENDI TURE. AL I S TOF 1 0NUMBERSI SAVAI L A BL EFROMTHEI OWA AMENDI NGFORME T H I C S&CAMPAI GNDI SCLOSUREBOARD.

COMMI TTEE NAME ( M u s tb e same a s o nS t a t e me n to fO r g a n i z a t i o n )r - -S 3 o v c~~ T Z ' 5 i S /

CANDI DATE NAMEANDADDRESSTOWHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

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THI SBOX APPL I E STOCANDI DATES'COMMI TTEE SONLY:

P u r c h a s e so fc e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0o rmo r e mu s ta l s ob e i n v e n t o r i e do nS c h e d u l eH. ( R e f e rt oS c h ed u l eH i n s t r u c t i o n s. )

E x p e n d i t u r e st op e r s o n s / e n t i t i e s p r o v i d i n gc 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 smu s ta l s ob ed e t a i li t e m i z e do nS c h ed u l eGb yt h ea mo u n t ,p u r p o s e ,a n dd a t e o fe a c ht y p e o f e x p e n d i t u r emadeb yt h ep e r s o n / e n t i t yo n b e h a l fo ft h ec.: n d i d a t e ' sc o mmi t t e e. ( R e f e rt oS c h ed u l eGi n s t r u c t i o n sa n dI o w aC o d e5 6. 6 ( 3 ) ( i ). )

P a g e

( f o rS c h ed u l eB )

FOR I NSTRUCTI ONS ,SEE BACK OF FORM SCHEDUL E

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATEPACCOMMI TTEE S: NOTE: FORCONTRI BUTI ONSMADETOSTATEWI DEORL E GI S L ATI V ECANDI DATE S ,L I S TTHECANDI DATEI DENT I F I C AT I ONNUMBERI NTHEDESI GNATEDCOLUMNAND THE 0 CHECK THI SBOX I FPAC CHECKNUMBERFOREACH EXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI L A B L EFROMTHE I OWA AMENDI NGFORME T H I C S&CAMPAI GNDI SCLOSUREBOARD. -

COMMI TTEENAME ( M u s tb e same a s o nS t a t e m e n to fO r g a n i z a t i o n )

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I D# ~u q

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FOR I NSTRUCTI ONS,SEE BACKOF FORM

COMMI TTEE NAME ( Mu s tb e s ame a s o n St a t emen t o fO r g a n i z a t i o n )

Z' Z

SUB- TOTAL1 $

TOTAL ( i fl a s t $

p a g e o f t h i s

s c h e du l e)

SCHEDULE

E I NK I ND( Re v. 0 6 / 9 7 )

ICONTRI BUTI O

0 CHECK THI S BOX I FAMENDI NG FORM

~S

' D i s c l o s u r el awr e q u i r e sc a n d i d a t e st o d i s c l o s e t h er e l a t i o n s h i p o fan y r e l a t i v ema k i n g a n i n k i n d c o n t r i b u t i o nt o t h e Page I o fc ommi t t e e. R e l a t i o n s h i pmu s t be s h own t o t h et h i r dd e gr e e o f c o n s a n gu i n i t y( b l o o dr 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 rSc h e d u l eE )b y ma r r i a g e ). ( S e ePage 2 o f f o r msp a c k e t. ) I fs u r n ameo f c o n t r i b u t o ri s t h es ame a s c a n di d a t e ,b u tt h e r ei s n of a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a p p l i c a b l e "i n t h er e l a t i o n s h i pc o l u mn.

DATERECEI VED( MM/ DD/ YR)

NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI PTO CANDI DATE' ( i fa p p l i c a b l e )

DESCRI PT I ONOF I NK I ND

CONTRI BUTI ON

ESTI MATEDFAI RMARKET

VALUE

4 I FFORFUND- RAI S

CONTRI BUTI ON

j ` I / ,6 0- 7 z . t , ? t i c - . YZ I