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FOR I NSTRUCTI ONS, SEE BACK OF F O,DI SCLOSURE SUMMARY PAGE

COMMI TTEE NAME ( Mu s t b e same 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 )

) a k 7l e- c + Pa l m, - _ r Y- r 5 +c f 4 e - _ , . I W_ rI MPORTANT : 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 Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) 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

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 an d c r i m i n a l p e n a l t i e s . P u r s u a n t t o I o wa Cod e s e c t i o n 6 8 B . 3 2 A ( 7 )t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mm i t t e e , an d t h e c h a i 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 mm i t t e e , i s t h ei n d i v i d u a l r e s p o n s i b l e f o r f i l i n g t i m e l an d a c c u r a t e r e p o r t s .

SI GNATL, OF PERSON F I L I NG REPORT

R e s e t F o r ,

7 S '

I AM F I L I N G A REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR.( r e p o r t d a t e ) I n d i c a t e b y #

HECK I F AMENDMENT TO REPORT DATED ) t 7 - L - ( L lC h 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 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 Fo 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 DR- 3 i s f i l e d . )

STATEMENT OF CASH ON HAND

FORMDR- 2( R e v . 1 2 / 2 0 0 5 )F o r O f f i c e Us e _ On l yComm . #L o g g e d I nS c a n n e dCompu t e rA u d i t e d

DI SCLOSUREREPORT

F i l e w i t h :I o wa E t h i c s an d Campa i g nD i s c l o s u r e Bo a r d5 1 0 E . 1 2 ` " , S t e , 1 ADe s Mo i n e s , I o wa 5 0 3 1 9Fa x : 5 1 5 - 2 8 1 - 3 7 0 1

6 / / - JaG- d S _ 0/TEL EPHONE DATE S I GNED

CASHON 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 o t a l o f a l l f u n d s h e l d b y t h ec o m m i t t e e T h i s amount 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PERI ODSc 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 Sc h ed u l e A) ( " a l s o s e e i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . . . . .Sc h ed 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 S c he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l 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 Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H ap pl i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $

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

CASHONHAND 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 mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

L o c a l C o mm i t t e e s , e n t e r Da 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 Co u n t y i nwh i c h E l e c t i o n i s h e l d

31 1 ? S D, X_ S

40, 32Y. 30

ZI P 2 1 1 2' " UNPAI D BI L L S ( Fr o m S c he d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ s 1 . s o* I N KI ND CONTRI BUTI ONS ( Fr o m Sc h ed u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3 y D- OUTSTANDI NG LOANS ( F r o m S c h e du l e F - A t t a c h S c he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULTANT BREAKDOWN ( Sc h e d u l e G A t t a c h e d ? ) -YES NOCANDI DATE COMMI TT EES ONLY :VALUEOF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e du l e H) $STATE COMMI TT EES : Su bmi t a r e c o n c i 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 .


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T H I S BOX A P P L I E S T O C AN DI D A T E S ' COMM , SMLP 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 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 a d i t u r e m a d e h ~ 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 mmi 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 C o d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

: 2 0 0 6 P a g e - Io f~3( f o r S c h e d u l e B )

FORI NSTRUCTI ONS , SEEBACK OF FORM R e s e t F or m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TT EE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE T O STATEWI DE OR L E GI 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 COLUMN ANDTHE 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 AMENDI NGFORME T H I C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( M u 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 )

i iI Y ~m al l i [ a~T~I "i L"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 me n t ) WAS MADE( MM/ DDNR) AND PACCHECKNUMBERI D# a r S k e i n n I o u r s c r . , e n }1 6 / WQy CK # I ~0 S 3 . J S l a n s u p p : e S $ 1 2 3 . 8 )' S6 1 1 . 2I D# G r1, r n a e I I P o s t 0 ~ F%c e/ 1 ' 1 f CK# Gr k ' V%n eI I , XA PS 1 3 9 0 . 0 6

I D# k 4 + 1 e / f l e a t S_ . .

l ~ ~ l I ~ O ~ I DK# ) A I DS 3 . , . R _ 7 5 7 . 00o 1 1D# 1 e 7_

CK # r a ~ o10Aao%y / UGw } - o r t e I " AI D# k 6 0 4 5 ' R 4 J , a/ o %/ a y CK# Os k a l o os q , =AS~5>1 ra~. b a o Q 519 . 9D

/ o / . 2 0 / 0 CK# moo, 1 ~ 0 4 Le GD# ~ " . Qt o%o ` oY CK #

I ~ e Xr a o CLoQ- OD . 0 I J '

I D # k ~ T~ o C . C c O c . 0l o l ~ ~~ oY CK # 4 d2 3 51 . 0 0

SUB- TOTAL -$ ~ 3 1 4 . 7 1TOTAL ( i f l 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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T HI S BOX APP 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 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 mu 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 Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

2 0 0 6Pag e.2-o f

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

FOR I NSTRUCTI ONS, SEE BACKOF FORM t SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TT EE ACCOUNT ( R ev 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTR I BUT I ONS MADE T O STATEWI DEOR L EGI S L AT I V ECANDI DATES, L I S T THE CAND I DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN ANDTHE CHECKT HI S BOX I FPAC CHECK NUMBER FOREACHEXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI L ABL E FROM THE I OWA AMENDI NGFORMETH I CS 8 CAMPAI GN D I 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 O r g a n i z a t i o n )

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACT I ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b ur s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBERI D# G

l . a o CK# $b~ ` Ot

1D#

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T HI S BOX APPL 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 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 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 Cod e 6 8 A . 4 0 2 ( 3 ) ( I ) . )

2 0 0 6

P a g e I -o f

( ' 0 , 7 , $ 6 , Y 8


FORI NSTRUCT I ONS , SEE BACK . . OF FORM ' SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI T T EE ACCOUNT ( R e v 0 7 / 0 3 ) EXPENDI TURES

S TA TE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE T O STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I ON NUMBER I N T HE DESI GNATED COL UMN AND T HE 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 T HE 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 e me n t o f O r g a n i z a t i o n )

CANDI DATE NAME AND ADDRES S TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACT I 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( MMI DD/ YR) AND PACCHECKNUMBER

( 0 ( ' 2 ' I C "I N J I : S ~ C l ~ ~ -c ~ . k f v d u G ~ 7 n 5CK# 5 c l y 0 1CXCCAe ~~ . I &Q~ A S t ~V- ) $ ~5 00~ " o n II D#

I t ; ~ 1 UI D 1 CK# c I C 4-- t 7 r L J , 6 , u~ALL- L 4-L 4-I NCK#1 D#CK#I NCK#I NCK#I D #CK#I NCK#

S UB- TO TA L $ 4 r ) " 6 7 7 - 1 1TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) $ ~ 0 y


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FOR I N STRUCT I ONS, SEE BACK C , . - - ORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( M u 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 )

I MPORTANT 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 an 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 ( 6 ) C i t y C an 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 an 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 eCANDI DATE COMMI TT EES ONLY :C a n d i d a t e Name

( % J . P c J 2w-,~O f f i c e S o u g h t

P o l i t i c a l P a r t y ( i f a p p l i c a b l e )- 1 1P t / i n o c n- t s - -D i s t r i c t ( i f S e n a t e o r H o u s e )

- n 4 4 6 4 ~ ~ Y 4 -S I GNATURE OF PERSON F I L I N G REPORTI AM F I L I N G A t o - Z ( v _ Dq

( r e p o r t d a t e )N O V - 1 2 0 0 4F I CHECK I F AMENDMENT T O REPORT DATED m1 0 - 3 6

6 q 1 - 2 A - t ) 5 6 3TELEPHONE

F 1 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 No t i c e - a - D i e s e l a t i o n F e r n - DR- 3 . - - -( Y o u m u 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 . )n 9 1

iREPORT FOR ( 1 ) EL E ` 4 " T I O N / ( 2 ) N ON - E LEC TI ON YEAR .I n d i c a t e b y #

R e s e t F o n n

SUBTRACT TOTAL MONEY SPENT T HI S PER I OD S I P - ) ( p 0 , q 3( S c h e d u l e H a p p l i e s t o C a n d i d a t e s ' Commi t t e e s O n l y )

SUB- TOTAL . . . . . $

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 e e d e b t s a n d l o a n s b e l o w ) . . .S c 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 S c 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 r ~b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . : ~ 1 . 1 5 . . . . J~0. 4 . . . . . . $* * UNP AI D BI LLS ( F r o m S c h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" I N KI ND CONTR I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" * OU T STANDI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES 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 S c h e d u l e H ) $

FORMDR - 2 DI SCLOSURE( R e v . 0 7 / 2 0 0 4 ) REPORTComm . #L o g g e dS c a n n e dC o mp u t e rA u d i t e d

L a t e r e p o r t s a r e s u b j e c t t op o s s i b l e c i v i l a n d c r i mi n a lp e n a l t i e s .

/ 6 -29- ( ) 1 - 1DATE S I GNED

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 & L o c a l C o mmi 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

~ C ) 3 q g 3 o

a ~ ~ , s U

4 , 6 0 g - F; 7 1

3 - 4 6 0 g ` '

STATEMENT OF CASH ON HAN~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 o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s a m o u n t 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 d 2 3 1 W y 5o 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 t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . $ "

ADD TOTAL MONEYTAKEN I N T HI S PER I ODS c 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 S c h e d u 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 : L o a 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 l e H : T o t a l S a l e s o f C amp a 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ - -


6/13

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

~ Un ^ r " ' ' Ol f . - t o oecf 0 ( A - ( r x P! Al ~k

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

CHECK T HI S BOX I FAMENDI NG FORM

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 O MMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PA C CHECK NUMBER I N T HE DESI GNATED 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 OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARDCAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa 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 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 .

* 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 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 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 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 .

SUB- TOTAL $ 0~~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 )

Page __ I - _ o f( f o r S c h e d u l e A )

DATERECEI 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 P AMOUNT 4 I F F OR( MM/ DD/ YR) AND PAC CHECK TO CANDI DATE*( i f a p p l i c a b l e ) RECEI VED FUND-RAI SERNUMBER I NCOMEO/ P 1 0 4 I D# j t ) e , r2 5 3 ~ ~ 1 1 &IL C - 1 1 $CK# 30 -o s k ~ - Q ~ o s ~ , , t 6 5 2 5 = 1I D# E . R. Sn - o r - I ~ r d - 1 CK# Fo ~~X t

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7/13

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o b .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 as o n St a t e me n t o f O r g a n i z a t i o n )

f o r a n y c o mme 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 .

STATE CAND I DATES NOTE : I F A CONTRI BUTI ON I S RECE I V E D FROM A S T AT E P AC ( P O L I T I C A L ACTI ON C OMMI T T E E ) , L I S T T HE PA C I D EN T I F I C A T I O NNUMBER AND T HE PA C 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 FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) I RECE I PTSQCHECK T HI S BOX I FAMENDI NG FORM

CAU T 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 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

SUB- TOTALTOTAL ( i f l a s t p a g e 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 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 . 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 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?%o f _3_-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 mn ( 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 ONSH I P AMOUNT J I F FOR( MM/ DDI YR ) AND PAC CHECK TO CANDI DATE '( i f a p p l i c a b l e ) RECE I VED FUND-RA I SERNUMBER I NCOMEI D# ~ 0 4C 7 CK# 3 9 ~ q 3 1 . E - -( 0 ~ ~ C h

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8/13

Fo r I n s t r u c t i o n s , Se e Back o f F or 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 S t a t e me n t o f O r g a n i z a t i o n )

f o Eea 6W ~eSTATE CANDI DATES NOTE : I F A CONTR I BUT I ON I S RECE I VED FROM A STATE PAC ( P OL I T I C A L A C T I O N C OMMI T T E E ) , L I S T T HE P AC I D EN T I F I C A T I O NNUMBER A ND T HE P AC 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 CAMPA I GNDI SCLOSURE BOARD .C AU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 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 a n y c 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 mmi t t e e s .

SUB- TOTALTOTAL ( 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 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 ) . 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 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 m n ( f o r S c h e d u l e A )

SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECE I P T S

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME A ND A D DR E S S OF CONTR I BU TOR R EL A T I ONS HI P AMOUNT J I F FORR ECE I V E D ( i f a p p l i c a b l e ) T O CANDI DAT E * RECE I V ED FUND-( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMEI D# bCK# I ` f N( u n e b b' n n t ( t t a t t " L

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9/13

T HI S BOX APPL I ES T O 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 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 mu 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 Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Page __% - - - o f _ _ - 3 ~ _ _ _ _


FOR I NSTRUCT I ONS, SEE BACK OF FORM I Z e s e SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI T T EE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

S T A T E PAC COMMI TT EES : NOT E : 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 NT I F I C A T I O N NUMBER I N T HE DESI GNATED COL UMN AND T HE O 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 AI L A B L E FROM T HE I OWA AMENDI NG FORMETH I CS & CAMPAI GN DI SCLOSURE BOARD .COMMI 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 )Co y v \ OV \ ~ , , - t o F mM19 , I r I tCANDI DATE NAME AND ADDRESS T OWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACT I ON) EXPENDEDEXPENDED ( i f a pp l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DDI YR) AND PACCHECKNUMBER

j o l ~ ~ I b ~I D # ~ , , , t ~ l , 2 a r S ~ f CWi t ~ + n ' ` YV~ e - w f ~ . rC l o d 3~CK# ' ~ C I I l ~ 5 ~ I LI D #CK# ( f n ~ t ~ ~ U , l U } So l c L

I D #~ ~ ( - Z 6 1 1 D 1 t ( ' a ~ ( i f l Qom- " I p - t p S4CK# N Q , w ' C m , 1 ~ 1

1 D # K{ >>o E ( 2 , & a c ,~ DI Z a I ~ ~ CK# 0 S t l l a o o s a1 D #CK# u l Aa wr S v 21 D #

_ 1 1CK# a t ' ~ v , r v ~. J w , ( ~k~~ O f l f l1 D#

, 4 I 3 s v o oCK# N ~ c r ~ ' r a 1 ~ 1 1 1SUB- TOTAL $

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


10/13

T HI S BOX APP 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 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 mu 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 Code 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Pa g e2- _ _ _ _ o f


FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t F or m SCHEDUL EEXPENDI TURES - - MONEY SPENT FROM COMMI T TE E ACCOUNT B MONETARY( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PA C COMMI TT EES : NOTE : F OR 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 F E N CHECK T HI S BOX I FPA C CHECK NUMBER F OR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e same 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 )

(Q U~St 7CANDI 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 me n t ) WAS MADE( MM/ DD/ YR) AND PA CCHECKNUMBER

I D # G ( ; n f n~~ CK# 6 1 C o . S S t - U l ~ 5 - - _$ (o p

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I D # ~LK- S I Qaa~ 9~ b l t i 2 f ~ ~ CK# p ~ t v , r n WK , ( A ~ ( c e d Ct ~~ QOM' ` I g / Z

I D # ` L I P - / I J PL . - A 1 9 r a r ~~o ~~ 3553 : 3CK# 6 r ~~~e t ~, l f 9I D # ~G~oG ~j , ~o y CK # o S o g S , ~ , 1 ~ 9 r u c ~ ~ o Cz G~ Z ` ~ 3 Z _1 D #CK#

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


11/13

T HI S BOX APP 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 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 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 Co d e 6 8 A. 4 0 2 ( 3 ) ( i ) . )

Pa g e _ _ _12_ _ _ o f _ _ _- _


FOR I NSTRUCT I ONS , SEE BACK OF FORM R e s e t Fo r m SCHEDULEEXPENDI TURES B- - MONEY SPENT FROM COMMI T T EE ACCOUNT MONETARY( R e v 0 7 / 0 3 ) EXPENDI TURESS T A T E PAC COMMI TT EES : NOTE : FOR CONTRI BUT I 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 COLUMN AND T HE F E N 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 T HE I OWA AMENDI NG FORME THI CS & CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEE NAME ( M u s t b e same 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 )~o / 1 t i w ~ t ~ t , ( , u ~~Wt P , ~ t ~ STS ~~ d t ,CANDI DATE NAME AND ADDRESS T O WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR 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( MM/ DD/ YR) AND PACCHECK

NUMBER

CK# Sq Sb CXCCUb ' u c Dr . v ; T t 0 t r l $ 3 5 1 0% . 0i ' o n 11 D #Ut S ~ ~ )Q, ,

F t : v ~t i 4 5l C h ( a ~ o ` + < CK# e I S ' s . c G i 1 . c - v ; 5 , v n ~ ( DI 61 D #CK#I D #CK#1 D #CK#1 D #CK#1 D #CK#I D #CK#

SUB- T O T A L $ ' 0 3 Z . tTOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) $ 0 5 3 . n 1


12/13

FOR ' I N STRUCT I ONS, SEE BACK OF FORMCOMMI 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 )

NOTE : D e b t s p r e v i o u s l y r e p o r t e d t h a t r e m a i n u n p a i d mu s t b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a n y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .4 e ( 4 , ~ & t ,

SCHEDULED I I NCURRED( R e v . 0 8 / 9 8 ) I NDEBTEDNESSCHECK T HI S BOXI F AMENDI NGFORM

An " i n c u r r e d d e b t " i s a d e b t f o rDEBTS / OBL I GAT I ONS REMAI NI NG T HI S REPORTI NG PERI OD g o o d s o r s e r v i c e s o r d e r e d o r( DO NOT I NCLUDE LOANS - - SHOWLOANS ON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f w h e t h e r a n i n v o i c eh a s b e e n r e c e i v e d .

* I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i ma t e d " b e s i d e t h e f i g u r e . P a g e o f( f o r c h e d u l e D

CANDI DATE COMMI TT EES NOTE :* I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h w h om t h e c a n d i d a t e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s 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 ro r g a n i z i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i m a t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

DATEI NCURRED( MM/ DD/ YR) NAME AND ADDRESS OF PERSONT O WHOM DEBT OR OBL I GAT I ON I S OWEDDESCRI P T I ON OF GOODS ORSERV I CES PROVI DED OR

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` 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 n i n k i n d c o n t r i b u t i o n t o t h e Pa g e o fc 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 ( f o r S c h e d u l e E )b y ma r r i a g e ) ( S e e Pa g e 2 o f f o r ms 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 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 CONTR I BU TORRELAT I ONSHI PT O CANDI DATE' ( i f a p p l i c a b l e )

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