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I MPORTANT: I n d i c a t e t y p e o f c o m m i t t e e y o u a r e r e p o r t i n g f o r : m( 1 ) S t a t e w i d e l 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 a n 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 mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mm i 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 s b - c A - - e - r - I

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[ S I GNEDP e n a l t i e s Du e F o r L a t e F i l e d Re po r t s R a n g e f r o m $ 1 0 t o $ 4 0 0

SEE I NSTRUCTI ONS ON BACKANDCOMPLETE THE FOLLOWI NGSENTENCE:

OCHECK I F AMENDMENT TO REPORT DATED

P t l y REPORT FOR A N/ A ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .( r e p o r t d a t e ) I n d i c a t e o n e

F l C 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 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 .( Yo u mus 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 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 HANDCASH 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 mon i e s h e l d b y t h e c o mmi t t e e . T h i s amoun 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 , OL '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 PERI OD ` rSc h e du 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 du l e C: F u n d - r a i s i n g Ev e n t s t o t a l ( A t t a c h Sc h e du l e C) . . . . . . . . . .Sc h e du 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H : T o t a l Sa l e s o f Camp 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 H a p p l i e s t o Ca nd i d at e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEYSPENT T HI S PERI ODSc h e du 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 du l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : L o a n Re p a yme n t s t o t a l ( A t t a c h Sc 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 al a nc e mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2F o r O f f i c e Us e O n l y

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L o c a l C o m m i 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 m m 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

U NP AI D BI L L S ( F r o m Sc h e du l e D - A t t a c h Sc h e du l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BU T I ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

YES VNO

136?-. o " ' ZOUTSTANDI NGLOANS ( 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 ) $CANDI DATE COMMI TTEES ONLY:CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H ) $

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F. o r I n s t r u c t i o ns , Se e Ba c k o f Fo r nCONTRI 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 be 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 o n)

STATE CAND I 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 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 .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 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 of o r a ny c ommer c i a l p u r p o s e b y a n y p er 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 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 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 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 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 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 . ( f o r Sc h e d ul e A)

SCHEDULEA MONETARY

( R e v . 0 2 1 9 6 ) RECEI PTSI CHECK T HI S BOX I

AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I O NSHI P AMOUNTRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI V E( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e )NUMBER

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FOR I NSTRUCTI ONS, SEE BACK OF FORMEXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNTPAC COMMI TT EES : NOTE: FOR CONTRI BUTI ONSMADE TO STATEWI DE OR L E GI S L A T I V EDI DATES, L I S T THE CANDI DATE I D EN T I F I C A T I O N NUMBER I N THE DESI GNATEDCOLUMN AND THECHECK NUMBER FOR EACH EXPENDI TURE. A US T OF I D NUMBERS I S AVAI LABLE FROM THE I OWAI C S 6 CAMPAI GN DI SCLOSURE BOARD.

MMI TT EE 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 )

SUB- TOTAL $ 7 / . I 'i s s c h ed u l e ) $ 1 7 / 'TOTAL ( i f l a s t p a g e o f t h

I S BOX APPLI ES TO CANDI DATES' COMMI TT EES ONLY:a mp a i g n f u n d s ma y b e u s e d o n l y f o rc a mp a i g n p u r p o s e s ,

) c o n s t i t u e n c y e x p e n s e s , a n d) e d u c a t i o n a l a n d o t h e r e x p e n s e s a s s o c i a t e d w i t h d u t i e s o f o f f i c e .i n s e r t t h e a p p l i c a b l e n u m b e r i n t h e p u r p o s e c o l u mn f o r e a c h e x p e n d i t u r e .

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 r x i $ 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 . )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 mi z e d o nh e d u l e G 6 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 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 oe Gi n s t r u c t i o n s a n d I o w a Co d e 5 6 . 6 ( 3 x . )

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CANDI DATE NAME ANDADDRESSTOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( D i s b u r s e me n t ) WASMADE ( CANDI DATES SEE EXPENDED( i f a p p l i c a b l e ) BELOW& ENTERMM/ D D/ Y R) AND PAC 1 , 2 , 3 )CHECK NUMBER

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