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FOR I NSTRUCT I ONS, SEE BACK OF FORM4

COMMI T T 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 )Wo n , - I c l T; j a er i - o i - . 5 c c r t ~ C . r - - , ) o+ A j r r " e c 4 l ~ u r eI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p or U ng f o r.( 1 ) S t a t e w i d e / L e g i s l a t i v e Ca nd i d a t e ( 2 ) S t a t e wi d e PAC ( 3 ) S t a t e P a r t y ( 4 ) Co u nt y / L o c al Ca nd i d a t e( 5 ) C o u n t y PAC ( 8 ) B a l l o t I s s u s/ Fr a n c hi s e C ommi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o m m i t t e e( 8 ) Su p p or t S t a t e o f C a n d i d a t e s

DI SCLOSURE SUMMARYPAGE

, - q ? o - 9 & ' ' ~ y - z 9 ~ o f i o oS I GNATURE OF TREA RER ( o r p e r s o n f i l i n g t h i s r e p o r t ) T EL EPHONE DATE S I GN DRou t 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 Re p o r t s Range f r om $ 2~ t d 7 l Q t b ~ , > 80q~

SEE I N S T RU CT I ONS ON BACK_ANDCOMPL ET E T HE FOL LNOSENTENCE : G J AN Z 2 2 0 0 2AM F I L I N G A I ' " / ' ? _ ~. ( 9 0 - ) - REPORT FOR A N / A ( 1 ) ELECT I ON

( r e p o r t d a t e )pCHECK I F AMENDMENT T O REPORT DATED

p 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 D R - 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 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 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 m o n i e s h e l d b y t h e c o mm i t t e e T h i s a m o u n t MUST b e t h esame 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADDTOTAL MONEY TAKEN I N T HI S PERI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 a mp 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( 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 ' C o m m i t t e e s O n l y )

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSUB- 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ` / ~ - C ( )S c h e d u l e F L o a n Repa y men 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 m u s tb e z e r o ) ( A t t a c h D R - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ,

UNPAI D B I L L S ( 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 CONTRI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . " " " " " " " " " " " " " " . $OUTSTANDI NG L OANS ( 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 T T EES ONL Y :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VAL UE 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 I DI SCLOSU( R e v . 0 1 1 9 8 ) REPOR

F o r O A IComm 8 _I n d e x e d IsA u d i t e d - - V 3 - - eC omp u t e r V

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 n v n i t t e e s , e n t e r C o u n twh i c h E l e c t i o n i s h e l d

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YES NO

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T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Pu 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 mus 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 Sc 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 mus t a l s o b e d e t a i l i t e m i z e d o nSc 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 ma 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 tSc h e d u l e G I n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

( f o r Sc h e d u l e B )

FOR I NSTRUCT I ONS, SEE BACK OF i M SCHEDULEEXPENDI TURES MONETARY- MONEY SPENT FROMCOMMI TT EE ACCOUNT ( Re v 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT 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 AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD.COMMI TT EE 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 o n )

R o Y l CL . 1 ! ' y 7 ,e ) ' - - f - o Y Se C ' 1 " e _ - " Y o A Y ' I z i Y' ~CAN CuATE NAME AND ADDRESS TO Wi HOM PURPOSE AMOUNTDATE 1 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 m e n t ) WAS MADE( MWDD/ YR) AND PACCHECKNUMBER- -I N n ' o Y l c L 7- 1 1 ' I e r P cz r " ( ; ~ ' a , MbaV5ernehx 9 1 2 5 6 ( Rt 3 B~~KeYJ ~l ~d n , o - ~ r i n d~. ; 6 - ~ - I ` r I r 1 P) 5CK# j 0 4 0 Fo r D i d 1 3 Z~ 5_6501 x 04 5, yn5 1 , r 1 Qd- t - p t , - u _ g $ c 7 01 ( ' Ug l d I N Un~ ~ d 1 h 4 e, Y - { ) c u r t , - e , 1 Fe h' r n bcwSf~ t 3 f 3 e - Ck e r d d n on~A5; i . ' ~ P ~ ' , k i P e - " 6 dCK# / 0/ 7 00Fo r 1 ~ ~OO ce ) 5 o 5 o ) y - u 9 - ~ k Y - 7 - 9- yPI N

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FORI NSTRUCT I ONS . SEE BACK OF FORMCOMMI TT EE NAME ( M i u a t b e swM a s , o U a b n w n f o f O r g a n i s a b o n )~ o r e s ~~ ~~~~ n e t ~ - ~o r Spc, re~r y o~ r ~CU~~ GYe

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 ma i n u n p a i d m u 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 ew o b l i g a t i o n s i n l a oW i n t h i s p e r i o d .A n ' i n c u r r e d d e b t ' i s a d e b tg o o d s o r s e r v i c e s o r d e r e d o

( DONOT I NCLUDE LOANS - SHOWLOANSON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b ye 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 nh a s b e e n r e c e i v e d .

DEBTSI OBLI GATI ONS REMAI NI NG T HI S REPORTI NGPERI OD

' 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 .

SCHEDULEI NCURRE( Re v. 02/ N I NDEBTEDN

QCHECKT HI S BOI F AMENDI NGFORM

( f o r S c h e d u l e D

CANDI DATE COMMI TTEES 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 whom 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 uo 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 a p r o c u r e s s e r v i c e s f o r i t e ms 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 no r o 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 ma 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 .

DATE - - BALANCE OWEI NCURRED NAME AND ADDRESS OF PERSON CLOSE OF( MWOO/ YR) T OWHOMDEBTOR OBL I GAT I ON I S OWED REPORTI NPERI OD'

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NOTE : De 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 ma i n u n p a i d mus 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 e a x y e d i n t h i s p e r i o d .

DEBTSI OBL I GATI ONS REMAI NI NG THI S REPORTI NG PERI OD( DO NOT I NCLUDE LOANS - SHOWLOANS ON SCHEDULE F )

DATEI NCURRED NAME AND ADDRESS OF PERSON( MMI DD/ YR) TOWHOMDEBT OR OBLI GATI ON I S OWED

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A n ' i n c u r r e d d e b t ' i s a d e b t f og o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n o t p a i d f o r b y te n d o f t h e r e p o r t i n g p e n o dr e g a r d l e s s o f w h e t h e r a n i n v oh a s b e e n r e c e i v e dB A L A N C E OWEDC L O S E OFR EP O RT I N GP E RI O D'

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FOR I NSTRUCT I ONS . SEE BACK OF FORMCOMMI TT EE MANE ( M u s t b e a s 4 . . 4 a Mv n a r K o f O r p a r r a a t i o n )

0 Q, Ti f 1 Lr To ; r See e ` , t , Y . r ' vNOTE : 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 r n 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 a 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 .

DEBTS/ OBLI GATI ONS REMAI NI NG T HI S REPORTI NG PERI OD( DO NOT I NCLUDE LOANS - SHOWLOANS ON SCHEDULE F )

' 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 .

SCHEDULEI NCURRED( Rw . 0 ? l g 1 1 I NDEBTEDNE

QCHECK T HI S BOI F AMENDI NGFORMAn ' i n c u r r e d d e b C i s a d e b t f og o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d . b u t n o t p a i d f o r b y te 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 oh a s b e e n r e c e i v e d .

P a g e 3 o f( f o r S c h e d u l e D )CANDI DATE COMMI TTEES NOTE :* I n c u r r e d ' n d e M a 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 a r d K y w i t h whom t h e c a n d i d a t e ' s e o n wt * l e e h a s N Me 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 uo r c o n t Y n u i r 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 a p r o c u r e s s e r v i c e s f o r t am s u c h a a d v e r t i s i n g , f u n d - r a i s i n g . po " . ma n a g i n go r o 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 a a n d t h e e s t i ma t e d p e r l o n n a n a r e a t o n s b h r e x p e c t e d o f t h e c o n s u l t a n t .

DATE BALANCE OWEDI NCURRED NAME ANDADDRESS OF PERSON CLOSE OF( MM/ DD/ YR) TOWHOMDEBT OR OBL I GAT I ON I S OWED REPORTI NGPERI OD'

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