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FOR' , NSTRUCTI ONS, SEE BACK OFRMDI SCLOSURE SUMMARYPAGE

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HECK I F AMENDMENT TO REPORT DATED

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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 l

o 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 amou n t MUST b e t h es ame a s t h e c a s h o n h a nd 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 mus 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 MONEY TAKEN I N T HI S PER I OD

FORMDR- 2( R e v . 0 2 / 9 6 )

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D I SCLOSUREREPORT

F o r O f f i c e Us e O n l yCo mm . #21

rTELEPHONE

DATE SI GNED

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

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FORWS TRUCTI ONS, SEE MANUAL

EXPENDI TURES - MONEY SPENT

CANDI DATE' S C MMI TTEE NAME ( Mu s t b e s ame a s on St a t e e n t o f Or g a ni z a t i o n)

SCHEDULEB

CANDI DATE

MONETARYEXPENDI TURES

For o f f i c e u s e o n l y

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P e n a l t i e s Du e F o r L a t e F i l e d Rep o r t s Ra n g e f r o m $ 1 0 t o $ 4SEE I N ST RU CT I ONS ON BACK ANDCOMPLETE T HE FOLLOWI NG SE NTENCE :

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STATEMENT OF CASH ON HAND

ADDTOTAL MONEY TAKEN I N T HI S PERI OD

A u d i t e dC o mp u t e r

DI SCLOSUREREPORT

DATE S I GN ED

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 nwh i c h E l e c t i o n i s h e l d

ATURE OF TREASU ( o r n f i l i n g t h i s r e p o r t )

TELEPHONE

FORMDR- 2( Re v . 0 2 / 9 6 )

F o r Of f i c e Use On l y

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 ou 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 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

c h i s e

m 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 m m i t t e e( 8 ) S u p p o r t ~f C a n d i d a l a s

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J AN 2 4 2 0 0 22 1 0 Y~R.

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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Fe r I n s t r u c t i o n s , See Bac k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

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SCHEDULEA MONETARY

( Re v 0 2 / 9 6 )I

R E CE I P T S

CHECK T HI S BOX I FAMENDI NG FORM

ST AT E CANDI DATES NOTE : I F A CO NT R I BU T I O N I S RECEI VED FROM A STATE PAC ( P OL I T I C A L A CT I ON COMMI TTEE) , L I S T T H E P AC I D EN T I F I C AT I ONNUMBER AN D T H E P AC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AN D CAMPAI GNDI SCLOSURE BOARDCAUTI 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 at 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 o rf o r a n y c o mmer 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 es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR R EL A TI O NS HI P AMOUNTR E CE I V E D ( i f a p p l i c a b l e ) TOCANDI DATE' R ECE I V E D( MM/ DD/ Y R) AND PA C CHECK ( i f a p p l i c a b l e )NUMBER

I D# &ql / / y f ~ ' , ~ ~' ~ _ _7 a 7 - I t i S - t - Su i r E 36ov $ 00c K# / l 3 7 e Co l o 2. e , ?

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CANDI DATE' 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 Or g an i z a t i on ) _ _f XAl 5 E - r o k -

r , , E ~

CONTRIBUTIONS-MONEYTAKENI N( i n c l u d i n g c an d i d a t e ' s p er s o n a l f u nd s )

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLE AT NOCOST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEA MONETARYSTATE I RECEI PTSCANDI DATEF o r o f f i c e u s e o n e

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 on f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c ont r i bu t i ons o r f o r a n y c omme r c i a lp u r p o s e by 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 .

DATERECD PAC I . D . NUMBER( i t a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( I f p r o c ee d s f r o m f u n d r a i s e r , s h o w f u nd r a i s er s p o ns o r ) RELATI ONSHI PTOCANDI DATE'( i f a p p l i c a b l e ) AMOUNTRECEI VED( oZl C~PF~ i r H / v i m / l 77 7 C $3 7 3 7 Gr ~ESTau / . 1 / , eo ~ -- 4 ( l y 3U hF ' 9 ~0 1 ~~ " S 4 0 2 6S `

~ L o~ Gol JE 1 " ~

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FOR ' I NS TRUCT I ONS, SEEBACK OFFMS I G

DI SCLOSURE SUMMARYPAGE

P e n a l t i e s Du e F o r L a t e F i l e d Rep o r t s Ra n g e f r o m $ 1 0 t o $ 4SEE I N ST RU CT I ONS ON BACK ANDCOMPLETE T HE FOLLOWI NG SE NTENCE :

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STATEMENT OF CASH ON HAND

ADDTOTAL MONEY TAKEN I N T HI S PERI OD

A u d i t e dC o mp u t e r

DI SCLOSUREREPORT

DATE S I GN ED

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 nwh i c h E l e c t i o n i s h e l d

ATURE OF TREASU ( o r n f i l i n g t h i s r e p o r t )

TELEPHONE

FORMDR- 2( Re v . 0 2 / 9 6 )

F o r Of f i c e Use On l y

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 ou 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 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

c h i s e

m 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 m m i t t e e( 8 ) S u p p o r t ~f C a n d i d a l a s

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J AN 2 4 2 0 0 22 1 0 Y~R.

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

/2 / ~

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Fe r I n s t r u c t i o n s , See Bac 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 TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)FR41,5E - - / 1 1 5 - 6 P. -

SCHEDULEA MONETARY

( Re v 0 2 / 9 6 )I

R E CE I P T S

CHECK T HI S BOX I FAMENDI NG FORM

ST AT E CANDI DATES NOTE : I F A CO NT R I BU T I O N I S RECEI VED FROM A STATE PAC ( P OL I T I C A L A CT I ON COMMI TTEE) , L I S T T H E P AC I D EN T I F I C AT I ONNUMBER AN D T H E P AC CHECK NUMBER I N TH E DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AN D CAMPAI GNDI SCLOSURE BOARDCAUTI 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 at 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 o rf o r a n y c o mmer 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 es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR R EL A TI O NS HI P AMOUNTR E CE I V E D ( i f a p p l i c a b l e ) TOCANDI DATE' R ECE I V E D( MM/ DD/ Y R) AND PA C CHECK ( i f a p p l i c a b l e )NUMBER

I D# &ql / / y f ~ ' , ~ ~' ~ _ _7 a 7 - I t i S - t - Su i r E 36ov $ 00c K# / l 3 7 e Co l o 2. e , ?

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CANDI DATE' 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 Or g an i z a t i on ) _ _f XAl 5 E - r o k -

r , , E ~

CONTRIBUTIONS-MONEYTAKENI N( i n c l u d i n g c an d i d a t e ' s p er s o n a l f u nd s )

NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PAC I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN . L I ST OF I . D . NUMBERSI S AVAI LABLE AT NOCOST FROMTHE ETHI CS AND CAMPAI GN DI SCLOSURE BOARD .

SCHEDULEA MONETARYSTATE I RECEI PTSCANDI DATEF o r o f f i c e u s e o n e

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 on f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c ont r i bu t i ons o r f o r a n y c omme r c i a lp u r p o s e by 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 .

DATERECD PAC I . D . NUMBER( i t a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR( I f p r o c ee d s f r o m f u n d r a i s e r , s h o w f u nd r a i s er s p o ns o r ) RELATI ONSHI PTOCANDI DATE'( i f a p p l i c a b l e ) AMOUNTRECEI VED( oZl C~PF~ i r H / v i m / l 77 7 C $3 7 3 7 Gr ~ESTau / . 1 / , eo ~ -- 4 ( l y 3U hF ' 9 ~0 1 ~~ " S 4 0 2 6S `

~ L o~ Gol JE 1 " ~

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EXPENDI TURES - MONEY SPENT

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