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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 Re p or t s Ra n g e f r o m $ 10 t o $4 0 0SEE I NSTRUCTI ONS ONBACKANDCOMPLETETHE FOLLOWI NG SENTENCE :7+ L2 . ! REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

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s 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 ,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 r i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ y~-ADDTOTAL MONEY TAKEN I N T HI S PERI ODSc h e d ul e A : C a s h Co nt r i b ut i o ns t o t a l ( A t t a c h Sc h e d ul e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e C : Fun 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 d ul e C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d 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 Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H . T o t a l Sa l e s o f Ca mp a i g n Pr o pe r t y ( A t t a c h Sc h e d ul e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e du l e H a pp l 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 T HI S PERI ODSc h e d u l e B : Ex p e nd i t u r e s t o t a l ( A t t a c h Sc h e d ul e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d ul 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 ul 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 ce mus tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L o c a l Co mmi t t e e s , e n t e r Da t e o f E l e c t i o n

Cou n t y 8 . L o c a l Co mmi t t e e s , e n t e r Cou n t y i nwh i c h E l e c t i o n i s h e l d

UNPAI D BI L L S ( F r o m Sc h e d ul e D - At t a ch Sc h e d ul e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m Sc h ed ul e E- A t t a c h Sc h e d ul e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h ed ul e F - A t t a c h Sc h e d ul e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :

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r2, 4115rNOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A 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 NO COST FROM THE CAMPAI GN FI NANCE DI SCLOSURE COMMI SSI ON,

p . 3

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Se c t i o n 5 6 . 1 0 ( 8 ) ( a ) , I o wa Co d e , s t a t e s " I n f o r ma 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 n t s s h a l l n o t b e u s e d b y a n y p e r s o n o t h e r t h a ns 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 f o r t h e p u r p o s e o f s o l i c i t i n g c o n t r i b u t i o ns o r f o r a n y c o mme r c i a l p u r p o s e . "

Di 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 c o n t r i b u t i o n t o t h e c o mmi t t e e . Re l a t i o n s h i pmus 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 on s an 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 y ma r r i a g e ) . Se e i n s t r u c t i o n s f o ra mo r e d e t a i l e d d e s c r i p t i o n o f r e l a t i v e s c o v e r e d b y t h e l a w .K - 0 0 9 4 3 7 1 1 4 0 - O D 5 4 - L I ( R e v . 1 9 9 2 ) P a g e / o f

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SCHEDULEACANDI DATE

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Sec t i on 5 6 . 1 0 ( 8 ) ( 4 ) , I o wa Code , s t a t e s : " I n f o r ma t i o n c op i ed f r om r e p o r t s a nd s t a t e me nt s s h a l l n o t b e u s e d b y a n y p e r s o n o t h e r t h ans t a t u t o r y p o l i t i c a l c ommi t t e es f o r t h e p u r p os e o f s o l i c i t i n g c on t r i b u t i o n s o r f o r a ny c o mme r c i a l p u r p o s e . "

Di s c l os u r e l a w r e q u i r e s c a nd 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 c o n t r i b u t i o n t o t h e c o mmi t t e e Re l a t i o n s h i pmu s t be s h o w n t o t h e t h i r d d eg r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s by ma r r i a g e) . Se e i n s t r u c t i o n s f o ra mo r e d e t a i l e d d e s c r i p t i o n o f r e l a t i v e s c o v e r e d b y t h e l a w .K - 0 0 9 4 7 7 / 1 4 0 - 0 0 5 4 - L 1 ( Re v . 1 9 9 2 ) P a ge o f

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