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FOR I NSTRUCT7ONS, SEEBACKOF FORM

DI SCLOSURE SUMMARY PAG

I MPORTANT: I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r

SI GNATURE OF TREASURER

[ ] CHECK I F AMENDMENT TO REPORT DATED

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f Or g e _( 1 ) S t a t e w i d e / L e g i s l a d 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 mmi 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

( o r p e r s o n f i l i n g t h i s r e p o r t ) TEL EPHONE DATE SI GNEDR o u 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 R e p o r t s Ran g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACKANDCOMPLETETHE .FOLLOWI NGSENTENCE :I AM F I L I NGA h " / 6 3 1Z~asr

( r e p o r t d a t e )

( heck i f t h i s i s f i n a l ( t e r mi 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 OR- 3 .( Y o 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 . )

FORMDR- 2 DI SCLOSURE( Re v . 0 1 / 9 8 ) REPORT

F o r O f f i c e Us e On l yComm. # 1 1 oqI n d e x e dA u d i t e dC o mp u t e r

REPORT FOR ANNA ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR.

STATEMENT OF CA SH ON HAND

I n d i c a t e o n e

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 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 amou n t MUST b e t h es ame a s t h e c a s h o n h an 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N THI S PER I ODSc h e d u 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 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 u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa 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 e du l e H a p a l l e s t o Ca nd i d at e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEYSPENT THI S PER I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

UNPA I D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUT 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u 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 ? )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 d u l e H) $

1 2L 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 nC o u n t y & L o c a l C o mm 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

- ? . 79Z . 55

- ? go9, zo7R09, Zo

YES NO

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Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI 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 TTEENAME ( 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 on )6 f ? 1; / l ` 1 A- Nf J FOa Goop Go V t i I t iJ , h

SUB- TOTALTOTAL ( i t l a s t page o f t h i s

s c h ed u l e )

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL 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 FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : 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 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 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 an y Co mmer c i a l p ur p o s e by 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 .

' 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 e .c o mmi 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 b yma r r i a g e ) ( S e e Page 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 as c a n d i d a t e , b u t t h e r e i s n o Page o ff a mi 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 du l e A )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECE I PTS0 CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUN( MM / DDNR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCO

CK# 4rhK~w swa - . S-~i OI D #_Z V 22b A) Dv ` f ' Kr 1 i , ' 0 o1 C Cl v ' c I - C rCK#

~ ' v ~ . Q 5 ~ot i SZZG ~I D#CK#I D#CK#1 D#CK#

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T HI S BOX AP PL I E S, T O CANDI DATES ' COMMI TT EES ONLY :P u r c h a s e s o f c e r t a i n c a m p 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 mi 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 tS 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 Code 5 6 . 6 ( 3 ) ( i ) . )

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

FORI NSTRUCT I ONS , SEE BACKOF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI T T EE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

S T A T E PA C COMMI TT EES : NOTE : FOR CONTR I BUT I ONS MADE TO STATEWI DE OR L E G I S L A T I V ECANDI DATES, L I S T T HE CANDI DATE I D E NT I F I C A T I O N NUMBER I N T HE DES I GNATED COL UMN 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 FROMT HE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( M u s t b e 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 )~/ 7 . - ~

CANDI DATE NAME AND ADDRESS T OWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI 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 me n t ) WAS MADE( MM/ DDI YR) AND P ACCHECKNUMBER- ~ I D#

CK# 3oS' - Y L t a . % , ~ S~- C ' o l ~ s $1 - 1 7 - 0 4 I D#

C2 ~ ' t l r 7 t i a ~ t l SCK# ~ 73 QSc t

Z. - I S - o f f I D# Cp , . s ~ u t . + OLCK# s bi P s ' 6 6 r --- q e Av-~3 ~S - l ' L C oA~. s

~. o oI D# C o 1 1 i e _ _ 5

~ ~ S c f ' .CK# - ) 3 ` ' )I D# VS ( g y p , - a 5 ~ 2 ~ . .CK# 740

I U" I3 I D# C l t c l r I I Q S Q2 " ] ' F 8 - L 4 . ,

S UB - T OT A L $ - 735 8 , 2 5TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) $

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T HI S BOXAPP L I E S TO CANDI DATES ' COMMI T T EES 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 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 mm i t t e e . ( R e f e r tS 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 5 6 . 6 ( 3 ) ( 1 ) . )

P a g e 2 o f

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

FOPR I N S TRUCT I ONS , SEE BACKOFFORM SCHEDULEEXPENDI TURES B MONETAn y- MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI T TEES : NOTE- FORCONTRI BUTI ONS MADE TO STATEWI DEOR L E G I S L A T I V ECAND/ DATES, L I S T T HE CANDI DATE I D EN T I F I C AT I O N NUMBER I N T HE DESI GNATED COLUMN AND T HE CHECK T HI S BOX I FPACCHECKNUMBER FOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLEFROM T HE I OWA AMENDI NG FORME T HI C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame s o n S t a t e me n t o f Or g a n i t r o nCalNk o v " 1 / ) %A - v r t / ;M1: 1A 0 r T-

CANDI DATE NAME AND ADDRESS T OWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b ur s e me nt ) WASMADE( MM/ DDNR) AND PACCHECKNUMBERs l z ~ e 7 C a w , -CK# P I 0 1 i 1P : PA . S -e r v 4 r- $ ' o' 3s- . ~ 4 3

I NCK# .I NCK#I D #CK#I D #CK#I D #CK#I D #CK#I NCK#

SUB - TOTAL $ s a r 3 ~ c - - -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 ) $ 7 9 D 9 , , - L

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FOR I NSTRUCTI ONS, SEE BACK OF FORMT h i s f o r m i s n o t a p p l i c a b l e t o 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 sNo t i c e o f Di s s o l u t i o n

O f f i c i a l Name o f Co mmi t t e e6 PEi RAI VA1 Fo f - 6r oD - T-

C i t y , S t a t e , Z i p C o d e>M~s . ~ A- ado / o - 575- : 5 7~55,

Di s s o l u t i o n s h a l l b e a c c o mp a n i e d b y ao s u r e Re p o r t Fo r m c u r r e n t t o t h e d a t e o f

E f f e c t i v e d a t e o f d i s s o l u t i o n

14, c gS i g n a t u r e o # T r e a s u r e r

T HI S BOXAPPLI ES TO CANDI DATES' COMMI TTEES ONLY :I , t h e c a n di d a t e , c e r t i f y t h a t my c a n di d a t e c o mmi t t e e ' s c a s h b a l a n c e i s z e r o , a l l d e bt s , o b l i g a t i o n s a nd l o a ns h a v e b e e n p a i d o r s a t i s f i e d i n a c c o r d a n c ewi t h l a w a s shown o n my c o mmi t t e e ' s f i n a l r e p o r t a nd a l l c a mp a i g n p r o p e r t y an d l e f t o v e r f u n ds h a v e b e e n d i s t r i b u t e d i n a c c o r d a n c e w i t h myc o mmi t t e e ' s l a s t f i l e d St a t e me n t o f Or g a n i z a t i o n .

Da t e S i g n e d

FORM

Fo r Of f i c e Us e On l y

DR- 3NOTI CEOF

DI SSOLUTI ON

Comm . #I n d ex e dAu d i t e dComput e r sC e r t i f i e d Da t e o f Di s s o l u t i o n

( Re v . 0 2 / 9 6 )

, 2 0 0S

WHEN TO FI L E :Th e N o t i c e o f D i s s o l u t i o n mu s t b e f i l e d w i t h i n t h i r t y ( 3 0 ) d a y s o f t h e c o m m i t t e e ' s d i s s o l u t i o n , w i t h a c o p y o f t h ef i n a l b a n k s t a t e me n t a t t a c h e d