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    FORI NSTRUCT I ONS, SEEBACK OF FORM

    COMMI TT 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 )

    I 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 po r t i n g f o r :( 1 ) S t a t e wx WL e g s l a n v e Ca n d 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 ) C o u n t y / L o c a l Ca nd i d a t e

    ( 5 ) Co u nt y PAC ( 6 ) B a l l o t I s su e / F r a nc h i s e Commi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Commi t t e e( 8 ) S u p p o r t S l a t e o fw

    DI SCL OSURE SUMMARY PAGE

    . , _ - , r ~p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNED

    e 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 Range f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ON BACK ANDCOMP j a FOLLOWI NGSENTENCE :I AM F I L I N G A REPORTF OR A N/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR

    6 - ` ` ' ` 0 ) I n d i c a t e o n e a( r e p o r t d a t e )( ] CHECK I F AMENDMENT TO REPORT DATED 1A - / 0[ Q 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 No 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 mu 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 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 mo n i e s h e l l b y t h e c o mmi 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 as 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 m u s t b e z e r o d t h i s i s f i r s t r e p o r t t i e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    ADD TOTAL MONEY TAKEN I N THI 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 Ca 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 v o l i e s t o C a n d i d a t e s ' C o mmi t t e e s OOMSUBTRACT TOTAL MONEY SPENT T H I S PERI ODS 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c 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 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 BUTI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    FORMDR- 2( R e v 0 1 / 9 8 )Fo r Of f i c e Use On l yCo mm. aI n d ex e dAu d i t e dComp u t e r

    L o c a l Co 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 mmi 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 l

    DI SCLOSUREREPORT

    SUB- TOTAL . . . . . 5

    CANDI DATE COMMI TT EES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NO

    LUE 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 ) $

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    F o r I n s t r u c t i o n s , Se e B a c k o f F o 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 TT EE NAME ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a d o n ) CHECK T HI S BOX IAMENDI NG FORM

    SCHEDULEA MONETARY( Re v . 9 7 ) RECE I PTS

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) . L I S T THE PAC I D EN T 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 1 0 NUMBERS I S AVAI LABLE F ROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Cod 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 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 of o r a n y c omme r 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 ommi t t e e s .

    SUB- TOTAL

    TOTAL ( i f l a s t p a g e o f t h i ss c h ed u l e )

    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 mm 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mm 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 ym a r r i a g e ) ( Se 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 a s c a n d i d a t e , b u t t h e r e i s n o Page o f _f 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 umn . ( f o r Sc h e d u l e A)

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J IRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FU( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RANUMBER I N

    ; . ~ I D#

    I D #CK#I D #CK#I D #CK#I D #CK#I D #CK#I D #CK#I D #CK#I D #CK#I D #C K#

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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 Sc 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 t oSc 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 ) . )

    Pag e o f

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

    FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TT EE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TURES

    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI 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 C~ 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 & CAMPAI GN DI SCLOSURE BOARD.COMMI TT EE NAME ( Mu s t b e s a m e a s o n St a t e me n t o f O r g a n i z a t i o n )

    CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI 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( MM/ DD/ YR) AND PACCHECK

    NUMBER

    CK# C,

    CK# `9 - ) s o - & t h I I GC- = - ' ~Z Q- So_ 3 / 4I D#

    S 3V6I D# c c _ k { V ? / ~c ' . { f ( , t i J . . a . C7c . ~ r = JCS ~ ' J3 - 8 0 1 5w- l ^ ) c ~e c c e n

    CK#I D#CK#I D#CK#I D#CK#

    SUB- TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $