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COMMI TTEE NAME' ( M ( b e s ame a s o n S r a r e r n e n r o f o r a 11. C n ) , . . . . ~ar~~ 1 1 3 J J P i WnL ~ \ ~~' waw~TRrGCv ~ ~~~ ~~' Ct 1L~LG~~I t i ~

( i ) St a t e wc e r L eg a l a u v e Ca n e d a ( e ( 2 ) SL a t e wr d e PAC ( 3 ) S t a t a P a r t y ( r ) Ca u nt y t Ld ' a l Ca r i GCa t e( 5 ) Co u n t y PAC ( a ) B a l l o t t s s u er F r a r c Na e Co r n m, t t e e f T ) C a u n r y i C l t y Cena -a l Commi t t e e l( 8 ) S u C ~ O a r t S t a t e o f CAn a f d a t e s s j s - 2 - / 9 - 2 s ? ?

URER ( o r p o r So n B l l n g t h i s r e p o r t ) TELEPHOI NE

Ro ut i n e Pen a l t i e s Du e Fo r L a t e F i l e d Re p or t s R a n g e f r o m S2 0 t o S800SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOV_1 t i " S

8 E -POAV F 1 5 l R ANNA ( t ) ELECTI ON / ( 2 ) N ON - EL ECT I ON YEA ; ; -I n d i c a t e o n e a

E j Check i ( 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 ` ~ o t ~ Ce o f O i s z c l u n o n F or m D o t - 3 .( Y ou mus t c on t i n u e t o f i l e r e c e r t s u n t i l a N o t i c e o f C i s s o l u t i o n i s f i l e d . )

NTENCE :

STATEMENT OF CASH ON ANDCASH ON HAND a t t h e t e g i n n i n g o f t h e r ep or 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 by t h e c o mmi t t e e . Th i s amou n t MUST be t h es ame a s t h e c as h on 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 er i od .o r mus t be 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SADDTOTAL . MONEY TAKEN I N T HI S PERI ODSc h e du l e . A : C a s h Co n t n b u t i o r s t o t a l ( A t t a c h Sc h ed u l e A ; . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . .

I I ISc h e du 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! ~ L . . . . . . . . .H : T o t a l Sa l e s o f Ca mp a i g n Pr o r r ( Aa a c n Sc h ed u l e H . .

( Sc h e du l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )SQB- TOTAL . . . . . .

Sc h ed u l e E : Ex r en di t u r e s r e t a l ( A r t a c n ScheCUl e ? ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . .Sc n e c u i a F : L e a n Re p a y me n t s t o t a l ( ACac h Sc n e d ui e F I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .r ) j A r ~CASH ON HAND 3 t t h e a n d e i t h i s r e - r i n g c e n c d ; i f f i n a l r e p o r t b al a n c e mus t, Y' C1 r `t e z e r o ) ( ACac h GP-3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Q . . . . . .

PA , : -: ] E 02 / E , ,rvnmDR- 2 Ot SCt _CSUgE( R e v , 01198 ) REP- - R7

r o r t ? Mc e Us e On l yCo r nm . 0I n d e x e dA u e i t e dCompu t e r

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UNPAI D B I L LS ( F n s m Sc h e du l e D - , A t t a c h Sc h e du l e ^ ' l - , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3I N KI ND CONTRI BUTI ONS i F r . o n Sc h e du l e - - . A r a c n Sc n e d u i e - ` , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SOUTSTANDI NG LOANS f = r om Sc n e d u l e = - A t t a c h Sc - e c u ( a ; = ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5CANDI DATE ( : CMMr r 7EES ONLY :

Y F- 5 1 4 % 0CONSULTANT BREAKDOWN ( SCn e d t a e O a ; r a c he d ' !VALUE CF CAMPAI GN PROPER TY ; F r om Sc h ed u l e - 4 - . ma c h Sc n ed u l e H)

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_ _ , i - i j o ~ , ! j i : i 0 4 1 ~ 41 ~ 8' 1 9 3 5FO) ; I NSTRUCTI ONS . SEE BACK OF FORM

COMMI TTEE NAME I ' M r b e s ame a s o n S r a r e me n r c f Or g a n i z a u o n ~ )k ' ~ r 1 ~ R. r v %~ , L o l a &, " Z1 - l o t a , . wOk ' ~ e ~ O k i t i t L _ tI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :t ) S : a t a w ~ c a , L e g t s l a u v

[Y e C a n d i d a t e ( 2 ) S r a l e w , d e PAC ( 3 ) S t a t e P a r t y ( s ) C c u n t y r t o c a i C a n d s d a t ot 5 ; C o u n t y PAC ( 6 ) e a l t o t I S S u 9J F r a n CNS H C o m m i r t t l e ( 7 ) C o u n y i C , t y C e n t r a l C o mm i t t e e) SUPOc r S l a t e o f Rn d l a a r e s

DI SCLOSURESUMMARY PAGE

, aUI NSTRUCTI ONS ON BACK ANDCOMPLETI AM F I U NG A OC- ~CA2- _ 1 o ' I , zooo

( r e p o r t d a t e ): CHECK I F AMENDMENT TO REPORT DATEDF~ 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 Fo r m DR - 3( Yo u mus t c o nt i n ue 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 Di s s o l u bo n i s f i l e d _ )

s ' l s ~ 2~l 9- 2s7~,SURER ( o r p er s o n f i l i n g t h i s r e p o r t ) TEL EPHONE

Ro ut i n e Pen a l t i es Du e Fo r L a t e F i l e d Rep o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e beg i n ni n g o f t h e r e p o r t i n g p e n o d . ( T h i s i s t h e t o t a l

o f a l l mo n t e s h e l d by t h e c o mmi t t e e . T h i s am o u n t MUST be t h es ame a s t h e c a s h o n h a n d a t t h e en 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 be 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SADD TOTAL MONEY TAKEN I N T HI S PERI ODS c he du l e A : C a c h Co nt n bu t i c n 3 t o t a l ( A t t a c h S c he du l e A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 09 3S c h ed 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 S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h ed 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 ed u l e H) . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . -_

_ L S c h ed u l p H a pp l i e s t o Ca n d i d ut e s ' Co mmi t t e es On l y )SUB- TOTAL . . . . . . S

SUBTRACT TOTAL MONEY SPENT THI S PERI ODS c h ed ul e 5 : E . ( n e n d i t u r a s t o t a l ( A t t a c h S c he du l e 8 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , 5 . 6 3Sc ` e d u l e F . L o a n R ep a y me n t s t o t a l ( A t t a c h S c h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t : h e en d o f t h i s r e p o r t i n g p e n o d ( i f f i n a l r e p o r t , b al a n c e mus tbe z e r o ) ( A t t a c h CR - 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . , . $

P~ : EFORMDR - 2( Re v . 0 1 / 9 8 ) DI SC LOSUFEREPORT

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UNPAI D BI L L S ( F r o m Sc hed ul e D - At t a c h S c he du l e C ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . , . . $I N KI ND CONTRI BUTI ONS ; , F r o m S c h ed u l e E - A , t t a c r , s c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S _OUTSTANDI NG L OANS = t o m Sc hed , i l e F _ , t a c h S c h ed u l e r i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5CANDI ATE COMMr TTFF S ONLY :CONSULTANT BREAKDOWN ; Sc h ed ul e , At t a c h ed " YES r l 0VALUE OF CAMPAI GN PROPERTY S c h ed ul e - + - A t t a c h S c h ed u l e H ' ! S

unry ~ n

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STATE CANDI DATES NOTE: I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( P O I J r I CAL ACTI ON COMMI TTEE) L I S T THE PAC I DENTI F I CATI ONNUMBER A N C ) THE VAC CHECK NUMBER I N THE OESi GNATEO COL UMN A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE EOARACAUTI ON: Sec t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h b i t s t h e u s e o f i n f o r ma t i o n Co oi ed 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 on t n o u t i o ns o rf o r any c o mme r a a t p u r p o s e b y a n y p er s o n o t h e r t t t 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 .

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SUB- TOTAL

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DATE PAC I D NUMBER NAME ANGADDRESS OF CONTRI BUTOR RE LA TI O NSHI P AMOUNT t i I F FORRECEI VED ( r f s h n l " b l e ) TO CANDI DATE' RECEI VED r uND-( MM/ OD/ YR) AND PAC CHECK ( i f a p pl , Ca b t e ) RAI SERNUMEER I r I CCMr _ -

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FOR I NSTRUCT I ONS, SEE BACK OF FORM R e s e t Fo r mEXPENDI TURES - MONEYSPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMr TT EES : NOTE : F OR C ON T R I B U T I O NS MADE TO S TA TEWI D E OR L E G I S L A TI V EC A N DI D A T E S . US T T HE C A N DI D A T E I D E NT I F I CA T I O N NUMBER I N T HF D E S I G NA T E D COLUMN AND T HEPACCHECK NUMBER FOREACH EXPEND I TURE . A L I S T OF I D NUMBERS I S AVA I LAB LE FROM ' HE I OWAETHI C S & CAMPA I GN D I S C L OSURE 90APD

T HI S BOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :

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CHECKTHI S BOX1 =AMENDI NG FORM

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CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( D ES C RI B E TRANSACTI ON) E' t PENDEDEXPENDED ( r r a p p l t c a me ) ( Di s b u f s e me n t ) WASMADE

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