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FQR I NSTRUCTI ONS. SEE BACK OF F^4M

DI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e same a s n S t a t e me n t o f O r g a n i z a t i o n )Tu m, Sa" _ r ewe_I MPORTANT : I n d i c a t e t y p e o f c ommi t t e e y ou a r e r e p o r t i n g f o r.1 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 a n c 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 Co mmi t t e e( 8 ) Su p p o r t S l a t e o f C a n d i d a t e s

SI GNATURE OF TREASURE ( 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 GNEDRo u t i ne 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 o r t s Range f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK ANDCOMPLETE THE F OLL OWI NG SENTENCE :I AM F I L I NG A REPORT FORAWA ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR.

( r e p o r t d a t e ) I n d i c a t e o n eCHECK I F AMENDM NT TO REPORT DATEDs aI d_ 4r w I ~ . 9,00a

_ ' P f I - e d A. nuAr 1 0 , QO Sl ] 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 and 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 DR- 3 .( Y o u must 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 . )

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 mo v i e s h e l d b y t h e c ommi t t e e . T h i s amount MUST b e t h esame a s t h e c as h o n hand a t t h e e nd 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 st 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 THI S PERI ODSc h e d u l e A: Cash 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 : Loans 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . AJ f lSc 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NA

( S c he du l e H a p p l i e s t o Ca nd i d a t e s ' Co mmi t t e es On l y )

SUBTRACT TOTAL MONEYSPENT THI S PERI OD

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STATEMENT OF CASH ONHAND

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Sc 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 8 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L oan Re p a y men 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 nd 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 mu s tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 I DI SCLOSURE( Re v . 0 1 1 9 8 ) REPORTF o r Of f t p Us e On l yComm. aI n d e x e dA u d i t e dC o mp u t e r

L o c a l C o 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 d

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OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ NACANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h e du l e G A t t a c h e d ? ) - . YES x NOVALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l e H - A t t a c h Sc h e d u l e H ) $ NA


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

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s c h e du l e )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) I RECEI PTSOCHECK T HI S BOX I FAMENDI NGFORM

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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 - MONEYTAKEN I N( k x k i d l n 0 c a n d l d a b ' s 9 a s a r a l h r d s )COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t eme n t o f O r g a n i z a t i o n )

I cmeSo n - ~ r ~J c - (S~JSTATE CANDI DATES NOTE I F A C ON T RI B UT I ON I S R E CE I V E D FROM A STATE PAC ( P O L I T I C A L A CT I O N C OMMI T T E E ) . L I S T THEPAC I D E NT I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COL UMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD.CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co 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 an d s t a t e m e 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 a n y c o m m e 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 o m m i t t e e s .

f , SUB - TOTALTOTAL ( i f l a s t p a g e o f t h i s

s c h e d u l e )

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DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL A T I ON S HI P AMOUNT J I F FRECEI VED ( i f a p p l i c a b l e ) TO CAND I DATE ' RECE I VED FUN( MM/ DD/ YR ) AND PACCHECK ( i f a p p l i c a b l e ) R AI SNUMBER I NCOI D# / U1 1 n c . f. ~J v hr t 4 ) r l

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Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N( h l d u d k q c a n d k i a t e ' s p w e o r m l O i l l d a )COMMI TTEENAME ( Mu s t b e s ame as o n S t a t eme n t o f O r g a n i z a t i o n )QSTATE CANDI DATES NOTE : I F A C ON T RI B UT I O N I S R E CE I V E D FROM A STATE PAC ( P O L I T I C A L A C T I O N C OMM I T T E E ) , L I S T THEPAC I D ENT I F I C A T I ONNUMBER AND THEPAC CHECK NUMBER I N T HE D E S I G NA T E D COLUMN . A US T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 an d s t a t e m e 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 c o mme 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 o mm i t t e e s .

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s c h e d 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 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 ec 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 Ml 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 ) ( S e e Pa g e 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 P a g ef a m i 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 .

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Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N( I n c k I d Y V c a n d i d a t e ' s p e r s a t a l h i n d s )COMMI TTEENAME ( Mu s t b e s ame as o n S t a t eme n t o f O r g a n i z a t i o n )

vi mPSQ, - 4Y use,STATE CANDI DATES NOTE : I F A CON TP 4 8U T I ON I S R EC E I V E D FROM A STATE PAC ( P OL I T I CA L A C T I ON COMMI TT EE ) . L I S T THEPAC I D E NT I F I CA T I ONNUMBER AND T HE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A US T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 an d s t a t e m e 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 c o mm e r c i a l p u r p o s e b y an 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 m m i t t e e s .

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s c h e du 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 m m 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 m a k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p m u 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 y 13m a r r i a g e ) ( S e e P a g e 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 p a g e . o ff a m i 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 m n . ( f o r S c h e d u l e A )

SCHEDULEA MONETARY

( Re v . 0 & 9 7 ) RECEI P T SR / CHECK T HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR R EL A T I ON SH I P AMOUNT J I F FORECE I VED( MM/ DD/ Y R) ( i f a p p l i c a b l e )AND PACCHECKTO CAND I DATE 'Of a p p l i c a b l e ) RECE I VED FUNDRA I S E

NUMBER I NCOM

1 1 1 0 5 1 1 ) 1I D#CK#

b or " CL I A L f 5 1 11 a a 5 r 7 SASST _ Z ' r f a c e -Cl t . v e - TA E 2- 0 3a6 Z 0 r I 1 T/ 1I D# g c ( h n t i , " d ~Pawa r d

I I ~ Q 5 / D ~ CK#Po &X 3 q - /Wi r x ~%J L A 5 -6 3 2 3 t o-I D#

I I / 0 ~ ~ 1 ~ 1 c K# . ~ LA *e. e - fe s Xt 6 i i nn TA o oC)I D# zmo. I \ QQi m2A-

1 1071 1 CK#~3 Su ` " 7 K v n . f i r ,

( I ~ ~ ~ lI D

#~ , . ~ v ~SQnn L. c~ Q, 4 r Bf 1aaoa N 1 , t 3 1 4 O ' w ' S ~ r e l z lC. Uv e 2A5o3a5 57, 00I D . p e r F _ o b e c t 5 -

I I l G7 ~ a1 CK# ( p ( a oW ! ! r _ 5 + , )1 D k S 0 1 t i MI D# !J h - e ~ ~a . ; - e - kz

Jb710 CK # 1 \ 5 E WdC~L J c ,P o kK : , TA 5021kI D# C~ e L LaO0S9 ~CK# e De s M- a i n I FS SA oDI D# ~,Fromena~romNo e

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f 7 ~D CK# 13 3 3 \ V~ ' E- a s-VT f ~ n1~; d -- r A 5a ` +o aa


8/16

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 i u d k q c a n d i d a t e s p e r s a l a l U x t d s )COMMI TTEE 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 )

T~r r _ e _ _ S , 6 - n rS T A T E CANDI DATE NOTE I F A C ON T R I B U T I O N I S R E CE I V E D FROM A S T A T E P A C ( P O L I T I C A L A CT I O N C O MMI T T E E ) L I S T T HE P A C I D EN TI F I C A T I O NNUMBER AND T HE P A C C H E C K NUMBER I N T H E D E S I G NA T E D COLUMN . A L I S T OF I D N U M B E R S I S A VA I L A B L E FROMT HE I O WA E T HI C S AND C A MP A I G ND I S C L O S UR E BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 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 a n y c o mme 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 o mmi t t e e s

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h e d 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 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 m a k i n g a c o n t r i b u t i o n t o t h ec o m m i 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 ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o ff a m i 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 S c h e d u l e A )

SCHEDULEA MONETARY

( Re v . 0 & 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PA C I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL A T I ON SHI P AMOUNT J I F FORECEI VED( MM/ DD/ YR )

( i f a p p l i c a b l e )AND PA C CHECKTO CAND I DATE '

( i f a p p l i c a b l e ) RECEI VED FUNDR AI S ENUMBER I NCOM

I D# t o Di ( o Ma n t A ~ c ` l u r e c l I , 6u s i h - PAC~ ~ ) 0 1 1 t ) l CK# j L j 3q 1 4DD OeA e So" Od r

I D# G 13 , 5 , 4 , w0L Ry a - ~


9/16

Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N( k w k x l k l p c a n d i d a t e ' s p e r s o n a l k r r r d s )COMMI TTEENAME ( Mu s t b e s ame as 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 Y~PSo r l AD Y ,

SCHEDULEA

( Re v . 0 8 / 9 7 )MONETARYRECEI PTS

QCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE I F A CONTP48UTI 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 UST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 8 . 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 op i e d f r o m r e p o r t s an 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 c o mme r c i a l p u r p o s e b y an 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 e s .

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

s c h e d 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 m m 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 m mi t t e e . R e l a t i o n s h i p mu s t b e s h ow 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 ame 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 ff a m i 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 NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI SENUMBER I NCOMI D#

i l f r a / a CK# a g g g ` 33~ ~Tr~. ~ - n 5 ' 0 a5 7 as v oI D# R o h r } ~ r fI I I t ? ~ L ( CK# ( 0 05W. r k e - mo r ee a r &e o ' 0 I E ) oI D# s ) u _ J A Wa C ,I I ~ I D J p l ~CK# 01 " 1 1 a g 7 5D 1A_ ) eSTbW11 arkLoaAl ) # 1 0 0e 0 e s A U o i r i e s ~TA_ O t eLI D# t o o a ' 7 Di e , Me . ~ ~ u - A ~ ~J I DPa CK# I $ g ) i s U ( o C

~ 7f - a yAALA e . - ~ . 1 . . + . J L 9 : ( l 0 1

e 5 v i ne s ' ` Uw I D# y e j ' OtAL &- CS ASSOC. PAOes Mol nes zp 4 503 O

I D# p~ a n e Sa. AL c ~_ e f s -I b 6` 7 I Y1 5' ' ~ =~~t1 1 / I S t 7 1 CK# W, f - \ A - e r 5j j : 4 Soa ' 73 Q. 5 , QI D# n om c ~ i n ` ~

1~~I ~bl CK# v~ ~' ba ~1ddI D# ~pi S ~Yp~ ! r CK# s ~ e

. S h ~ L 10 .00l D# , / a r n f ' S n l i nCK# ( 9 1 1 5~M~J CL r l I e c j At 1 . 7 a5o1 ob. , e so31 D# ~ I t r 5 1 n l u ,CK# 9a~w. ~cf s a l ~ WOOD3


10/16

Fo 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( h t d u d h t p c w t d d s t e ' s p a r s o r t a l f u n d s )COMMI TTEE NAME ( M u s t b e same a s o n S t a t e m e n t o f O q p n i z a t i o n )

TL~MFSor - ~ r p v _NL t S~S T A T E CANDI DATES NOTE I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E P A C ( P O L I T I C A L A C T I O N C O MM I T T E E ) . L I S T T H E P A C I D EN TI F I C AT I ONN U M B E R A ND T HE P AC CHECK NUMBER I N T H E D E S I G NA T E D COLUMN . A US T OF 1 0 N U M B E R S I S A VA I L A B L E FROMTHE I O WA E T HI C S AND C A MP A I G ND I S C L O S UR E BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 a t e m e 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 a n y c o mme 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 o mmi t t e e s

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h e d 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 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 ec o m m i t t e e R e l a t i o n s h i p m u 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 ym a r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o f$-f a m i 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 c h e d u l e A )

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS0 CHECK THI S BOX I FAMENDI NG FORM

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESSOF CONTRI BUTOR RELAT I ONSHI PTO CAND I DATE ' AMOUNTRECEI VED J I F FFUND

( MM/ DD / YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I S ENUMBER I NCOMI D* _ 1 1 \ o mss R o r r v

1 1 1 9 0 / & 1 CK# a - r 1 l o a ~ t r e _e ~ "! 5 o g L r l 3 ( 3 I nI D# kw4~\

I J o t 0 / Q ~ CK# ~ 2$~ r s~~W,MI NI D# Mr s, a t ' e j d C T- e x l n C a o a . r

I I l 21 ~ a I CK# a 0U LP ~ui c M " > , V C - v - As a ~~ 1I D# l bear \ Ccx . t . L ; ~ I t e

I I I ZI ~QI CK# 316 S . ' - S * , c e _ 9 _ t5 e 5b73I D s f y \ r s Oc wt a ' S c d o c k ~ e - rI 3 / p CK# P - 0 , 60X L 4 a ~e r r r A o 7 i ~ }I D # bor l i l , i S u r c s r n c L

~PAC

I I a3~o~ CK# 3O 5goo WPS*~n ? A r V, . - ~ /r 1 a e Or s Mo t r ' v t S S. A b a1 . t , ~ , t l "I D # "a l e u ~ k n X , aQhsl a ob 01 CK# 3 5 N, ~?0003 5 00I D # . , .~ " r L ~

,y r S

1~ l 0 ( 0 1 0 1 CK# 53 I I N I r n d hoodht l - e~ " . 000 0I D # f qmeS u0)

' 7~ f p CK# > 95 S 7 , q~- St r ee tp~s o I me s - TA ~C)I D # Gr ej I C I I SCL b r c i c :CK# ~ L 4 1 o 1 y ~ , w 9 1 t j~ n ACA oa 3 , 00


11/16

F o r I n s t t ~ i c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN 1 K

( I n c h r d l n g c a n d i d a t e ' e p e r s o r w i f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )l ' o r n t o s o n J r - -

CANDI DATES NOTE . I F A CONTRI BUTI ON I S RECEI VED F ROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT 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 F ROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68 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 nd s t a t 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 ny c o mmer c i a l p u r p o s e by a ny 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 e s .

SUB- TOTAL $ - T o , 6o$ 5 5 1TOTAL ( i f l a s t p a g e o f t h i ss c h e d 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 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 l i r n l t y ( r e l a t i v e s b y ~ ,m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t . ) . I f s u r n ame 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 m i 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 d ul e A)

SCHEDULEA MONETARY

( Re v . 0 6 / 9 7 ) RECEI PTS0 / CHECK THI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORECE I VED ( i t a p p l i c a b l e ) TO CANDI DATE' RECEI VED F UND-( MM/ DDNR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMI D# Ja c K F e ,

Sk er l da n Ao e v , u v) a j a f o I CK# I 5 ` 7 a a oI 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#CK#


12/16

I 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 l 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 mu s t a l s o b e d e t a i l I t e mi z e d o nc 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 r x f i t u r e m a 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 oc 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 . _ . L. - o f "?

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

FORI NSTRUCTI ONS, SEE BACKOF F A SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DE ORLEGI SLAT I VECANDI DATES, L I ST THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE OCHECK THI S BOX I FPAC CHECKNUMBERFOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( 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 o n)

I l beSCh ~ r f j Us eCANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f ap~e) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECK

NUMBERI N V; c . t na ~ ~En t e rFPr ~ y e sr Mo w v - + S + ~~ 1 0 5 t t - ~C' S~~ ,0 1 / 0 q / 0 ) CK# S a y - . &JYl S~ChM0 4 ^ 4 1 2 ? - N ~ f i o n $o f OQueavor t - TA S- I &O -I N JO& - ,7 y me54r p 4 - 1 r v V r L t f o r St k" D _

0 I 1 15 ~0 1 cK# 15a~ f N- ~~h f ~ay bI ' Nkv, a , aC6d " r o ad i n ~0 3 s b s c r - p a n s ; I ~ a e c a s t + f ! c X8 1I D # Eu `r t ham A c t O o cat N e t o s e a e e C ~ d U ' ~ l i ~ i S ( r ~ -- 7 1 1 ~ cK# 590 ~ j e Mapl e . r3ox 3a7 C~rS+i ~w~' SunI f e ~I l g Ear j hctm 44 5oorl a , jI N MAWSi t v l a d i S a n z a - r i N e i , j 5 p a c p e r t ~ t d V e l f r 5 t i uf~~o l CK# a ( v I 1

; Z LW. CourtWj r - tW ' o f f C~sf i f u er ~ f Si u r Ve q 00

l o # ~t J ~ p. . ~r r~ Sf . 8X98~~~' ~ i ~ l l P~ ' t r s l n ~/ l x / 01 CK# l a i 3~3Pt r ( I : A 5oaao i ons - ; - f ~ Sure

I D# I I a s ~e~I ( J p wSJ / 1v~0/ cK 112Y

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SUB- TOTAL $TOTAL ( N l a s t page o f t h i s s c h e d u l e ) $ "


13/16

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 mu s 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 i e n 6 Ue 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 mu s 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 m a 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 C o d e 5 6 . 6 ( 3 ) ( i ) . )

Pa g e - a- o f( f o r Sc h e d u l e B )

FOR I NSTRUCTI ONS, SEE BACKOFF A SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 09W) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0 CHECKTHI S BOX I FPAC CHECKNUMBER FOR EACH EXPENDI TURE. A L I S T OF 1 0 NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NGFORMETHI CS t i CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( M u 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 )

1r n e s v n 4 i l r Wf h s - e _CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l f c e Ws ) ( D i s b u r s e m e n t ) WAS MADE( MWDD/ YR) AND PACCHECKNUMBER) D# S I n Pr o () 1 1~ ` r x c a l l

6 2 , s . ) ' OU. r W,CK# 1 1 3 1 Aes 5 o o a r h a 9 n ~ f i ~ St ~ n S 9 111 1 g oI N i 1 4 1 4 cOr d - d / year Y1 ewl - ) -peyefo ' ~ l ~ / o ~ ~ " # 1132

P D a o ) ( asq_A 5 o I a 5 5

~ i ~ l i h S ~ ' t 7 ~ ~ ' 13 5 . 00I N S e e l " e f a . I ' L , of S L . i * s f s a4AA La 6 e J s

~~ D$ ~ / CK# Pover I s LL . : k J ~S r / Mot ~sanrre. t -33 beS k Ao I vqS j 1A 6~) 31 9 I ~ O1 ~- I " u r es) D# 1 A . S. P0Si 0- ( ~q , c e- RMeu) annual Permi f

1 a~~~/ D1 CK# 4n r . t , Soat 73 ~r b~L r n a , t - Ir

13 v0 )) D# Pr i r a i t j 6 ' c ' ess grock. r e s , I s r I ' e , ~ i y

f l / zWl CK# ~5q5 / j u. ) ( ~ ` r ' Cc 1 r c QS e r i v r z e o C e s , - t ' I . k y v35 OesMoi nFS 50 l o ~r ns s c~. r ~s gaa, ~a) D# U, 5 , Post 5~~Ce- i , i s' p ~Fc e s o~ bc,UL

1110 1DI CK# Ot Y4Ys. J , .A5ba(73 IMaA a< ' OD( D# ( A- S, d5 - + c ' ce Sr o115 of S S-hr

Q/ CK# i t 1 ' ) d r a~ s r ~ Lp 7 C- ~ 5I , ~ . rJ~o Z ' ! - a4 , k sow 661 D# ( A' S, ".E. 09Q_ vq&aPi , ec es o V - bcAkCK# ab I , c . .1n~, SA5oar13 x ' ` 0 2 a I ' - ~ ' " f

SUB- TOTAL $ `TOTAL ( H l a s t page o 1 t h i s s c h e d u l e ) $


14/16

I S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :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 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 . )x p e n d i t u r e s t o p e r s o n s / e n t i b 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 nc 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 m a 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 oc 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 ) ( 1 ) . )

P a g e _-~-_ _ o f

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

FORI NSTRUCTI ONS, SEEBACKOFF( - f SCHEDULEEXPENDI TURES B- MONEY SPENT FROM COMMI TT EE ACCOUNT MONETARY( Re v . 09M7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LAT I VE O CHECKCANDI 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 THI S BOX I FPAC CHECK NUMBER FOREACHEXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS 3 CAMPA I GN DI SCLOSURE BOARD .COMMI TTEE 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 )

r r n e s 6 - , - 6 - q b u s e ,CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I 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 me n t ) WAS MADE( MM/ DD/ YR) AND PAC

CHECKNUMBERI N CL t k e s C o Ne e C ) hf - L j ea r Y1e_~ Qd . , p e r ^, I b Gua~5 Bo x 1 9 0 .t / 1 ~ 1 6 1 CK# f SL . ~ o s ~ - , o ~ $ao R d e , i TA Sooo 3 50I NCK#I NCK#I NCK#

` I NCK#I NCK#I NCK#I NCK# '

S U B - T O T A L $,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 ) $


15/16

FORI NSTRUCTI ONS, SEEBACKOFFORD

COMMI TTEENAME ( Mu s t b e same a s o n S t a t e me nt o f O r g a n i z a t i o n )

NOTE: De b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p a i d must b e i n c l u d e d o n t h i sSc h e du l e , a s w e l l a s an y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

SCHEDULED I NCURRED( Re v . 0 8 / 9 8 4 I NDEBTEDNE

CHECK THI S BOI F AMENDI NGFORMAn " i n s ur e d d e b t " i s a d e bt f oDEBTS/ OBLI GATI ONS REMA I NI NG THI S REPORTI NGPER I OD g o o d s o r s e r v i c e s o r d e r e d o r

( DONOT I NCLUDE LOANS - - SHOWLOANS ON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y te n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f wh e t h e r an i n v oh as b e e n r e c e i v e d .

' I f a c t u a l f i g u r e i s u n k n ow n . s h o w " e s t i m a t e d " b e s i d e t h e f i g u r e . PageIo f( f o r Sc h e d u l e D)CANDI DATE COMMI TTEESNOTE :` I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h wh om t h e c a n d i d a t e ' s c o mm i t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s 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 , oo r g a n i z i n g s e r v i c e s . R e p o r t On S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i ma t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

DATEI NCURRED( MMI DDI YR)NAMEAND ADDRESS OF PERSONTOWHOMDEBT OR OBLI GATI ON I S OWED

DESCR I PT I ON OF GOODS ORSERVI CES PROV I DED ORPURCHASEDBALANCE OWED ACLOSE OFREPORTI NGPERI OD '

1 o 8 1 o aJ OG~c . 7~m~$ OYtj 4wy 1 ( o 9t - - r_ 4 5v &E3i

r n i t s , ar q q 5

meS6Y\I S a 4TJWA. . 3 - y 1 ( 0 9TA s ~ W7

Y e . p~XSc o w-~ ao 1 - 4 D, oo

CPO4 0 A I I I 0 4~

SUB- TOTAL $q L 4 S '

TOTAL DEBTS OWED BY COMMI TTEE AT THE END OF THI S REPORTI NGPERI OD $1 . 5

t1 -0 I


16/16

FOR I N STRUCT I ONS, SEEBACK OF FORAY.COMMI TT EE NAME ( M u s t b e s am e a s o n S t a t e m e n t o f O r g a n i z a t i o n )

NOTE : D e b t s p r e v i o u s l y r e p o r t e d t h a t r e m a i n u n p a i d mu s t b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a n y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

SCHEDULED I NCURRED( R e v . 0 8 1 9 8 ) 1 I NDEBTEDNESCHECK T HI S BOI F AMENDI NGFORM

An " i n c u r r e d d e b t " i s a d e b t f o rDEB T S / OBL I GAT I ON S REMAI N I NG T HI S REPORTI NG PERI OD g o o d s o r s e r v i c e s o r d e r e d o r( DO NOT I N CL UDE L OANS - - SHOWLOANS ON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y t he n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f w h e t h e r a n i n v o ih a s b e e n r e c e i v e d .

* I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i ma t e d " b e s i d e t h e f i g u r e . P a g e O ' - - P ~ ~ - o f l( f o r S c h e d u l e D )CANDI DATE COMMI TTEES NOTE :* I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h w h om t h e c a n d i d a t e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e . E n t e r t h e n am e o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s 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 , m a n a g i n g , o ro r g a n i z i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i ma t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

DATEI NCURRED( MMI D DI Y R) NAME ANDADDRESS OF PERSONT O WHOM DEBT OR OBL I GAT I ON I S OWEDDESCRI PT I ON OF GOODS ORSERV I CES PROVI DED ORPURCHASED

BALANCE OWED ACLOSE OFREPORT I NGPERI OD*

a $ ~ 0 6 L 0 1J o d i i m P s v n) 5 01 4 W6 1 u j a ~ 1 6 C lw~ l e e r ^ _ A a ' 7 3

Pa r ode . GP g r a dess ~m'

- F o 1 ^- P u r d t a S e

$

I ~ 4 9

08 a8 ~~, 1 a ~ =

~ n. j w e s 6 n

- e , ~ - ' I B C )~A S c ~ ~ ` 7 3A -~ ) 5 ' m~~ s - r , GPsr ' r ~ d C' S g

oJ o d ir a ( ~hT~meS6 ~- j~ ~ q x c r k r + c d h Z ~~

, , .

SUB- TOTAL $0 ? 0

TOTAL DEBTS OWED BY COMMI TT EE AT T HE END OF T HI S REPORT I NG PER I OD $~ 3 7 rq

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