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FOR I NSTRUCTI ONS. SEE BACK OF FORMDI SCL OSURE SUMMARY PAGECOMMI TT EE NAME ( M u s t b e s a m e a s o>emen t o f r g a r z a t i o n )

I M P OR T A NT ' I n d i c a t e b y # t y p eo f c o m m i t t e e y o u a r e r e p o r t i n g f o r( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e P A C ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l Co mn i t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y P A C ( 9 ) C i t y P A C ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n P A C ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TT EES ONL Y :

EI CHECK I F AMENDMENT TO REPORT DATEDE l 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* M ' I u o n " M( Y o u m u 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 D R - 3 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 o t a l o f a l l f u n d s h e l c d b y t h ec o mm i t t e e T h i s a m o u n t MUST b e t h e s a m e a s t h e c a s h o n h a n d a t t h e e n d / 7 0 0 JY ~ ~ 7o 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 i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ c , I -

ADD TOTAL MONEY TAKEN I N T H I 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 ) ( ' a l s o s e e i n - k i n d b e l o w ) . . . . . . .S c 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 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 C a m p 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 p p l i e s t o C a n d i d a t e s ' C o m m i t t e e s On l y )SUB TOTAL . . . . . $

SUBTRACT 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 ) ( ; " a l s o s e e d e b t s a n d b a n s b e l o w ) . . . .S c h e d u l e F L o a n R e p a y m e 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 DR - 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 K I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMD R - 2 D I S C L O SU RE( R e v 0 7 / 2 0 0 4 ) REPORTF o r O f f i c e U s e On l yCome # _L o g g eS c a n n e dC o m p u t e rA u d i t e d

L a t e r e p o r t s a r e s u b j e c t t op o s s i b l e c i v i l a n d c r i m i n a lp e n a l t i e s

o u n t y & L o c a l C o m m 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

NNOCANDI DATE COMMI TT EES ONL Y FICONSULT ANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YESVALUE 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 Fo r mCONTRI BUT I 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 )

STATE CANDI DATES NOTEkO A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LA B LE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68B. 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 ma 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 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 ny 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 er t h an 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 .

TOTAL ( i f l a s t p a g e o f t h i s 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 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 must b e s h o w n t o t h e t h i r d d e gr 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 ) . 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 ut 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 ul e A)

SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME1 D#

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( 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 )

STATE CANDI DATES NOTE : I VA CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CA TI ONNUMBER AND THEPACCHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A BL E FROMTHE I OWA ETHI CS AND CAMPA I GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 68B . 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 ma t i o n c o p i e d f r o m r e p or 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 a ny c omme 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 an 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 .

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 ommi 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 an y r e l a t i v e mak 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 must b e s h o w n t o t h e t h i r d d eg 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 ) I f s umame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b ut t h e r e i s n of 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 .

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

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SCHEDULEA MONETARY( Re v . 0 7 / 0 3 ) RECEI PTSQCHECK 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 F FORECEI 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 ) RAI SERNUMBER I NCOMEi

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T HI S BOX APPL I ES TOCANDI DATES' COMMI TTEES 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 Sc h e du 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 l 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 a mu 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 mmi t t e e . ( R e f e r t oS 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 6 8 A . 4 0 2 ( 3 ) ( ) . )

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

FOR I NSTRUCT I ONS , SEE BACK OF FORM I R e I l e t EOM SCHEDULEEXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNT B MONETARY( R e v . 0 7 1 0 3 ) EXPENDI TURESSTATE PAC COMMI TT EES : NOTE : FORCONTRI BUTI ONS MADE- TOSTATEWDE- OkL EGI S t AT I VE-CANDI DATES, L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 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 FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD_

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CANDI DATE I I , NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACT t 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( MMI DDI YR) AND PACCHECKNUMBER MC IU 1 D # - p (

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An " i n c u r r e d d e bt " i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n ot p a i d f o r b y t hee 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 whef r a n i n v o i c ehas b e e n r e c e i v e d .

Pag e ~-o f~-( t o t 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 l y w i t h whom t h e c a n d i d a t e ' s c o mmi t t e e ha s e n t e r e d i n t o a c o n t r a c t dung 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 ma n c e . E nt e r t h e name o f t he c o n s u l t a n t who p r o v i d e s o r p r o c ur e s s e r v i c e s f o r i t e ms s u c h as a dv 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 , manag i n g , o ro r g a n i z i n g s e r v i c e s . Re p o r t o n Sc h e d u l e G t h e n a t u r e o f p e r f o r ma n c e an d t h e e s t i ma t e d p e r f o r ma 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 .

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FORI N ST RU CT I ON S, SEEBACKOF FORM

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