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FOR I NSTRUCTI ONS. SEE BACK OF FORM

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rI 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 p o r t i n g f o r :i ) 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 l o e PAC ( 3 ) S t a t e P a r t y ( a ) 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

S I GNA E OF TREASURER ( o r p er s o n f i l i n g t h i s R p o r t ) - TEL EPHONE

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Ro u t 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 Ra n g e f r om $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :

REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR.I n d i c a t e o n e F L I

STATEMENT OF CASH ONHANDCASH 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 l

o f a l l mon i e s h e l d b y t h e c ommi 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 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - - l . . .. . . . l . l . . . . . . . . . 5ADD TOTAL MONEYTAKEN I N THI S PERI ODSc h e du 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 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 S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H : T o t a l S a l e s o f Camp a 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 ed u l e H a p p l i e s t o C a n d i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . . S

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc n e o u l e o t x p e n o l t u r e s t o t a l ( A t t a c n 3 c n e o u l e t i ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . > . . . . . . ~ . . . . . . . . . . . . . . . . . . $CASH ON HAND a t t h e en 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 mu s t ,

UNPAI D BI L L S ( Fr om Sc h e d u l e D - A t t a c h Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - $I N K I ND CONTRI BUTI ONS ( Fr o m Sc h ed u l e E - A t t a c h S c h e d u l e E ) ~J. . ~ . . . . . ~ . ~ . t i.30Q. . . .0~. . . . . . $OUTSTANDI NG LOANS ( Fr om Sc h ed u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

/ 0 - a9- 0 C/DATE S I GNED

L 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

330 CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( Fr om S c h e d u l e H - A t t a c h Sc h e d u l e H) $

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FOR I NSTRUCTI ONS, SEE BACK OF FORMCOMMI T TE E AME ( 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 )

. . S7 i j 1 t ~ l o ~ - t s cSCHEDUL EE I N K I ND( Re v . 0 2 / 9 6 ) 1 CONTRI BUT I ONS

CHECK T HI S BOX I FAMENDI NG FORM

' 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 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 ma k i n g a n i n k i n d c o n t r i b u t i o n t o t h e Pa g e o fc o mmi t t e e . R e l a t i o n s h i p mu st 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 ) an d a f f i n i t y ( r e l a t i v e s ( o r Sc h e d u l e E )b y m a r r i a g e ) . ( S e e Pa g e 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 same a s c a n d i d a t e , b u t t h e r e i s n of 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 .

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I MPORTANT : I n d i c a t e ' t y p o f c o m l r n i t t e e y o u a r e r e p o r t i n g f o r : I Z I( 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 Commi 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

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SEE I NSTRUCT I ONS ON BACK AND COMPL ETE THE FOLLOWI NG SENTENCE :I AM F I L I N G A

pCHECK I F AMENDMENT TO REPORT DATED0 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 F o r m DR- 3( 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 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 m o n i e s h e l d b y t h e c o m m i 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 a s 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 , q Io 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -Tl .

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 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 LOANS ( 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES ONLYCONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE 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 ) $

DI SCLOSURESUMMARYPAGE

- GS-43) c; 2 L PL - - o L / r s - / a - a9 - - aEASURER ( o 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

ADD TOTAL MONEY TAKEN I N T HI S PERI OD

REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .

STATEMENT OF CASH ON HAND

A u d i t e dCo mp u t e r

Pe n a l t i e s Due Fo r La t e F i l e d Re po r t s Ran ge f r o m $ 1 0 t o $ 4 0 0

( r e p o r t d a t e ) I n d i c a t e o n eI Z IL o c a l C o m m i t t e e s , e n t e r D a t e o f E l e c t i o n

C 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

Sc h e d u l eA: 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 Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~S 0 DSc h e d u l e C : F u n d - r a i s i n g Ev e n t s t o t a l ( A t t a c h Sc h e d u l e C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 Ca mp a 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 p l i e s t o Ca n d i d a t e s ' Co mmi t t e es On l y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT 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 m en t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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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 )COMMI TTEE NAME( Mu s t b e same a s o n S t a t eme n t o f Or g an i z a t i o n)BRAUNSFOR STATEHOUSE

R e s e t F or m

SUB- TOTAL- ) V q l * 7 S' , O o

TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )

STATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHEPACCHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t 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 op i ed f r om r e p o r t s an d 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 ns o rf o r an y c omme r c i a l p u r p o s e by 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 ommi 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 commi t t ees 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 any 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 ecommi t t e e . R e l a t i o n s h i p mu s t b e s h own 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 ) an 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 name o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b ut t h e r e i s no Page 1 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 umn . ( f o r Sc h e d u l e A)

SCHEDULEA MONETARY

( Re v . 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

DATE PACI D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D# NF I B I o wa S a f e T r u s t $ 2 5 0 . 0 01 0 - 1 6 - 0 4 CK# 1 2 0 1 F S t NWS t e 3 0 01 1 9 3 4 Wa s h i n g t o n , DC2 0 0 0 4I D# RPI S t a t e A c o u n t1 0 - 2 0 - 0 4 CK# 6 2 1 E 9 t h S t 1 5 5 0 . 0 02 2 1 1 2 Des Mo i n e s , I A 5 0 3 0 9I D# Ra l p h B u s t e r1 0 - 2 0 - 0 4 CK# 1 9 3 5 T r o l l e y Av e 7 5 . 0 0 E]3 5 8 6 Mu s c a t i n e , l A 5 27 61I D# 6 1 2 5 I A R e a l t o r s PAC1 0 - 1 9 - 0 4 CK# 1 3 7 0 NW1 1 4 t h S t , S t e 1 0 0 1 0 0 0 . 0 0 E : 12 4 1 6 C l i v e , 1A5 0 3 2 5I D# 6 1 6 3 I o wa S o f t D r i n k PAC1 0 - 1 8 - 0 4 CK# 8 0 1 G r a n d , S t e 3 1 0 0 1 0 0 0 . 0 02 9 1 1 Des Mo i n e s , I A 5 0 3 0 9

_ I D# S we e t l a n d AG T e c h1 0 - 1 8 - 0 4 C 3 0 9 4 1 7 0 t h S t _ - - - - - " " c a t i n e , I A 5 27 61I D# 6 1 2 5

1 0 - 1 8 - 0 4 YAI .1 3 7 0 NW1 1 4 t h S t 2 0 0 0 . 0 02 4 0 7 O l i v e , 1A5 0 3 2 5

1 0 - 2 3 - 0 41D# J o h n T i l l i e2 1 0 7 D r i v e 5 0 . 0 0 E : 1CK# Fa r eway5 9 9 7 Mu s c a t i n e , I A 5 2 7 6 1I D# C h a r l e s L e wi s1 0 - 2 3 - 0 4 CK# 7 Co l o n y D r i v e 5 0 . 0 05 0 8 0 Mu s c a t i n e , I A 5 2 7 6 1I D# Fa r eway S t o r e s PAC

1 0 - 2 3 - 0 4 CK# 2 6 0 0 E 8 t h S t 1 0 0 . 0 05 0 9 6 B o o n e , I A 6 0 0 3 6

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F p r I n s t r u c t i o n s , Se e Ba c k o f F or 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 EENAME ( Mu s t be same a s o n St a t e me n t o f Or g a ni z a t i o n)BRAUNS FOR STATE HOUSE

R e s e t F or m

STATECANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROM ASTATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I ST THEPAC I DENTI F I CATI ONNUMBER ANDTHEPACCHECK NUMBER I N THEDESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCL OSURE BOARDCAUTI 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 nf o r ma t i o n c op i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c ont r i b ut i o ns o rf o r any 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 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 .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h ed ul e )0

' 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 any 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 ommi t t e e . R e l a t i o n s h i p must b e shown 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 ) and a f f i n i t y ( r e l a t i v e s b y 2ma r r i a g e ) . 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 same as c a n d i d a t e , b ut t h e r e i s no 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 d u l e A)

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 ADDRESSOF CONTRI BUTOR RELAT I ONSH I 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-( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMI D# D a v i s S t a n l e y1 0 - 2 6 - 0 4 CK# 1 1 5 S u n s e t Dr i v e $ 2~~5 4 6 1 Mu s c a t i n e , I A 5 2 7 6 1I D# 1 3 1 3 ~ ~ L e g i s l a t i v e M a j o r i t y Fund1 0 - 2 5 - 0 4 CK# 6 2 1 E 9 t h S t 5 0 0 0 . 0 0 E lT r a n s f e r Des Mo i n e s , I A 5 0 3 0 9I D#CK#I D#

0- I D#

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THI S BOX APPLI ESTOCANDI DATES' COMMI TTEES ONLY:P ur 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 pe nd 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 Gb y t h e amo 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 pe nd i t u r e mad 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 . ( Re f e r t oSc h e d u l e Gi n s t r u c t i o n s a n d I o wa Cod e 6 8A . 4 0 2 ( 3 ) ( i ) . )

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

FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t Fo r m SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TOSTATEWI DEOR L EGI SLAT I V ECANDI DATES, L I S T THECANDI DATE I DENT I F I CATI ON NUMBER I N THEDESI GNATEDCOLUMN ANDTHE D CHECKTHI S BOXI FPACCHECKNUMBER FOREACH EXPENDI TURE . A L I STOF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e sa me a s o n St a t e me n t o f Or g a n i z a t i o n)BRAUNS FORSTATEHOUSE

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( r f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WASMADE( MM/ DDI YR) AND PACCHECKNUMBERI D # Y VEE F o o d S t o r e P i z z a &Po p f o r L i t Dr o p1 0 - 1 6 - 0 4 CK#561 4 0 0 2 n d Av e $ 6 2 . 3 6u s c a t i n e , 1 A 5 2 7 6 1

I D# o s t m a s t e r 5 r o l l s s t a mp s1 0 - 1 6 - 0 4 CKA62 1 0 0 Ceda r S t 1 8 5 . 0 0u s c a t i n e , 1 A 5 2 7 6 1I D# a p p y J o e ' s P i z z a P i z z a f o r L i t Dr o p1 0 - 1 6 - 0 4 0 3 L a k e P a r k B l v d 5 5 . 0 0CK#563 u s c a t i n e , 1 A 5 2 7 6 1I D# WC a b l e Ad s1 0 - 1 8 - 0 4 CK#564 2 0 5 a r t 2 1 5 8 . 6 5u s c a t i n e , 1 A 5 2 2 7 6 1I D # KWPC Ad s1 0 - 1 8 - 0 4 3 2 1 8 Mu l b e r r y Av e 1 1 8 8 . 0 0CK#565 Mu s c a t i n e , I A 5 2 7 6 1I D # CC Ca b l e Ad s

1 0 - 2 1 - 0 4 5 2 C o l o r a d o 1 2 . 0 0CK#5M u s c a t i n e , I A 5 2 7 6 1I D# PW C a b l e Ad s1 0 - 2 4 - 0 4 3 2 0 5 Ceda r S t 3 5 3 0 . 8 0CK#567 u s c a t i n e I A 5 2 7 6 1I D#CK#

SUBTOTAL $ 7 1 9 1 . 8 1TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) $ , ~,

8/7/2019 Brauns Barry__1517__scanned

7/7

FORI NSTRUCTI ONS, SEEBACKOF FORMCOMMI 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 )BRAUNS FORSTATEHOUSE

R e s e t F or m

SUB- TOTAL

TOTAL ( i f l a s tp a g e o f t h i s

s c h e du l e )

SCHEDULEE I I N K I ND

( Re v . 0 6 1 9 7 ) CONTRI BUTI ONS

QCHECKTHI S BOX I FAMENDI NGFORM

' D i s c l o s u r e l a w r e q u i r e s c a nd i d at 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 n i n k i n d c o n t r i b u t i o n t o t h e P a g e 1 o fc 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 gr e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s ( f o r Sc h e d ul e E)b y ma r r i a ge ) . ( Se e P a g e 2 o f f o r ms 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 a m e 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 u mn .

DATERECEI VED( MM/ DD/ Y R) NAME ANDADDRESSOF CONTRI BUTOR

RELATI ONSHI PTO CANDI DATE* ( f a p p l i c a b l e )

DESCRI PTI ONOF I N K I NDCONTRI BUTI ON

ESTI MATEDF AI R MARKETVALUE

I F FORFUND- RAI SERCONTRI BUTI ON

1 0 - 1 8 - 0 4 RP16 2 1 E 9 t h S tDe s Mo i n e s , 1 A 5 0 3 0 9P r i n t i n g S 4 , 0 0 0 . 0 0

1 0 - 1 8 - 0 4 RP16 2 1 E 9 t h S tDes Mo i n e s , 1 A 5 0 3 0 9P o s t a g e 4 , 0 0 0 . 0 0 F

F-1aF-1F -1F-1F -1F - 1F-1