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' FOR I N ST R UC T I ON S, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI 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 t i o n )

Fr t emc~ s a - ' 5 ' t " e v e- 1 ` ' l f lI 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 :( 7 ) 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 P A C ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o m m i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o m m i t t e eCANDI DATE COMMI TT EES ONLY :Ca n d i d a t e Name r JAN ' - 7 L 0 0 - t ) P o l i t i c al P a r t yS~he. y 2 ; ~~~ c cr r - f -O f f i c e S o u g h t ) ~ ^ D i s t r i c t ( i f S e n a t e o r H o u s e )

n 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 D R - 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 . )STATEMENT OF CASH ON HAND

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 l o f a l l mo n i e s h e l db y t h e c o mm i t t e e T h i s a m o u n t MUST b e t h e s ame a s t h e c a s h o n h a n d a t t h e e n do 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $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 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 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 mm i t t e e s O n 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 l o 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 D R- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

* * U N P A I 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $' " ` O UT S T A N D I N G 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 BREAK DOWN ( 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 ) $

FORMDR- 2 D I S C L O S UR E( R e v 0 7 / 2 0 0 3 ) REPORTF o r O f f i c e U s e O n l yComm#~L o g g e d I n S- J &!S c a n n e dC o mp u t e rA u d i t e d

SI GNATURE TREASURER ( 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 S I EDL a t e f i l e d r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l a n d c r i m i n a l p e n a l t i e s

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOL LOWI NG SENTENCE :AM F I L I N G A T Au * 1 - 1 REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) N O N - E L E C T I O N YEAR

( r e p o r t d a t e ) I n d i c a t e o n e[ CHECK I F AMENDMENT TO REPORT DATED L 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

Co u n t y & L o c a l Co mmi t t e e s , e n t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

i J 70 .1 0 - 7 9- 7 1

1 1 . , l q . ~lr

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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 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 TTEE NAME ( Mu 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 t i o n )

F - r i ' - e r i ds o - ~ S4e. ve-M~ Lc de , r -SCHLA( Re v . 0 7 / 0 .

CHEG .AMENDi .

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN_ A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON S e c t i o n 6 8 8 . 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 o rf 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 o mmi t t e e s .

SUB- TOTAL $ 70TOTAL ( l f l a s t p a g e 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 I c 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 wn 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 Wp t i v e s b yma 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 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 pp i i c a * " 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 )

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORECE I VED ( f a p p l i c a b l e ) TOCANDI DATE' RECEI V ED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMI D# ~ua i T ' i 3 e n SOn

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THI S BOX APPLI ES TO CANDI 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 os t i n g $ 5 0 0 o r mo r e must a l s o b e i n v e n t o r i e d o n Sc h ed u l e H . ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s . )E x p en 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 must a l s o b e d e t a i l i t e mi z e d o nSc h e d ul e Gb y t h e amo u n t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x pe nd i t u r e made b y t h e p e r s o n f e n t i t y o n b eh a l f o f t h e c a nd 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 Code 68A . 4 0 2 ( 3 ) ( i ) . )

FOR I NSTRUCTI ONS, SEE BACK OF FORM . d SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TOSTATEWI DEOR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THEDESI GNATEDCOLUMN ANDTHE CHECK THI S BOX I FPAC CHECKNUMBERFOREACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME( Mu s t b e sa me a s on St a t e me n t o f Or g a ni z a t i o n)F r i t , A a , S 6~- e 5 - ~~o

CANDI DATE NAME ANDADDRESS TO WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE( MM/ DDNR) AND PAC

CHECKNUMBERI D# Nt JwSPk ? 4 4y o( - $ %j 4 AwC6

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TOTAL ( i f l a s t page o f t h i s s c hed u l e ) $1078 7 ' } i