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FOR I NSTRUCT I ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE

COMMI TTEE NAME( Mus t b e s ame a s o n S t a t e me n t of O r g a n i z a t i o n )

Pe op l e f o r J ud i c i a l Qu al i t y , I n d e p en d e nc e and I n t e g r i t y

CANDI DATE COMMI TT EES ONLY.- 3a

I AM F I L I N G A

OF PERSON FI L I NG REPORT

Oc t o ber1 9 , 2 0 0 4

( r e p o r t d a t e )

CK I F AMENDMENTTOREPORT DATED 1 0- 1 9 - 0 4

Chec 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 an d a t t a c h N o t i c e of D i s s o l u t i o n Fo r m D R - 3 ,( Y o u must c o n t i n u e 4 o f i l e r e p o r t s u n t i l a DR- 3 1 s f i l e d . )

I MPORTANT : I n d i c a t e b y # t y p e o 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 l d e t 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 PAC ( 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 C o m m 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 PAC ( 9 ) C i t y PAC ( 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 l

S u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u e

T l i t i c a l P a r t y ( i f a p p l i c a b l e )

STATEMENTOFCASHONHAND

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 o t a l o f a l l f u n d s h e l d b y t h e

c o mmi t t e e . T h i s amount MUST b e t h e same a s t h e c a s h o n h a n d a t t h e en d

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FORM

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p e n a l t i e s .

1 0 - 3 9 - 0 4

DATE S I GNED

REPORT FOR ( 1 ) ELECT I ON 1 ( 2 ) NON- EL ECT I ON YEAR .I n d i c a t e b y # 1

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 n

C 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 n

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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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0

ADD TOTAL MONEYTAKEN I N T HI S PER I OD,

Sc 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 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 ) . . . . . . . 4 , 6 1 5 . 0 0

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 ) . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

Sc h e d u l e H : T o t a l Sa l e s o f Campa i gn 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 Ha pp l i e s t o C a n d i d a t e s ' gomr t a l _ t t e e r sOn l v )

SUBTRACTTOTAL MONEYSPENT T HI S PER I OD

S 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 Sc h e d u l e B ) ( " ' a l s o see d e b t s an d l o a n s b e l o w ) . , . . 0

Sc h e d u l e F : L o a n Repayment s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

CASH ON HAND a t t h e end of 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 ) . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . , . . . , . . , . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . , . $ 4 , 6 1 5 . 0 0

" UNPAI D BI L L S ( Fr om S c h e d u l e D - A t t a c h Sc h e d u l e D) . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . , . $ 2 0 2 . 8 8

" I N KI ND CONTRI BUT I 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 ) . . . . . . . . . . . . , . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0

" OUTSTANDI NG LOANS ( Fr om Sc h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . , . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . $ 0

CANWATE_COMMI TTEES ONLY :

CONSUL TANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) ©YES 1 7 1 NO

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 ) $ 0



OCT - 1 9 - 2 0 0 4 1 5 : 5 6

Fo r I n s t r u c t i o n s , See Ba c k o f Fo r m

CONTRI 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 h u l a s )

COMMI TTEE NAME ( M u s t b e same a s on S t a t e m e n t o f O r g a n i z a t i o n )

Peop l e f o r J ud i c i a l Qu al i t y I n d e p e nd e n c e and I n t e gr i t y

f o r an y c o mme r c i a l p ur p os 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 .

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SCHEDUL E

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RECEI PTS

CHECK T HI S BOX I F

AMENDI NGFORM

STATECANDI DATES NOTE : I F A CONTR I BUT I ON I SRECEI VED FROMA STATE PAC( P OL I T I CA L ACT I ON COMMI TT EE) . L I S T THEPACI DEMI F I CAT I ON

NVMSER AND THEPACCHECK NUMBER I N THEDESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN

DI 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 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 o n t r i b u t i o n s o r

TOTAL . ( i f l a st page o f t h i s s c h ed u l e )

P . 03/ 09

Di s d oa u r o l aw r e q u i r e s c a n d i d a t e o ommi t t e f t o d i s c l o se 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 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 ) and a f f i n i t y ( r e l a t i v e s by

mar nape) . Ml mSme o f c o n t n 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 no Page 1 o f : 5

f a m i l i a l Mat l o f t h i p , e nt e r ' ? t 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 rSchedul e A)

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR R EL A T I ON SH I P AMOUNT J I F FOR

RECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE" RECEI VED FUND-

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OCT- 19- 2004 1 5 : 5 7

Fo r I n s t r u c t i o n s , Se e Back o f Fo r m

CONTRI 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 t 9 D n e l h i n d s )

COMMI TTEE NAME ( Mus t be same as on S t a t emen t o f O r g a n i z a t i o n )

Peop l e f o r J ud i c i a l Qu a l i t y I n d ep end enc e and I n t e g r i t y

STATECANDI DATES NOTE I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( POL I T I CAL ACT I ON COMMf T TI + E) , L I S T ' HE PAC; C I E N T I F I C A T I O NNUMBER AND THEPACCHECK NUMBER I N THEDESI GNATED COL UMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE : OWA ETHI CS AND CAMPAI GN

DI SCLOSURE HOARD.

CAUT I ON : S e t d 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 o p i e d f r o m r e p o r t s and s t a t e m e n t s f o r s o l i c l i n g c o n t r i b u t i o n s o r

f o r any c omme r c i a l p u r p o s e b y any 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 commi t t e es .

P . 04i 08

SUB- TOTAL

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

' D i s d o s u r a l a w r e q u i r e s wn d l d e l 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 mak i n g a c o n t r i b u t i o n t o meC o m m i t t e e . R e l a V o n s h l p mu s t be S r a * 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 ymama0 ) . " u r h a me 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 o Page 2 o f 5f a m i l i a l I e l a d o r a h l 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 d t e d u i eA)

SCHEDULE

A MONETARY

( R e v . 0 7 1 0 3 ) RECEI PTS

CHECK T HI S BOX 1 F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT t I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-

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OCT - 1 9 - 2 0 0 4 1 5 : 5 7

F o r I n s t r u c t i o n s , See Back o f Fo r m

CONTRI BUT I ONS - MONEY TAKEN I N( I n c l u d i n g c a n d i e a t e ' a per somi f t v t d s )

COMMt 7TEENAME ( M u s t b e same as o n S t a t eme n t o f Or g an i z a t i o n)

Peop l e f o r J u d i c i a l Qual i t y I n d e p e nd e n c e and I n t e g r i t y

SCHEDUL E

A MONETARY

( R e v . 0 V0 3 ) I RECEI PTS

CHECK T HI S BOX 1 5

AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC( POUTI CAL ACT I ON COMMI TT EE) . J S T THE PAC; OENTI F I CAT I ON

NUMBER AND THEPAC CHECK NUMBER I N THEDESI GNATED COLUMN. A L I S T OF 1 0 NUMBERS I S A VA I L A B L E FROMTHE : CwA ETHI C S AND CAMPAI GN

DI SCLOSURE BOARD.

CAUT I ON : S e c t i o n 6 8 8 . 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 o e n s a n d s t a t e m e n t s f o r s o l i c t i n g r o n t f b u t i o n 5 o r

f o r a n y c ommer dal 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 .

P . 0 5 / 0 8

TOTAL ( i f l a s t page o f t h i s s c h e d u l e )

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DATE= PAC I O NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ON SH I P AMOUNT I F FOR

RECEI VED ( i f a p p l i c a b l e ) TOCANDI DAT E' RECEI VED FUND-

( MM/ DDr YR) I AND PACCHECK ( i f a p p l i c a o l e ) RAI S ER

NUMBER I NCOME

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OCT - 1 9 - 2 0 0 4 1 5 : 5 8

Fo r I n s t r u c t i o n s , See Back o f Fo r m

CONTRI BUTI ONS - MONEYTAKEN 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 as 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 )

Pe op l e f o r J u d i c i a l Qu al i t y I n d e p en d e nc e and I n t e g r i t y

Re se t F or m

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TT EE) . USTTHEPAC ; DENTF I CAYI ONNUMBER AND THE PACCHECK NUMBER I N THEDESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I $ AVAI LABLE FROMTHE : CWA ETHI CS AND CAMPAI GN

DI SCLOSURE BOARD .

CAUTI ON: Sec t i on 688 . 3 2A( 5 ) . 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 or mat i on c o pi e d f r o m r e p o r t s and s t a t e m e n t s f a 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 r

f o r an y c o mme r c i a l p u r p o se 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 ommi t t e e s

SUB- TOTAL

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 di d a t e c ommmee s t o d l s d os 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 eCommi t t e e . R e l a t i o n s h i p must ba s h own t o t h e t h i r d d eg f mo 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 Dy

r n a m a g e ) nu r neme a t 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 no Page 4 o f 5f a m i l i a l I r e l a t l o r e t d t i p , er ne r ' no l 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 . ( t a r Sc h e d u l e A)

P . 06 / 0 8

SCHEDULE

A MONETARY

( R e v . 0 7 1 0 3 ) RECEI PTS

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AMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CCNT RI Bt J ' f OR RELAT I ON SH I P AMOUNT " - I F FOR

RECEI VED ( i f ap p l i c " ) TOCANDI DATE" RECEI VED FUND-

( MM/ DOf yR ) ANDPAC CHECK I ( I f a p p l i c a o l e l RAI SER

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OCT - 1 9 - 2 0 0 4 1 5 : 5 8

F o r I n s t r u c t i o n s , See Back o f Fo r m

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f 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 COMTI i t ees .

' D i s c l o s u r e l a w r e q u i r e s c a n di 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 of an y r e l a t i v e ma k i n g a c o n t n b u t i o n l o t h ec ommi t t e e. Re l a b on ah i p must be s h own 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 ) an d a f f i n i t y ( r e l a t i v e s byma r h 4 e ) . I T ' s u r n e me 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 o Page 5 o ff a m i l i a l r B l a t l o f t h i p , en t e r ' no 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 co l umn . ( f o r Sc h e d ul e A)

P 0 7 i 0 8

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( MMI DDI YR) ANDPAC CHECK ( I i a p p l i c a b l e ) RAI SER

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OCT- 19- 2004 1 5 " 58

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COMMI TT EE NAME ( Mu s t b e same 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 )

Pe o p l e f o r J ud i c i a l Qu al i t y , I n d e pe n de n c e & I n t eg r i t y

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 ma 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 new 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 .

DEBTS I OBL I GAT I ONS REMAI NI NG T HI S REPORT I NG PERI OD( DO NOT I NCL UDE L OANS - - SHOWL OANS ON SCHEDUL E F )

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OCT - 1 8 - 2 0 0 4 1 1 : 1 1

FOR I NSTRUCT I ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARYPAGE

COMMI TT EE NAME ( M u s t b e same a s on S t a t e m e n t o f O r g a n i z a t i o n )

1 ~ ( o r 1~ a r t ~, , . O t ~ _ ~ n , ~ , c ~ v . t a ~ \ r t e ~ ~a~ P~ t i > > t a ' < i 1 Q~

I MPORTANT : I n d i c a t e b y S t y p e o f c o mm 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 1 d e l t . e g i s I a t i v e l 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 PAC ( 3 ) S t a t e P a r t y

( 4 ) C o u n t y C e n t n i l C o m m i t t e e ( S ) C o u n t y C a n d i d a t e ( t 3 ) C i t y C a n d i d a t e ( 7 ) S c h oo l B o a r d o r O t h e r

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P . 0 2 / 0 9

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0 i s , c ,

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c o m m i t t e e . T h i s amount MUST b e t h e same a s t h e c a s h o n h a n d a t t h e e n d O

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 rmu s t

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ADD TOTAL MONEYTAKEN I N T HI S PERI OD

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S c h e d u l e F : Loans 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Sc h e d u l e H : T o t a l S a l e s o f Campai gn P r o p e r t y ( A t t a c h S c h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 8 oh e du l e H a p p l i e s t o C a n d i d a t e s ' Comml t t e a yOn l y )

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S c h e d u l e F : L o a n Repayment s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

CASHON HAND a t t h e en d 0 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

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ( )

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OCT- 18 - 2004 1 1 : 1 2

Fo r I n s t r u c t i o n s . Se e Ba c k o f Fo f n

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S T A T E C AN D I D AT E S NUM I F A C ON T R I B U T T O N I S R E CE I V E D F R O M 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 M M R T E E I U S T T H E P A C I D E N T I F I C A T I O NN U M B E R A N D T H E P A C C H E C K N U M B E R I N T H E D E S I G N A T ED C O L U M N _ A L I S T OF I D N U M B E R S I S A V AI L A B L E F R O M T H E I O WA E T I 1 1 0 8 A N D C A MP A I G N

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DI SCLOSURE BOARD.

CAUT I ON : S e c t i o n 68B_W( 6 ) . I o wa Co d e , p r o h t b i b 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 and 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 r

f o r any c o mme r c i a l p u r p o s e b y any 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 Commi t t e e s .

e Dh d a s t x e l a w r e q u i r e c e r l a i e a r e o o mm i t t e e a t o d i e dw t h e m i a b o n s h l p o f a n y m l a d v e m a k i n g a c o n t r t b u d o n t o t h e

Oomer uae!l at i onshi pm u s t b e s h o wn t o g o t h i r d deem o f c o n s a m u k d t y ( b l o o d r n l a t t v m ) and a f f i n i t y ( r e f a d v e s b y

~ me n t * a mc o n d ' I b u t o r l a 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 o P a g e ' 2 . 7

p p l i a b b ' 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 NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FOR

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OCT- 18 - 2004 1 1 : 1 2

Fo r I n s t n t c t i o n s , See Back o f Fo r m

CONTRI BUTI ONS - - MONEYTAKEN I N

( I n d u O i n g c o n d i d a t w e p e r s o n a l h e r d s )

COMMI TTEENAME ( Mu s t be s ame a s on Sf a f e t wn t o f O r g a n i z a t i o n )

STATE CAPOI DATES NOTE I F A COWFJWnON 1 3 RECEI VED FROM A STATE PAC ( P OL I T I C AL AC T I ON CBMMr r r E E ) . L I S T TH E PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER, I N THE DES I 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 .

SUB- TOTAL


S

P . 05/ 09

CAUT I ON : S e c t i o n 6 8 B . 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 m a t i o n c o p i e d f r o m r e p ORS 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 r

f o r a n y c o r r v n e r d 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 .

" Ol s d o mm l a w r e q u i r e s mr d d i f t c omr d 2 s a t o d i s d o d s t h e r e l a d o n a f t i p a a n y r emve ma k i n g a c o n t r i b u t i o n t o t h e

c o mm i t t e e . R 4 I 0 1 l o n e h i p m u s t b s a f w wn l o g o 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 d r o f 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

t a mtuwM) . Wwj f t M a s c a n d i d a t e , b u t

b M o I t a h y p , e n t e r ' t t o t a p p o = b b ~ i n f t r e l a t i o n s h i pc

Owe t o n o Page( f o r S c h e d u l e A )

SCHEDULE

A MONETARY

( Re v . 0 7 1 0 3 ) RECEI PTS

Q CHECK T HI S BOX I F

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DATE PAC 1 0 NUMBER NAME ANDADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT , I I F FORRECEI VED ( i f . a p p l k a D i e ) TO CANDI DATE' RECEI V ED FUND-

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Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r m

CONTRI BUTI ONS - - MONEYTAKEN I N( I n d u d Y q c a n 0 ~ 1 a a p a a o n a l f u n d s )

COMMI TTEE NAME ( Mu s t b e s a me 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 )

J

SCHEDULE

A I MONETARY( R e v . 0 7 1 0 3 ) I RECEI PTS

P . 0 6 / 0 9

0CHECK T H I S BOX I FAMENDI NG FORM

STATE CANx t ?ATES NWE: 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 C L I I I C A L A CT I O N C O MMI T T E E ) , USTTHE PAC I D E N T I F I C A T I O NNUMBER ANDTHE PAC CHECK NUMBM I N T HE D E S I G N A T E D COLUMN. A L I S T Of I D NUMBERS I S A V AI L A B L E FROMTHE I O WA E T HI C S ANDC A MP A I G NO I S C L O St s t E BOARD .CAUTI ON: Se ct i o n 6 8 8_ 3 2 A( 6 ) , I o wa Code , p r o hi b i b 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 r

f o r a ny c omme r c i a l p u r p o s e b y any 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 .

SUB- TOTAL

TOTAL ( i f l a s t page o f t h / s s c h e du l e )

' DWoa" l a wmq u l r s a c wr Q i d a t e c or w r i f e a t o d e d o e e t h e ml a t b r wh l p o f an y mWov e mak i n g a o o n v i b u C i o n t o Vv

o o mm1 t t a e ~ Re l a do n a t o p mus t b e g r o wn t o f t t h i r d c h ai s e dc o r o a n g u l n i t y ( b l o o d r t a a 0 v e s ) a n d a f i l y ( r e t a t i v m b y e7

n u r r t r a b e ) . Ku a f l s me o f c o n e bAor I s We s a n e a s t ~ u 0d at e , b u t t h e r e I s n o P a g e o f

f a mi l l d r e l s t b f o l l p . e i d e r ' t a t a p p 8 r a b b ' I n t h e r e l a t i o n s h i p c o l u mn .( f a S c f l e d u f eA)

DATE P AC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR

RECEI VED ( d ap p i a b l e ) TOCANDI DATE' RECEI VED FUND-( MM1DQr YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

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OCT- 18- 2004 1 1 : 1 3

Fo r I n s t r u c t i o n s , Se e B a c k o f F or m

CONTRI BUI TONS- MONEYTAKEN I N

( I n d u l s r q 1 n S r d l t b d s P e r s o n a l h i n d s )

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

STATE CANDI DATES NOTE I F A C ON i R 1 6 UT I ON I S RECEI VED FROM A STATE PAC ( POUTI CALACTI ON COMMI TTEE) . L I S T THE PAC [ D EN n F I C AT I O NNUMI 3 E R ANDTHEPAC t ? E V ( NUMBER I N THE DESI WTED COL UMN . A L I S T OF I D NUMBERS 1 3 A VA I L A S L E FROM THE I OWA E T H I C S AND CAMPAI GN

DI SCLOSURE BOARD .

SUB- TOTAL


' 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 l e a l e m r r > < Y i e e a md i s c l o s e t y r o r e l a t i o r m t r i p o f a n y r e t a i l " m a k i n g a c o n t r i b u o on T O t h e

COMMR e b l b n a h l p m u s t b e s n o r r n t o Me t t * d dogma o r a o n e a r g t i n i t y ( b l o o d r e l a t i v e s ) a n d aM n h y ( mi aCms b y

m a n t s b e ) . I r s w f n * 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 em I s n o Pag e 6 o f

t a m 0 1 e 1 MMCo r f h i p , e nW' n o t a p p i k a b l s ' I n t h e r e l a t l o n s h l p COMM. ( f o r S c h e d u l e A )

P . 0 7 / 09

SCHEDULE

A MONETARY

( R e v . 0 7 1 0 3 ) I RECE I PTS

QCHECK T HI S BOX I FAMENDI NG FORM

CAU T I ON : S e c t i o n 6 8 8 . 3 2 A ( 6 ) , I o w a 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 nd 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 r

f o r a ny c o mme r c i a l p u r p o s e b y 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 .

DATE PAC 1 0 NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELA7 70NSH I P AMOUNT V I F FOR

RECEI VED ( i f a p p i r z b l e ) TO CANDI DATE' RECEI VED F L I N D -

( MM0D I YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ER

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OCT- 18- 2004 11 : 1 4

Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r t h

CONTRI BUTI ONS- MONEYTAKEN I N

( 1 1 c k r d i r r g c a n r s n a o e ' e p e r s o n a l f u n " )

COMMI TT EE 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 )

STATE CANDI DATES MOTS I F A CONTRI OUn ON I S R E CE I V E D FROMA S T A T E P A C I P OU 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 T I F I C AT I O N

NUMBERA ND T HE PACCHECK NUMOR I N T HE D E S I G NA T E D COL UMN . A L I S T OF I D NUMSERS 1 6 A VA I L A B L E FROMT HE I O WA E T H I C S AND C A MP A I G N

D I S C L O S UR E BOARD.

P . 0 9 / 0 9

CAUTI ON : S e c t i o n 6 8 8 . 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 r

f 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- TOTAL

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

" D l a d o s r n l a w r e q u i r e s w t d i d a t a=nn! t o dWMt h e r e l a t i o n s h i p o f a n y mi n c e ma k i n g a o o n t r i t w G o n t o t h e

c a mI n ! t t e a . Rg MdWSWmu l l b e a h o v i " mt h e t h i r d d e g r e e o f w n s a n g l d n i t y ( b k m o d n e l a t l v e s ) a n d s t o n i l y ( r e l a t i v e s b y

ma n f a b a ) . ma n a r n 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 r a t h e r e I s n o p a g e ° f

f amAWr l d a t i o f " I t p , wam ' n o t a p p k a b b ' I n t h e r e l a t ) o n a h l p o d u r n n . ( f a r S c h e d u l eA)

SCHEDULE

A MONETARY

( R e v , 0 7 1 0 3 ) RECEI PTS

C3 CHECKTHI S BOX I F

AMEND I NG FORM

DA TE P AC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FOR

RECENED( MMr DO( YR)

( I f a p p s c a b l e )AND P AC CHECK

TO CANDI DATE '( i f a p p l i c a b l e )

RECEI VED FUND-R A I SER

NUMBER I NCOME

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OCT - 18 - 2004 11 : 1 4 P . 0 91 09

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 m

CONTRI 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 h i n d s )

COMMI TTEE NAME ( Mu s t b e s a me a s o n S t a f e me n t o f O r g a n i z a t i o n )

Re a m F o r m

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 AC T I ON COMMI TTEE) . L I S T THE PAC I D EN T I F I C AT I ON

NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUT I ON : S e 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 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 r

f 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 mm i t t e e s ,

SUB- TOTAL


' D i w J 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 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 mmk t e e . R e 1 a W n a h d p m u s t b e d r 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 ( r e l a t i v e s b ym a n i a b e ) . I f s u r n a m a 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 fN F T A I W WBI b Ml t i p , e n t e r t r 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 )

SCHEDULE

A MONETARY

( R e v . 0 7 1 0 3 ) RECEI PTS

©CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F F ORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MMI DDYR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER

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