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CO i ` A i T TEENAME ( Mu s t e same as o n S t a t e me n t o f Or g a7Z t " ' Cy r 7 o C . - 5I 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 :

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SEE I NSTRUCTI ONS ON BACK AND COMPLETE T HE FOLLOWI NGSENTENCE:I AM F I LI NG A

ASURER ( o r p e r s o n f i l i n g t h i s r e p o r t )Ro ut i ne P e n a l t i e s Due F o r L a t e F i l e d Re p o r t s Range f r o m $ 20 t o $ 8 0 0

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IZf3 r l L ~ ! 9 ^ '~REPORT FORAWA ( 1 ) ELECT I 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 ne -

CCh 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 nd 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 mus 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 KANDCASH 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 o mmi t t e e . T h i s amount MUST b e t h es ame a s t h e c as h o n h a n d a t t h e e i i 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 mus 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 THI S PERI ODSc 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 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 d u l e H : T o t a l Sa 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 ul 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 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o a n Re p a yme n t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASHONHAND 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

UNPA I D BI L LS ( 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 Sc 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 Sc h ed ul e F - A t t a c h Sc h e d u l e F l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES ONLY :CONSUL TANT 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 ) $

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 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

y Z - y v 4 . . . . .

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2/12


3/12

Fo r I n s t e uc t i o n t , See Back o f Fo r mCONTRI BUTI ONS - MONEY TAKEN ) N( I n c l u d k V c a r l 3 d a l s ' s p ~ r s o r t s l t u n * )COMMI TTEENAME ( Mu s t b e s a n s a s o n Sbt e r n s n t o f OT a 1 f z r s e i o n )

d "6&45 ' 0 ! ~ > 7oiCHECK T HI S BOX I FAMENDI NGFORM

SCHEDULEA MONETARY

( Re v . 0 6 4 1 7 ) RECEI PTS

STATE CANDI DATES NOTE: I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OU T ) C A L ACTI ON COMMI TT EE) . US T THE PAC I DENTWI CAT) ONNUMBER AND THE PAC CHECKNUMBER I N THE DESI GNATED COLUMN_ A US T OF I D NUMBERS I S AVNLABLE FROMT HE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 68B . 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 o mme r c i a l p u r p o s e by 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 page 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 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" 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 mus 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 t t y ( b l ) o d r e l a t i v e s ) a n d a" ( r e l a t i v e s b ym 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 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 Page 12- 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 - 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 he d ul e A )

DATE PAC I D NUMBER NAMEAND ADDRESSOF CONTRI BUTOR RELA T I ON S HI P AMOUNT J I FRECEI VED ( i t a p p i l i C a b l e ) TOCANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( 1 f a p p l i c a b l e ) R AINUMBER I NCI D f eCK#

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& - ~2 ~r p ~X~CWCK#. r am ~A 5~7G 5Go 4I D f t _ f FANl ea5SA5~ 5 ~ ,V A ( / ~ y daI D # S f L N U 4 f fCK# p o d y d 9 / ~ Up1 D t tCK# f SZ8d3


4/12

F o r I n s t t ' u c t i o n d , Se e B a c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN r t d( f n d u A r q e a r l d d r l s ' s o a wr y t A n d s )COMMI TTEE NAME ( M u s t b e s a n s a s o n S t a t e m e n t o f O r g a r & a d o n )

, ' 1~~l r , e 1 70 _WYa CHECK T HI S BOX I FAMENDI NG F ORM

SCHEDULEA MONETARY( R e v . O t f l t : T ) RECEI PTS

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATEPAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THEPAC I DENTI F I CA TI ONLI MBER AND THEPAC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I STOFONUMBERS I S AVA I L ABLEFROM THE I OWA ETHI CS AND CAMPA I GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 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 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 k l c a l c o mm i 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 t 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 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" ( r e l a t i v e s b yma r r i a g e ) ( S e e Pa g e 2 o 1 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 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 . ( f o r S c h e d u l e A )P a g e -3o f 9

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i f a p p l l c a d e ) TO CANDI DATE' RECEI VED FUN( MMI DD/ YR) AND PAC CHECK O f a p p l i c a b l e ) RAI SNUMBER I NCt 0 #CK# Sz a f 0 - ~I D #CK#I D # Sv f ~ , q - M~ f a 7~ ~CK# 7 1 ` r ~ . ~Gc ~ ' ~ _ a v d? ~d 3I D#CKN

- SZ ~ Z z - ~ J " 0 6CK# / Od G c . ) 7x 7705 z a dI D# 1 9 S e - o ~Ei r fCK#

PAW AZge3I D# k - - ~ I G>NW,"4CK# 27 / ` 7 r 7 L - 6 U < GI D#CK# ~ fy5Z l +U , -r ~ ~x lI D #CK# a ~ 0 ~N~Ej Z~G~I D #CK# 6 _ q ( GO - ~ 5 v e ~t 7 J, # S Z - $ 6 - 3 0


5/12

F o r I n s t e u c t i o n i t , Se e Ba c k o f F o r mCONTR I BUT I ONS - MONEY TAKEN I N( l n c k r d i n p c r n d i d w e * 8 0 r r A n d *COMMI TT EE NAME ( M u s t b e s a n s a s o n S t n t e m s n t o f O r g s n f z s f i o n )

S U B - T O T A LT O T A L ( I f l a s t p a g e o f r h I ss c h o d d l e )

CHECK T HI S BOXI FAMENDI NGFORM

SCHEDULEA MONETARY( Re v . 0 6 I T) RECEI PTS

STATECANDI DATES NOTE: I F ACONTRI B U T I ON I S RECEI VED FROMASTATE PAC( P OL I T I CA L A CT I ON COMMI TT EE) . L I ST THEPAC I DENT I F I C AT I ONNUMBERANDTHEPAC CHECK NUMBER I N THE DESI GNATEDCOLUMN. A L I ST OF I D NU61BERS I S A VA I L A B L E FROM THE I OWA ETHI CS ANDCAMPA I GNDI S CLO S L I R EHOARD.CAUTI ON : Se c t i o n 6 8B . 3 2A( 6 ) . I o wa Code . p r o h i b i t s t h e us e o f i n f o r ma t i on 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 ont r i b u t i ons o rf or 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 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 .

' Di s c l o s u r e l a w r e q u i r e s c an f 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 r d n b ut i o n t o t h ec o mmi t t e e . Re l a t i o ns h i p m u s t b e shown t o t h e t h i r d d e gr e e o f c on s an gu i n i t y ( Moo d r e l a t h r e s ) a nd a f l t r i l l y ( r e t a t t v e a b y ~ma r r i a ge ) ( S ee P a g e 2 o f f o r ms p a c k e t . ) . I f su r name o f c o n t r i b u t o r I s t h e s ame a s c a nd 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 l i c ab 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 ch e d u l e A)

DATE PACI D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i t a p p l i k a b 1e ) TOCANDI DATE' RECEI VED FUN( MMI DD/ YR) ANDPACCHECK Of a pp l i c ab l e ) RAI SNUMBER I NCO

A 0 I o n Z 7 T 3CK# v5-78o9 ,

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6/12

Fo r I n s t r u c t i o n * , Se e B a c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN . A( 1 n c l u d n 0 C - 1 C l i f f a S P _ 0COMMI TTEE NAME ( M u s t b e s a n s a s o n S t s t e r n e n t o f O r g a n i z e t b n ) 0CHECK T H I S BOX I FA M EN D I N G FORM

SCHEDULEA I MONETARY( R e v . 0 5 4 1 7 ) R EC E I P T S

S T A T E C A ND I D A T E S NOTE I F A C ONT R I B U T I O N I S R EC EI 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 I T T E E ) , L I S T T H E P A C I D E N T I F I C A T I O NNL I MS E R A ND T H E P A C C H E C K N U M B E R I N T H E D ES I GN A T E D C O L U M N . A U S T O F I D N U M S E R S I S A V A I L A B L E F R O M T H E I O WA E T H I C S A ND C A MP A I GND I S C L O S U RE B O A R D .CAUTI 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 m m e r c i a l p u r p o s e ! b y a r r 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 .

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h t d u l t )

' 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" ( r e l a l 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 eI a r r t i f 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 . o f( 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 ONSHI P AMOUNT J I F FRECEI VED ( i f a p p k a b l e ) TO CANDI DATE ' RECE I VED FUN( MMI D D/ Y R) AND PAC CHECK O f a p p l i c a b l e ) RAI SNUMBER I NCO

q/ 1 6 1l o # sCK# ~ I ~ 13 31~r s 7

I c o i ~ ~SC~Na I f G Cr / Z OI D # nCK# Z / ~ , m` Tsy ~ hC~D .s p a odI D # ~ AT c ' T ~ I I i I Z M. t 1 TLCK # f , o3 4 / 1 43 #I D # 4*ue, - s /ZbA0CK # 5?~Jr 16A, v s y 4/Z5z 3 ~ 9 ~ 0I D #CK# Z ' t Z 0 1/ 3 ~ 'y 7 g 1 / Z~03 /04&tI D # ~oS~ P I f ~ ' S U ( , J , Z A D~SCK# y v ~ 7 j 1 ' 1 . 1 u .

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CK # ~ I 1 - 7 00 5Z i t J D ~ ` ~ -~fI D # ?AYj PCK# ; 7 _ / : 3 S G c s r G y N A )a t . l l r ' _ . Z 1 3 e ' 1 " 7 0 Z ~O~ r a Z JI D # c T C ' # N 3 c " g e l l C -CK # 6 Z / C, P


7/12

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 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 EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)

L - 2 - 10, 45 t t - e r , 77-4SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) I RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED F ROM A STATE PAC ( P O L 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 L I S T OF I D NUMBERS I S A VA I L A B L E F ROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 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 and 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 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 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 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 - i b u t i o n t o t h ec o mm 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 yma r r i a g e ) ( S e 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 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 ( f o r S ch e du l e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED F UN( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D # / q c . y r c ~ EwC~n -CK#

_70 / ~ - ~~ I - ~ L L~7 c J l 4 Tz G~ l 0~~ c ~z v r 1

I D# Svr ~hC ~ f i l v c J~l c , ~ . c ~ ` ~~375 pT/ da

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I D#CK# y C? 2/ / CCGe v l ' ?1Zl l O' JD#CK# w r y 0 A1 e V" , Vk , ~ l zP 5 / ( A d e v u S v ~3 / `ro. . c r Z ~-I D # ~ ~ ~~ ~l ~Cl 1a~~. L ~ L ~ CV 9 LCJ ~ i t i G~ t G/ l ` ~ J " L 2 rCK# 5 ~10 ~ l 3 a Z L ? ~ r ~ f J Z. VP ~ t / E 7 ?I D # &U7G ~OGG~A L c 1 f ~

-1 D # ( p o ' 7 "c s t u r f - ~ i ? L ' S~ , 4sSC?e/ 5V/ 4 17 ' e v - S7 STi ~ 7~CK# C~ G )

c K# l y 5 ` 1 ~ 07f / s ' T ST , t ~ ' ~ ' ' ` 1CvI D # 0 I ) ( , l r w / t , ~ / 7 s C i v i l > ~ ~~ r . 1 s F n Zs

v 2 S 3 c ) ' R e - 5 A - r s o i ; 1, ? 5C1 3o , 2 l o o v ~ f


8/12

' Fo r . I n s t r u c t i o n s , See Back of Form

CONTRI BUTI ONS- MONEYTAKENI 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 TTEENAME( Mu s t be s ame a s on St at ement o f Or g a ni z a t i on )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 )

IRECEI PTS

CHECK T HI S BOX I FAMENDI NGFORM

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM A STATEPAC ( POL I T IC AL ACTI ON COMMI TTEE) . L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PACCHECK NUMBER I N THE DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVA I L ABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI 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 or ma t i on c op i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c ont r i b ut i on s o rf 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 c ommi t t e e s .

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i ss c he 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 nd 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 ny 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 ommi t t e e R e l a t i o n s h i p mus t b e s hown 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 ' ' ]ma r r i a g e) ( Se e P a g e 2 o f f or ms p a ck e t . ) . I f s ur name o f c o n t r i b u t o r i s t h e s ame a s c a nd i d a t e . b ut t h e r e i s no 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 nt 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 c o l u mn . ( f o r Sc h e d u l e A)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a bl e ) RAINUMBER I NCI D # L . V . ~ . F > f ~ , l ~ ~ y; Z - 7 a ; $CK# l ~ ' ~ ' 7 l Z 7 7 ZI D # ~ _ y / j , f t e j7 a 7 t 7 9 y S~ Sr i 3 / 0 00c K# ! l J ~~ ~ ~J Gi ~ j [ 60 9 - o 2 - 0I D #CK# f 3 ` l Z y ( 0 1 5 C i &I D #

5 C ! ` f A. 1 A4 , 9 n ~1 Re ~ ' c w s p ocK# e ( 41 r o ( - e > 7L ocy~ y & r v e .I D # A 1 1 A r c v P- t c ~1CK# ; Z

, 7/ Z + 6 f C7 *, A , ' _ 1 A r z g a 7 0 C~I D # E K ' o r C , P OZ (1AW u vPyC K # 7 l ( f SCo &4N/ f cSHv l z t 7-~ e _L ~CA ~ Z - `1 20 Z I Cv . C/ oI D # Ezes w 1 6 t i , t t G" J. a5 r ~ l Gv C~. c s l 3 ~ ~CK# ' S z f s ~ ~ ~ ~ ; ~ c z iI D # ( w73 ~ To , a4 Pj 7 , , 7 OFCK# , o l e e , ( l ' 1 z ~ 9 D - -, . , 7I D # I c e , I 3 L r C 7 L o G ? c f - e ~7,CK# ~~ l 7 ~ i L E7 ~ / sP/ t v r l z r i ~ ~P UvI D # j p3~3 Gam& P 6 9 L eCK# r / ' I ` 7I 7 / 4_ L % Lf 3pT71ZW

pe-5 . ~ 6- C' 3C~ `. , ' r ~C


9/12

, F o VI n s t r t i c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKENI 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 )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( POL I T I CA L ACTI ON COMMI TTEE) . L I ST THE PAC I DENT I F I CATI ONNUMBER AND THE PACCHECKNUMBER I N THE DESI GNATED COLUMN. A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 686 . 3 2 A( 6 ) , I o wa Code , p r o h i b i t s t h e us e o f i n f o r ma t i o n c op i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns 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 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 p a g e o f t h i ss c h ed u l e )Di s c l o s u r e l aw r e q u i r e s c a nd i d at 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 e

c o mmi 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 ) a n d a f f i n i t y ( r e l a t i v e s b y ~ma r r i a g e) ( Se e Pag e 2 o f f o r ms p a c k e t . ) . I f su r name o f c o n t r i b u t o r i s t h e s ame a s c a nd i d at 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 l i c ab 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 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I F FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DDNR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI ZkC) / G' I D# OLs e_- , L * e R c - e s t - , c ? z ~

CK# J / PT


10/12

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 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 er a o ns / e Ml d e s pmvk f t c o n s u l t i n g , a d v e r t i s h g , t u n d " r a i s l n g . p o t t i n g . me n a g t r t p , 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 Nt n i z e d o nc h e d u l e G b y t h e am o 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 r v 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 ) . )

P a g e - L- o f --

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

FPR I NSTRUCTI ONS SEEBACKOF f 4 SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . OB / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TOSTATEWI DE OR LEGI SLATI VE 0 CHECK THI S BOX I FCANDI DATES . L I ST THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATEDCOLUMN AND THEPAC CHECK NUMBER FOR EACHEXPENDI TURE . A UST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t be 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 )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c e " e ) ( D i s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

I D# ( / , L 1 /. ZAI ~ T ~ ~. Ls r GOD / l 3D. l 1 OCK# I Zr3 Za0

. a 0 $ 3~UG~ ~ ' , ~ r ~CK# I Z l i 1 ~ 3 - z w> Y l f , S = l

I D# / ' ~~ C - r y Gf J l C. 3 v ~ / -~Oj J p r U~CK# l Z` ~ i ~ 3D 1 S` 1

Z1 ~ ~l b fI D# t SSAn ~ j v ~ j Sc . f A ~ ~ ' , c ~ , , c , Z s s l 6 r -CK# ` 0 G / ` ~ / z a a p rf Z ' t l vy jaI D#j y4 4 l Io CK# I f / 7 w - 1 l 3oeT I D# V , f - e j f - o ~I 3 L7 1 5 ~Al ~ - 5 1 1 1 ~ ' h ~ Z E S~ LCK# l I Z- 7 , P h t y ) 0 4I N T ~os y u~

~ I Zv o CK# l 7Rl 3 Ul

I N ~~ y 1 ~ , ~ - A T L+ CK# I Z Gj / 5 / ! 5 wPAO . 2 1 - 1 Sz~~ ~oon - N~ ~~ %~ / , L l 9SUB- TOTAL

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


11/12

I S BOX APPL I 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 o s t i n g 5 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 . )x p e n d i t u r e s t o p e r s o n s t e Mi Me s p r o v i d i n g c o n s u l d n o . a d v e r t l s s l n g . f u n d - r a i s i n g , p o l s n g . ma n a g i n g , o r g a Nz 1 n g s e r v i c e s mus t a t s o b e d e t s l 7 i t e m i s e d o nc h e d u l e G b y t h e am o 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 mad e b y t h e p e r s o r v s n t f 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 C o d e 5 6 . 6 ( 3 ) ( i ) . )

o f

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

FOR I NSTRUCTI ONS, SEE SACKOF f W SCHEDULEEXPENDI TURES - MONEY SPENT FROMCOMMRTEEACCOUNT B MONETARY( Re v . o e t s 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE CHECK T HI S BOX I FCANDI DATES . L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AN D THEPAC CHECK NUMBER FOREACH EXPENDI TURE . A UST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS d CAMPA I GN DI SCLOSURE BOARD .CO I TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g an i z a t i o n)

7 7 `Z7l ~, & -r o& .~ e? , ' Jn f -CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI 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/ DDI YR) AND PACCHECKNUMBERI D# 7 ~ 7 - 7 , L Uu ~ c i a f LC 1/ 3 r %l 7Z65v 3 5 - 7 1 1CK# ~ f cg CUA-G~77 l l ~ ~~OTJ IZZLI D# f a r : , v

I G 6 1 CK# Z0vo l b- 1 1 1 I ds h rZ F e l l - SSL4 r v0 L " 1 l ~ , I r Gp _ 3 S_ c n~ C ~ J / c , I D# " 7 , 0 7 1 , 1 u , I ~ i Z h~e~ 7p( ~I J CK# ( 1 - 3 / 55 ) q MGr 1 C' V P1 I 1 ' n 2 X15 Gi 7 t : ; A c j - - j t s - A x 5 o ; l o o F k t : - l r l co?4. 5 Z . z

1 I I G,I D# 1 ~ ' 4 r Z7 e , r l ~u ?4 7c K#1 f 3 Z t ; 1 d w3/ .

`f l 1 0

I D# ~ -7 L 1 T L ( X r r g 9 9 v . ZLLOVHkt o Z, v 1 2I c K# 1 1 3 - 3 1 7 , ~ s l ~ t a ~N, ~ s < l 5 0 3 i t ~ ~ r o~- ~ v NI 7 / ~ l I 1 s ; E l z ?761 D#CK#I D#CK#I NCK#

SUB- TOTAL $ ~~TOTAL ( N l a s t p a g e o f t h i s s c h e d u l e ) $ 1 ~ ,


12/12

F , OR r , Y ST R L J O TK 7 W$ SEEBAGCOf " FORb1

COYI A~TTl t NAYS( A l u s r be s r r w a s o n Se Ns n wr r t of Or g w r u a O o n )

s u e - OTOTAL ( I f l a s t

p a g e o f t h i ss c h e d ul e )

SCHEDULE

( Re v .

064E I N KI NDCONTRI BUTI ONS

El CHECK T HI S BOX I FAMENDI NG FORM

' Di s c l o s ur e l a w r e q ui r e s c a nd i d at e s w d i s cl os 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(o f-~c o mmi t t e e . Re l at i o ns h i p must b e shown t o t h e t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o od r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s ( f o r Sc h e d u l e E)by ma r r i a g e) . ( Se e Pa g e 2 o f t o me s p ac 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 same a s c a nd i d at e . bu t t h e r e i s n of a r r a l i a l r e l a t i o n s h i p , e nt e r ' n o t a pp l i c ab 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/ YR)

NAMEANDADDRESSOF CONTRI BUTOR

RELATI ONSHI PTOCANDI DATE

( i t a pp k ab l e )DESCRI PTI ONOF I N KI ND

CONTRI BUTI ONESTI MATED

F AI R MARKETVALUE

J I F FORFUND- RAI SERCONTRI BUTI ON

I S O . ~ - ~ ~t

y 3 ~.

T TAL e

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