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- OR I NSTRUCTI ONS,SEE BACK OFF ' M

DI SCLOSURE SUMMARY PAGE

COMMI TTEENAME ( Mu s tb e s a me a s o n St a t emen t o fOr g a ni z

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o fa l lmo n i e sh e l db yt h ec o m m i t t e e. T h i samoun tMUSTb e t h e ~s ame a s t h ec a s ho n h a n da t t h ee n do f t h el a s tr e p o r t i n gp e r i o d ,S 1 ~ o fo rmu s tb e z e r oi ft h i si s f i r s tr e p o r tf i l e d. , $ADD TOTALMONEY TAKENI NTHI SPERI OD . r ,S c h e d u l eA: CashC o n t r i b u t i o n st o t a l( A t t a c hS c h e d u l eA) . . .. .. .. . . .. ... .. .

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S c h e d u l eF: L o a n sRe c e i v e dt o t a l( A t t a c hS c h e d u l eF ) . . . . .. .. .. .. . . . .. .. .. .. .. . . . . . . . . . . .. .. . . . .. . . . . . . . .. ..S c h e d u l eH: To t a lSa l e so fCampa i gn P r o p e r t y( A t t a c hS c h e d u l eH) .. .. . . .. . . . . . . . . . . . . . .. . . . . .. . . . ..

( S c h e d u l eH a p p l i e st oCa n d i d a t e s 'Commi t t e e sOn l y )

SUB- TOTAL. .. . ..$

SUBTRACTTOTALMONEYSPENTTHI SPERI ODS c h e d u l eB : E x p e n d i t u r e st o t a l( A t t a c hS c h e d u l eB ) . . . . . .. . . . .5 1. e .S c h e d u l eF: L o a nRep a y men t st o t a l( A t t a c hS c h e d u l eF ) . .. . . .. . . . . . .. ... .. . . . . .. .. .. . .. .. ... .. .. .. .. .. ... .

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e n do ft h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a n c em u s t

b e z e r o )( A t t a c hD R - 3 ). .. .. . . . .. . . . . . . .. .. ... .. .. .. . . . . . . . . . . . . . . . . . . . .. . . .. .. .. . .. .. .. .. .. . . ... . . . . .. .. .. . .. . . . . . .. .. .. .. ... .. . $

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OUTSTANDI NG LOANS( F r o mS c h e d u l eF -A t t a c hS c h e d u l eF ) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . .. .. .. .. ... . $CANDI DATECOMMI TTEES ONLY:

CONSULTANTBREAKDOWN ( S c h e d u l eG A t t a c h e d ? )

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FORMDR- 2 I DI SCLOSURE( R e v. 0 1 / 9 8 ) REPORT

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CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc an d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s tb e s ame as o n S t a t eme n t o fOr g a n i z a t i o n )

Q' , A ' ,2sw, V _VA,STATE CANDI DATES NOTE : I FA CONTRI BUTI ONI SRECEI VEDFROM A STATE PAC ( POL I T ICALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENTI FI CATI ONNUMBER AND THE PAC CHECK NUMBER I NTHE DESI GNATEDCOLUMN . A L I S TOF I DNUMBERS I SAVAI LABLEFROM THE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

CAUTI ON : Se c t i o n 6 8B . 3 2 A( 6 ) , I o wa C o d e , p r oh i b i t st h e u s e o f i n f o r ma t i o nc op i e d f r o mr e p o r t s a n d s t a t e me n t s f o rs o l i c i t i n gc on t r i b ut i o nso rf o r a n y c omme r c i a l p u r p o s eb 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 yp o l i t i c a lc o mmi t t e e s.

' Di s c l o s u r e l a wr e q u i r e sc an d i d at ec o mmi t t e e st o d i s c l o s et h e r e l a t i o n s h i po f an y r e l a t i v ema k i n g a c o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pmu s t b e s h o w n t o t h e t h i r dd e g r e e o f c on s an g ui n i t y( b l o odr 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 sb yma r r i a g e)( Se e P a g e 2 o f f o r ms p ac ke t. ). I f s u ma me o f c on t r i b u t o ri s t h e s a me as c an di d a t e , b utt h e r e i s n o P a g e I f -f a m i l i a lr e l a t i o n s h i p ,e n t e r " n o tap p l i c ab l e "i n t h e r e l a t i o n s h i pc o l u mn . ( f o rS ch e d u l eA)

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FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TT EE ACCOUNT( Re v. 0 9 / 9 7 ) EXPENDI TURES

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