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DI SCLOSURE SUMMARY PAGE

TTEE NAME ( Mu s tb e s ame as o n S t a t eme n to f Or g a n i z a d c

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NSTRUCTI ONSON BACK AND COMPL ETE THE FOLL OWI NG SENTENCE :

L I NGA ! "" 7_006 REPORT FOR AN/ A( 1 )ELECTI ON/ ( 2 ) NON- ELECT I ONYEAR .r td a t e ) ) I n d i c a t eon e 0

CK I FAMENDMENT TO REPORT DATED

e c ki ft h i si sf i n a l( t e r mi n a t i o n ) r e po r ta n d a t t a c hN o t i c eo f D i s s o l u t i o nF o rm DR- 3.( Yo umu s t c o n t i n u et o f i l er e p o r t su n t i la N o t i c eo f D i s s o l u t i o ni s f i l e d. )

STATEMENT OF CASHONHAND

ON HAND a t t h eb eg i n n i n go f t h er e po r t i n g p e r i o d. ( T h i si s t h et o t a lo f a l lmon i e s h e l db y t h ec ommi t t e e. T h i samount MUST b e t h es ame a s t h ec a s h on h a nd a t t h e e n d o f t h e l a s tr e p o r t i n gp er i o d ,o r mu s t b ez e r oi ft h i si s f i r s tr e p o r tf i l e d. ) . .. . . . .. . . . . . . .. . . . . .. . . .. . . . . . . . . . . . . . . .. . . .. . . . . . . .. . . . . . . . . . . .. . . .. . . . . . .$

ADD TOTAL MONEY TAKEN I NTHI SPERI ODSc h e d u l eA : Ca s h C o n t r i b u t i o n st o t a l( A t t a c hSc h e d u l eA) . . . . .. . . . .. . . . .. . . . . . . . . .. . . . . . .. . . .. . . . . . .. . . . . .

Sc h e d u l eC : F u n d - r a i s i n gEv e n t s t o t a l( A t t a c hSc h e d u l eC) . . . . . . . . . . . .. . . .. . . . . . . .. . . . . . . . . . . .. .. . . .. . . . . .

Sc h e d u l eF : Loans Re c e i v e dt o t a l( A t t a c hSc h e du l eF ). . . . .. . . . . . . .. . .. . . . . . .. . . . . . . . . . . . . . . .. . . .. . . .. . . . .. . .

Sc h e d u l eH : To t a lS al e s o f Camp a i g n P r o p e r t y ( A t t a c hSc h e du l eH) . . .. . . . . . . .. . . .. . . . . .. . . . . . . . . .. .

( Sc h ed u l eH a p p l i e s t o Ca nd i d a t e s ' _Commi t t e e s On l y )

SUB- TOTAL. . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI OD

Sc h e d u l eB : Ex p e n d i t u r e st o t a l( A t t a c hSc h e du l eB) . . . . . . . . . . . . . .. . .. . . .. . . .. . . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . . .

Sc h e d u l eF : Loan Rep a y men t s t o t a l( A t t a c hSc h e d u l eF ) . . . . .. . . . . . . . . . . .. . . . . .. . . . . .. . .. . . . . . . .. . .. .. . . . . .

L o c a l Commi t t e e s , e nt e r Da t e o f El e c t i o n

Co u n t y& Loca l Commi t t e e s , e nt e r Co u n t y i nwh i c hEl e c t i o ni s h el d

L7 ; g - I ? Ll

4 c )5 . 5

ON HAND a t t h ee nd o f t 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 al a nc e mus tb e z e r o )( A t t a c hDR- 3) . . . . . . .. . . . . . . . . . . .. . . . . .. . .. . . . .. . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . .$ . _

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N DCONTRI BUTI ONS ( F r o mSc h e d u l eE - A t t a c hSc h e d u l eE). . . . . . .. . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . $

TAND I NGLOANS ( F r o mSc h e du l eF - A t t a c hSc h e d u l eF ) . .. . . . . . . . .. . .. . . . . . . . . . . .. . . . . . . . . .. . . . .. . . . . . . . .. . .$

I DATECOMMI TT EES ONLY :

ULTANT BREAKDOWN ( Sc h e du l eG At t a c h e d? ) YES NO

EOF CAMPAI GN PROPERTY ( F r o m Sc h e du l eH - A t t a c hSc h e d u l eH) $

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CAUT I ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,I o w aCode ,p r o h i b i t st h eu s e o fi n f o r m a t i o nc o p i e d f r o mr e p o r t san d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yc o mme r c i a lp ur p o s e b y a nyp e r s o no t h e rt h a ns t a t u t o r yp o l i t i c a lc o m m i t t e e s.

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o m m i t t e e st od i s c l o s et h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga c o n t r i b u t i o nt o t h ec o m m i t t e e. R e l a t i o n s h i pm u s tb e s h o wnt o t h et h i r dd e g r e eo fc o n s a n g u i n i t y( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb ym a r r i a g e )( S e eP a g e2 o ff o r m sp a c k e t. ). I fs u r n ameo fc o n t r i b u t o ri st h es ame a s c a n d i d a t e ,b u tt h e r ei sn o Pag e~_ o ff 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 ta 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 pc o l u mn. ( f o rSc h e d u l e4 A

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