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FOR I NSTRUCTI ONS SEE BACK OF F f ' " ' 1 A

DI SCLOSURE SUMMARYPAGE

COMMI TTEENAME

u s t b e s ame a s o n S t a l m e n t o f O r g a n i z a t i o n )

I MPORTANT : I n d i c a t e t y p e o f c o mm i t t e e y ou a r e r e p o r t i n g f o r :

( 1 ) S t a t e w i d e / L e ( y s l a l 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 ( o ) 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 PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e

( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s

SEE I NSTRUCTI ONS ON BACK ANDCOMPLETE THE FOLLOWI NGSENTENCE :

AM FI L I NG A

11 ~ 5 ~ a 1 - -

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

OCHECK I F AMENDMENT TO REPORT DATED

OC 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 Fo r m OR- 3 .( Y o u mu 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 . )

REPORT FOR AN/ A ( 1 ) E LECT I ON / ( 2 ) NON- EL EC

I n d i c a t e o n e 1 9

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 d b y t h e c o mmi t t e e . T h i s am o u n t MUST b e t h e

s a m e a s t h e c a s h o n h a n d a t t h e e n 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADDTOTAL MONEY TAKEN I N T HI S PERI OD

Sc 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FORM

DR- 2DI SCLOSURE( R e v 0 1 / 9 8 )

REPORT

F o r O f f i c e U s e O n l y

Comm a _

I ndexedS0__

A u d i t e d

C o mp u t e r

CL/ - - , i - UJ

SI GNATUREOF TREASU

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 GNED

R o u t i n e P e n a l t i e s Du e F o r L a t e F i l e d R e p o r t s Range f r o m $ 2 0 t o $ 8 0 0J AN 2 2 2 0 0 2

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 n

C o u n t y 8 L o c a l C o mmi t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d



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 -

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 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 Or g a ni z a t i o n)

J

SCHEDULE

A MONETARY

( Re v . 0 6 / 9 7 ) ,

RECFI PTS

CHECK THI S BOX I F

AMENDI NGFORM

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 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 AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON : Se c t i o n 6 8 B . 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 l o r ma t i o n c o pi e d f r o m r e p o r t s a nd 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

f o r any c omme r c i a l p u r p o s e by 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 o mmi t t e e s

DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT v I F FOR

RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOME

I D#

1I ~

c 1CK# a y j At 6 ~I ,

DA-

I D# t o . I A - ) ; R&W. . -

%-: r-- 7 AEaC K# t ( 8

t o _ . _ . ,Ul a . w . Sb 3a

4 4I D# b o ` 3 CJ r , . . , , ~ ' t -r t e~ , , Q1 4 s s o c ~ o J '

s12/

, b , 5. s ' "

o f CK# 8 1 6 - 75o t f 2 -



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

CONTRI BUTI ONS - - MONEY T AKI L . . 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 ds )

COMMI TTEENAME( Mus t be s ame a s o n St at eme n t o f Or g a n i z at i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE) . L I ST THE PAC I DENT I F I CATI ONNUMBER AND THEPACCHECKNUMBER I N THE DESI GNATED COLUMN A L I S T OF l D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON : Se c t i o n 66B . 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 mat i o n c op i e d I 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 on t r i b u t i o ns o r

f 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 .

SCHEDULE

A MONETARY

( Re v 0 6 / 9 7 ) 1

RECEI PTS

CJ CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I F FORRECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f ap p l i c ab l e ) RAI SER

NUMBER I NCOME

/ I Da ( o < l 3 0 t o . $ . . , SAr - t , . A,

CK#i l y06

t . . ~ - 1 0 . . > . 4 s o s o wI Da t e 1 4 1 6 A - s c - - P . 4 C-

R C- 0 t s-

CKN

I Da

b( ~CK# J S- $f 9 a I a s Ye~owr . ~

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10 2. L +b~ I ( . ~o . , , d ~ 1

: ~e i + w , p4c -

CKa ' 1 0 2. 1 c o r ,

( 0I Da ( Qf ~S ~ ( .~r t , A ~4co+ww. . "w~~) k-

CK# - LO- 7O1 / i 1 ~~ . _ . .

I Da



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 O r g a n i z a t i o n )

MONETARY

RECg I PT S

CJ CHECK T HI S BOX I F

AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) . L I S T T HE PA C I D EN T I F I C A T I O NNUMBER AND T HE 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 TH E I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON : S e c t i o n 68 B . 3 2 A ( 6 ) , I o wa Co d e , 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 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 r

f o r an y c o mme r c i a l p u r p o s e b y an y p er 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 I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RE L A T I ONS HI P AMOUNT v I F FOR

RECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOME

-I D# T ~ . ~ . . .

c Ka 3 i l e r0 1 0. 1 ' / " ~ b . wr a + 1 ~, , L . 3 r o 3 0 1 ?

I D # '

r .CK# g 5 _ 5 - e 6 g 1 . 3 0 6_~~

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/ C~ a~ r > ` 6 ~ ~ ' o J - c a m-

I D # ~ 4 - C-

CK# CC.3 o c 1

r~~~~ L~ . s - ° ~I D# o , . . - e . . .

9 a - 8 a a %

I D# ( p 0 &? gc . . . r . . ~. I L ) Gl , CPh A w+ Awr t

I D #

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

ACONYRI BUTI ONS - - MONEYTAKL . . I N

( Re v 0 6 1 9 7 ) 1( 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 )



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

CONTRI BUTI ONS - - MONEY TAKh - . + I N( I n c l u d i n g c an d i d a t e ' s p er s o n a l f u n ds )

COMMI TTEENAME ( Mus t be s ame a s on St at ement o f Or g a n i z a t i o n )

I

G-654-

SCHEDULEA MONETARY

( Re v . 0 5 / 9 7 ) 1

RECEI PTS

CHECK THI S BOX I F

AMENDI NG FORM

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( POL I T ICAL ACTI ON COMMI TTE E) . L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PACCHECKNUMBER I N THE DESI GNATED COLUMN A L I S T OF 1 0 NUMBERS I S A VA I L A B L E FROM THE I OWA ETHI CS ANDCAMPA I GNDI SCL OSURE SOARD-

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 l o r ma l 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 n s o r

f o r any c o mme r c i a l pu r po se 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

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

RECEI VED ( i t ap p l i c ab l e ) TOCANDI DATE' RECEI VED FUND-

( MM/ DD/ YR) ANDPACCHECK ( i f ap p l i c ab l e ) RAI SERNUMBER I NCOME

I D # ( 2 6 33 CA- t c . -_-

Y,CK# 1

1 (. 62-. , . d30

I N i 6 aa? `

l Z ( CK# 1 8O? 4 4G C, "4,4 S. .~t7o7 . . . . ~ - - -

I D #

SR1 ~r , I D # 60 o W) e r ,

Sz l ~ ' 1v . . . . . ~'S:CK# ~' l s '

,w V W r 50301 - r S 3 i l

7 rl 1 9 C K # ` , 3s 19

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~. ~ . s 3 . , c r Z " z1C3

c a f ' . . . . . . 6- M. e

I D #

CK# 3 " f f 3

I D # .



Fo r I n s t r u c t i o n s , Se e 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 f u n d s )

COMMI TTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f Or g a n i z a t i o n )

SCHEDULE

AMONETARY

( R e v , 0 6 / 9 7 )

RECF I PTS

0 CHECK T HI S BOX I F

AMENDI NG FORM

STATECANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ONCOMMI TTEE ) , L I S T THE PAC I DENT I F I CAT I O N

NUMBER AND THEPACCHECKNUMBER I N THEDESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETH I CS AND CAMPAI GNDI SCLOSURE BOARD

CAUTI ON : Se c t i o n 6 8 B . 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 an d s t at 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 an y c o mmer c i a l p u r p os e b y an y p er 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 es

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I F FOR

RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RA I SER

NUMBER I NCOME

CK#7?

I D# b o a 1 8 V a. , .

' ~ ) I J CK#/ 6U'

1 D#Tt J t Z, ~,

1 . 2

i l lCK# 7094 a` ' ! XS 'W ~

L l . I "

I D#

8 6 c ~U CLacK#

` -L

I D# v '

CK#` !

D#

CK#



FOR I NSTRUCT I ONS, SEE BACK OF FORm SCHEDULE

EXPENDI TURESB MONETARY

- - MONEY SPENT FROM COMMI TTEE ACCOUNT( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VEO CHECK T HI S BOX I F

CANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBER FOREACHEXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORM

ETHI CS S CAMPAI GN DI SCLOSURE BOARD

COMMI 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 )0

Ct i

r

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDED

EXPENDED ( 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/ DDNR) AND PAC

CHECK

NUMBER

I D# 3

/ CK# s o 7 ~ ( ~ - ~ $ ~ o ao f

X 7 CK# o .50

-I D#

l X2 8 4o .CK# s o9 e

- 1

_

I D#

/ 9 c K# , y q o a

/ r -

3 6 CK#A) . . , j LL J P. -3' 0LI I

1 D #k-L

.

S



FOR I NSTRUCT I ONS , SEE BACK OF FOFu v l SCHEDULE

EXPENDI T URES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : F OR CONTR I BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VEO CHECK T HI S BOX I F

CANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN ANDTHE

PAC CHECK NUMBER F OR EACH EXPENDI TURE A L I S T OF I DNUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORM

ETHI CS 3 CAMPAI GN DI SCLOSURE BOARD .

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


DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACT I ON ) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE

( MMI DD/ YR) AND PAC

CHECK

NUMBERI D # S. ~ A t GQ . . . . d 7 c . . . .~®" " , . "

K #

I D # u. s .

? , o . l a e ~c o 3 . ¢ . . , : QQ ' ~ ' I r e fZ CK#, ,

I D#

~z CK#

3 /I D #

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CK#SI - 7~ ~ ~ + ~ I y s Y



IFOR I NSTRUCT I ONS , SEEBACK OF FORm SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( R e v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTR I BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VE

CANDI DATES, L I S T T HE CAND I DATE I DEN T I F I CAT I ON NUMBER I N T HE DES I GNATED COLUMN AND THE OCHECK T HI S BOX I F

PAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETH I CS & CAMPA I GN D I SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n )

G f t a 4 c ,CANDI DATE

_

NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPEND I TURE ( DESCRI BE TRANSACT I ON ) EXPENDED


( MMI DD/ YR) AND PAC

CHECK

NUMBER

CK# SI P, -Ca-Ko~ $

~ o L( . l o . . row ~ . . . ~ v - ~ . . ~ . . .

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FOR I NSTRUCTI ONS, SEE BACKOF FOHM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VEO CHECK T HI S BOX I F

CANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBER FOREACH EXPENDI TURE A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORM

t T HI CS 8 CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e 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 )

s r "

CAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED


( MM/ DD/ YR) AND PAC

CHECK

NUMBER

I D#

I D# u - a .

7 /

r 1 , ~ Oa3. "

CK#

I D#

6

533

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FOR I NSTRUCT I ONS, SEE BACK OF FOr I M SCHEDULE

EXPENDI TURES MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VEOCHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORM

ETHI CS & CAMPAI GN DI SCLOSURE BOARD .

COMMI TTEE NAME ( Mu s t b e 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 )


DATE I D NUMBER EXPENDI TURE ( D ESCRI BE TRANSACTI ON) EXPENDED


( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D# 7 1 o _ co- -Q "- - - ~

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FOR I N STRUCT I ONS , SEEBACK OF FORM

T HI S FORM I S USED BYCANDI DATES ' COMMI TTEES ONLY

COMMI TT EE NAME ( M u s t b e s am e 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 )

PART 1 - ONGOI NG I NVENTORY OF CAMPAI GN PROPERTY

PART 1 1 - SALES OR TRANSFERS OF CAMPAI GN PROPERTY

* *

SCHEDULE

H

( R e v . 0 2 / 9 6 )CAMPAI GN

PROPERTY- .

ATTACH SCHEDULE H TOEACH REPORT, MAKI NGCHANGES AS REQU I RED .

pCHECK T HI S BOX I F

AMENDI NG FORM

TOTAL VALUE CAMPAI GN PROPERTY T H I S REPORT

PROPERTY SALES & TRANSFERS TOTAL

TOTALS

$

$

( T RANSFER TO SUMMARY PAGE) $

S00

( TRANSFER T O SUMMARY PAGE) $

* I f e s t i ma t e d , s h o w e s t . b e s i d e f i g u r e .

( A t t a c h A d d i t i o n a l S c h e d u l e s i f N e e d e d )

P a g e

o f

P a g e s

( F o r S c h e d u l e H )

D a t e P u r c h a s e d( S c h e d u l e B )

o r D a t e R e c e i v e d( S c h e d u l e E )MM/ DD/ YR

D e s c r i p t i o n o f P r o p e r t yP u r c h a s e

P r i c e o r E s t .

V a l u e Whe nA c q u i r e d *

C u r r e n tV a l u e a t F a i r

M a r k e t T h i sR e p o r t

w

" ~ 7 7 / Soo-

D a t e( MM/ D D/ Y R)

Name a n d A d d r e s s o f P u r c h a s e r / D o n e e D e s c r i p t i o n o f P r o p e r t y S o l d ?Y I N

S a l eP r i c e

V a l u e o fD o n a t i o n

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Gipp Chuck__586__scanned

Gipp Chuck586scanned