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FOR I NSTRUCTI ONS . SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu 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 )C 1 T( 7 t ? r J S G: A e r n 4 Qt 1 AI ZDI MPORTANT : I n d i c a t e 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 :

SI GN

C] CHECK I F AMENDMENT TO REPORT DATED

i t ) S t a t e w i d e / I - e g i s l a O 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 ( 4 ) C o u n t y / L o c a i 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 up p g y t S l a t e o f C a n d i d a t e s

UR F TREASUPO ( o r p er s o n f i l i n g t h i s r e p o r t ) TEL EPHONE DATE SI GNEDR 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 R a n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK ANDCOMPL ETE THE FOL L OWI NGSENTENCE : 4~I AM FI L I NG A D P c e + r l 3 I Z I 9 O REPORT FOR AWA ( 1 ) ELECTI 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 n e P

Ch 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 an 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 F o r mDR- 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 . )

STATEMENT OF CASH ON HANDCASH 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 lo 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 amou n t MUST b e t h esame 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 f a s t r e p o r t i n g p e r i o d ,o r must 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 T HI S PERI ODSc h e d ul 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 Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d ul 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 ul 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 he d ul e H a a o l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e d ul 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 ul e F : Loa n Repa y men t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t t h e e n d 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I ND CONTRI BUTI ONS ( F r o m Sc h e d ul e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG L OANS ( Fr o m Sc h e d ul e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TT EES ONL Y :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 Sc h e d u l e H - A t t a c h Sc h e d u l e H )

SUB- TOTAL . . . . . . S

FORMDR- 2 DI SCLOSURE( Re v . 0 1 / 9 6 ) REPORT

F o r O f f i c e Us e On 1 vCo mm . > sI n d e x e dA u d i t e dCompute

~ 7 , z 1 f ) c 9 1

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 mm i 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

d5. Cs0 1 1 0 " o

a35 7* , ' O O

YES NO

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Fo r I n s t r u c t i on s , Se e Back o f Fo r rCONTRI BUTI ONS - MONEYTAKEN I N

( I n d ud k >I y c Wn d l d e t e ' s p e r s o n a l h i n d s )

COMMI TTEENAME ( Mus t be s ame a s on S t a t emen t o f Or g an i z at i o n )Cr 1 " l u l i l s Fw, 6 wGwo a 6oVSTATE CANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMASTATEPAC( P OL I TI CA L ACT I ONCOMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER ANDTHE PACCHECKNUMBER I N THE DESI GNATED COLUMN . AL I ST OF I D NUMBERS I S AVA I L AB LE FROMTHEI OWA ETHI CS AND CAMPA I GNDI SCL OSURE 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 ma t i on 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 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 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 as t p ag e o f t h i ss c h e du 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 ec o mmi 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 od 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) ( Se e P a g e 2 o f f o r ms p ac k e t . ) . I f s umame 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 er e i s n o P a g ef 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 appl 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 PTS

CHECK T HI S BOXI FAMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FU( MM/ DD/ YR) AND PACCHECK ( i f appl i c ab l e ) RAINUMBER I NCI D*Q~~

/ c o o v nCK# I " I3 1 l

I D # P 1 C, AaV S - 0CK# _ i v " I Mt t " ) CM ,I D# l C, r l o & e , ` ' J ) nv"~l q , I n ( CK# 9 v ~ _ 1 Q~ t a Sv

` 3 f 3 ~ o l I D#c K# ) 0 0 $ p X OL I g Sv sI D#CK# r n v s v i aI D*CK# ~i ' V ~ JU~ N SI D#CK#I D#CK#I D#CK#I D*CK#

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T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEE S ONL Y :P u 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 mus 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 e r s o n s / e n t i f i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g f u n d - r a i s i n g , p o l l i n g . ma n a g i n g , 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 i t e m i z e d o nSc h e d u l e G b y t h e a mo 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 m a d e b y t h e p e r s o N 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 oSc 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 ) ( 1 ) . )

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

FORI NSTRUCTI ONS, SEE BACK OF f t i l SCHEDUL EBEXPENDI TURES MONETARY- MONE Y SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LAT I VE O CHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC 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 FORMETHI CS d CAMPA I GN DI SCLOSURE BOARD .COMMI TTE E 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 )Cl TZFAS f i i ~

CAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I 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/ DD/ YR) AND PACCHECKNUMBERI D # 1 7 - Nx " . , W o " u ' G/ 0 1 CK# f f l - v i g u r ) " V & 1. c r 7 1 0

IN Fw s r N- 9 Ti t r n 9l & I wkp ~ CK#

I D # 0 9 r o s 7 ~ AL SV9 L 7I D , , ~ ~ r 2 ^ i ~~ J ICK#

1 1 i I~I D # ' i j P S - 7 / f l ~ i a ' ) ~ l / l h 7 , ~ ~ ~ ~ a ~ 2 - - - -CK#I D #CK#

CK#I D # F 2 Sf J V A r " I r 0 n a ( d r p - n / < I ( 3 w - A l ~yes

~ .CK#SUB- TOTAL $ r ~ R

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

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T HI S BOX APPLI ES TOCANDI 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 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 S c he 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 e r s o n s i e n d t i s s p r o v i d i n g c o n s u l t i n g . a d v e r t b i r t g , f u n d - r a i s i n g . Pi g. ma n a g i n g . wgwi bV s wv i a s m u s t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e W*^ p u r p o s e . a n d d a t e d s &M t y p e o f e x p e n d h u n m a d e b y 1Mp Ms o n / a r d t y a n b e h a l f d t h e p n d i d a t e ' s Co mmi t t e e . ( R e f e fSc 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 8 . 6 ( 3 ) ( 1 ) . )

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

FORWSTRUCTI ONS . SEEBACKOF FORM SCHEDULEEXPENDI TURES MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . D S / 9 7 ) EXPEI DI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES . L I S T THE CANDI DATE I DENT I F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND THE O CHECK T HI S BOX I FPAC CHECK NUMBER FOREACH EXPENDI TURE . A L I S T OF 1 0 NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORME THI C S & C A MP A I G N DI SCLOSURE BOARDCOMMI 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 )Cr r ~ z ~ n ~ s r 012 01148QUAR- D

DATE CANDI DATE1 0 NUMBER NAME ANDADDRESS TOWHOMEXPENDI TURE

PURPOSE( DE SC RI B E TRANSACTI ON)

AMOUNTEXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Df s b u r s wn n t ) WAS MADE( M MI DOI YR) AND PACCHECKNUMBER

~ / 3 1/ w , 1 D# F11. s ? A/ 4 T1o f l a / Bwgf ko , , 0 6 SO1, ~F; ` n k PeSCK# 3 o o E 'a n a $ 1 . 6 : 3~ ' 1 v SCq - - f y ~. ~Sa76I D# Mi q 1 t : - 1 3 QX6 s r 11 G P~ot o c o p l e SO o? G 7 5CK# 6 0 S

f ~g~0 I D#CK# F l j e STN. AT t o r * I Qt 4 N k .GA~k r e e S 1 . 1 2 S1 D# US, P o 9tAI ~ei evfcL

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1 o # - F ) r s r N 4 v o n a l SAt k // 3 a nI 7 $I J / 3 1 1 0 1 C K 1 11 , 1 3 0 1 0 1 I D# F1 P - ST - I V AT Im18~ e>~~GPs r . ~3

CK#I D# I YI USc 4 r f w Covwy emc r . 4 y &, STl e 1 &vratJ of- ~

0( CK# n1~04~Y 3 1 1 1( ~ f t k &- + 1 2e ~Qt t n g pvM60S 10170 7CAFTAVt . . z~ Sa - 7 6 V

I D#CK#

SUB- TOTAL 05, 8 11TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) $