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DI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( M u s t b e st Y ) Cr + ? ,

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C a n d i d r a h e ( 2 ) a f a i m d d o PAC ( 3 ) 6 1 MPnhp ( 4 ) Ca + n b &o d C A j Wj f t f A( 3 ) Ca r + 4 r PAi c ( e ) a . a k mmf r nddmCOr mY l b o ( 7 ) C o u n g i K : q d r wa h Comr ades( e ) s u p w g r i t o r

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1 3A~ ozDATE SI GNED-POMNUS Duo F o r L a t h F l i e d Rspo r f Rang * t r o m $ 1 0 t o $ 1 0 0

9 1 4 BACKAND COMPL EE T 1 4E FOL LOMNO SENTENCE :

J AN 1 7 2 0 0 2

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1 +I AMF I L I NGA

0 1

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t J o .

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( r e p o r t d a t e )OCHECK I F AMENDMENT TO REPORT DATED

OChe c k 0 t h i s i s I t n a t ( l e r m ( n a d o n ) r e p o r t a n d a t t a c h Nodoe o f D i s s o l u t i o n Fo r mOR- 3 .( Yo u must c on f i r m t o f i l e r e p o r t s u n t i l a N o t i o n o f O l s s o f u f i o n I s t i l e d . )

STATEMENT OF CASHONHANDCASHONHAND c t h e b e g i n n i n g o f t o r o p o r t h r 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 v i e s h e l d b y t h e c o r n n r l t t e e . I b i s smount MUST b e t h es ame a t h e c a s h o n h a n d a t t h e a n d o f f i r s t e s t r e po r " p e r i o d .o r mu t t b e z e r o I f t h i s i s d i e t r e p o r t I i l e d . ) . . . . . . . . . , . . . . . . . . . . . . . . . . . - . . . - . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S

DR-2 as c i os ui m( Re v . 0 2 r tM

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L o a d Ca f n l e n s . e i a - Owo f E l e c t i o nCou* a Lo t h Co r m" We s , emr c o v * I nw h i c h E b e t i o n WhW

' 7 33 4- 82.


2/8

FOR' I I " ST RUCT I ONS , SEEBACK OF FORM

DI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e s ame

St a t eme n t o f Or g a n i z a Bo n )

I ' n e r ~ ' Z Fo r e p r e s e a r 4 - o _ 4 r o t ,I 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 . 0( 1 ) S t a t e w i d e / L e g i s l a t 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 ( 4 ) 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 ( 8 ) 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 sSI GNATUREOF TREASURER ( 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 GNED

SEE I NSTRUCTI ONS ON BACK ANDCOMPL ETE THE FOL LOWI NGSENTENCE :

J A N 1 7 2 0 0 2

I AM FI L I NG A

Q( j Cu& i - 3 1 ~

-

000

REPORT FORAWA( 1 ) ELECT I ON / ( 2 ) NON- EL E

I ON YEAR.

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

I n d i c a t e o n e 1 0

OCHECK I F AMENDMENT TO REPORT DATED

Pen al t i e s Due Fo r L a t e F i l e d Rep o r t s Ra n g e f r o m $ 1 0 t o $ 4 0 0

pCh e c k i f t h i s i s f i n a l ( t e r mi 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 Fo r m DR- 3 .( Yo 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 . )

STATEMENTOF CASHONHANDCASH 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 a m o u n t MUST b e t h e

s ame a s t h e c a s h o n ha 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 m u 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PERI ODS c h e d u l e A : Ca sh 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FORMDR- 2 DI SCLOSURE( R e v 0 2 / 9 6 )REPORTF o r O f f i c e Us e On l yCo mm #I n d e x e d I t 'A u d i t e dC o mp u t e r

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 ommi 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 l

' 7 3 3 4 -8


3/8

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

o n S t a t emen t o f O r g a n i z a t i o n )

r 5

Ta_ i 4 i f - .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 DENTI F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: Se ct i o n 688 . 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 op i e d f 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 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 er 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 es .

SCHEDULEA MONETARY( Re v . 0 2 / 9 6 ) 1

RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNTRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e )NUMBERI D# Se e OSr . 1AbA1 - God 6 o 0 e v t i i r y ) e u 4 - r t i ~ d

c ? 20 0 1 CK#g 0, >) _ __

l o o - 7 W)arke 4 - S- i ~ Ca o . v ) i o l l o - 2 5 $ l C? D aL0 ` 7 / - o f ~nr l b C`I D#CK#

I D#CK#I D#CK#I D#

CK#I D#


4/8


5/8

FOR I NSTRUCTI ONS, SEEBACK OF, . ? M SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 2 / 9 6 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE: FORCONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THEDESI GNATED COLUMN AND THE QQ CHECK THI S BOX I FPACCHECK NUMBER F OR EACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCL OSURE BOARD.COMMI TTEE NAME ( Mu s t b e s ame a s t e me n t o f O r g a n i z a t i o n )

f f ~ e r+Z C01 r leP r e s t A . 4 CL- A . v e .CANDI DATE NAME AND ADDRESS TOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( Di s b u r s e r n e nQWAS MADE ( CANDI DATES SEE EXPENDEDEXPENDED ( i t a p p l i c a b l e ) BELOWd , ENTER( MM/ DD/ YR) AND PAC 1 , 2 , 3 )CHECK NUMBER

I D# Qwe4- Ie l e ~ h o t i ~ e -Dq - l ( L CS I CK# S 7 Z ) ( s e e a b c j e ( 2 1 S $ ~~35

I D # Iv r r s s u. - O , c r . ~k ~ , d ' ) a v 4 i , b "0 ( p ?. ( o 0 l CK# S Z Z ( 2 0 u " 4 1 Gur h o u s c . ( 3 ) / 000 6 1 )I D# Qwes4 - 1 e 1 t 1 Ol ~ , u e . ( 6 Z0 71 - 1 0 1 CK# ~Z 3 ( s e c c t b o o e - ) ( 2 , 3 ) 2 3 ( 0I D# l *wo ~ c s r Y1 e ~ - 2 - ~c ~m~K

0? l ? 0 1 CK# SZ 4 1 0 0 2 - 7D' L * ' / Q0 c . &14M S ~ 270~b0 1 - l o s e n J ! ; - 9600 t ' w f h C a r t , k t s ~ l ' o r t e1 D # ~ o l o r e s MLr - TL~ ~ I [ . C 4 i h l D U V f G0 ' 1 1 ~ 0 1 CK#e2 (Wabooe - ~m,~~33321m t e t l + i u - C ' S ~ o

I D# -~ l OV l ~ e ~ i n b u v s e , l ~ ' rf ! S / ~t , r - ~ h r m l %o ( 3 / ~


6/8

FOR I NSTRUCT I ONS, SEE BACK OF , , RMEXPENDI TURES - - MONEYSPENT FROMCOMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CON TRI BUT I ON S MADE TO STATEWI DE OR LEGI S LAT I V ECANDI DATES . L I ST T HE CANDI DATE I DENT I F I C AT I ON NUMBER I N THE DESI GNATED COLUMN AND T HEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWAETHI C S 3 CAMPAI GNDI SC LOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a

s o n S t a t e me n t o f Or g a ni z a t i on )M2t +, t ~r7i 1Ort S eA, l 4"GL1 - 1 L ) ( ! -

SCHEDULEB MONETARY

( R ev . 0 2 / 9 6 ) 1

EXPENDI TURES

QCHECK THI S BOX I FAMENDI NG FORM

CANDI DATE NAME ANDADDRESS TOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( D i s b u r s e r n e n t ) WAS MADE ( CANDI DATES SEE EXPENDEDEXPENDED ( i f a p p l i c a b l e ) BELOW& ENTER( MM/ DD/ YR ) ANDPAC 1 , 2 , 3 )CHECK NUMBERI D# I V' u nn aA . r n . / d I J t ~ At Qi l + oa . r

6 16 2 3 0 1 CK# SrZ$ - 0 ( 0 1 l eu e , ( . 3)i as a - Sr0 32I D# "( ~ ov e r u o r ' S O u t o f " i l embe r 4" ) , p082301 co $ ~ ~ww ~ , / ( 3 ) c a/ DOD( s e e - a l o o o e )

I D# i w ) o v e sMe r +z f - ~ c + e 1 ' . t x ~ " ' ~ wbt i 1 30 1 CK# 5 - 30 ( s e e abo , ) 2 . ~ ,f ~ o l ~ ' c y ( 3 ) l ( p 0

D# l ~ ~ l o~ Ps 1 ` f Yl e ~ - f z P l o . t i r e , i 1 LI L ~ efOc t 130 1 CK# fS31 ( s ee Ci / _K 7 C t ) e) COU I U 0 " I 0 ~s j a 4e goo ( 3 )

7

I D# l 1 l o v es W)eYf 2 PY1Pu I s( ~' 1 3d i cK#S32 See ab o o f

~ s l a ~C - x c h u r ~ j G . 3 ) / 0 5

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7/8

FOR I NSTRUCT I ONS, SEE BACK OF ,RMEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNTSTATE PAC COMMI TTEES : NOTE: FOR CONTR I BUT I ONS MADETO STAT EWI DE OR L EGI S L AT I VECANDI DATES . L I S T T HE CANDI DATE I DENT I F I C AT I ON NUMBER I N T HE DES I GNATED COLUMNAND T HEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWAETHI C S & CAMPAI GN DI S C LOSU RE BOARD.

SCHEDULEB MONETARY( Re v . 0 2 / 9 6 ) I

EXPENDI TURES

QCHECK THI S BOX I FAMENDI NG FORMCOMMI TTEE NAME ( Mu s t b e s , me a s o n S t a t e me n t o f Or g a ni z a t i on )

I ,Ie. 4 - 2 2 , i v r ep f es el vf - ~ - a , ) L , 0c _

CANDI DATE NAME ANDADDRESS TOWHOMEXPENDI TURE PURPOSE AMOUNTDATE I D NUMBER ( Di s b w s e me n q WAS MADE ( CANDI DATES SEE EXPENDEDEXPENDED ( i f a p p l i c a b l e ) BELOW& ENTER( MM/ DD / YR ) AND PAC 1 , 2 , 3 )CHECK NUMBER

I D# t ~ o l v Y r s ~er - I - z , No l e l ~ Amf r , c l i f fl D l ~ UI CK# S3 S - ( S e e Gt bvJ f ( ~ ,- X CG I i rSr e , ( ) $ 77C bu , u c , t7- I D#

I ( ] I CK# S ~( O ( S e i e Gbo o e ) Wo y f t 4I I CN " "~/ q(I L CI II D# ~1 JOi o i e5 w7l e r - ~ '~b t - e i t A j o t o r n t n , /

f b , i 9 C I CK# S3~ s e e CZ Wc )J e I t i ~ b l " wA o 2 0I . ' c .I D# Gwes - f -

I t s / i 0f CK#


8/8

FOR I NSTRUCTI ONS, SEE BACKOF FORMCOMMI TT EE NAME( Mus t b e same a s

0 Y l eV+Z-t a t e m e n t o f O r g a n i z a t i o n )

NOTE T h i s s c h e d u l e r e p o r t s money l o a n e d t o t h e c ommi t t e e wh i c h i s d e p o s i t e d i n t h e c ommi t t e e a c c o u n t .o ~ +TOTAL UNPAI D LOANS FROM LAST REPORTI NGPERI OD $

4 &- ) C )

PART I - MONETARY LOANS RECEI VED T HI S REPORTI NG PERI OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , mu s t b e s h ow n I f a t h i r d p a r t y i si n v o l v e d I n c l u d e l o a n s f r om c a n d i d a t e ' s p e r s o n al f u n d s. )

TOTAL ( PART 1 )

$

' 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 ommi 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 ema k i n g a c o n t r i b u t i o n t o t h e c ommi t t e e R e l a t i o n s h i p must b e s h ow n t o t h e t h i r d d e g r e e o fc 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 ) ( S e e Pa g e 2 o f f o r m sp 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 same a s c a n d i d a t e , b u t t h e r e i s n o f a mi l i a lr 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 umn wh e n i t a p p l i e s

PART 1 1 - MONETARY LOAN REPAYMENTSMADE_T HI S REPORTI NG PERI OD( L o a n s f o r g i v e n mu s t b e r e p o r t e d o n Sc h e d u l e E - - I n - k i n d C o n t r i b u t i o n s . )

TOTAL CASH REPAYMENTS ( PART 1 1 ) $F r o m Sc h e d u l e F - TOTAL LOANS FORGI VEN

$

TOTAL OUTSTANDI NG LOANS END OF REPORT PERI OD

$

( f o r S ch e d u l e F )

SCHEDULEF LOANS

( R e v 0 2 / 9 6 ) RECEI VED& REPAI DQQ CHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VED( MM/ DD/ YR)

NAME AND ADDRESS OF LENDER( i n c l u d e E n d o r s e r ' s Name, I f A p p l i c a b l e ) RELAT I ONSHI PTO CANDI DATE( I f A p p l i c a b l e ' )

AMOUNTOF LOAN

DATE PAI D( MM/ DDI YR) NAME AND ADDRESS OF LENDER( I n c l u d e E n d o r s e r ' s Name, I f A p p l i c a b l e ) RELAT I ONSH I PTO CANDI DATE'

( I f A p p l i c a b l e )AMOUNTREPAI D

$

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Mertz Dolores__527__scanned

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