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7 CT - 1 4 - 2 0 0 4 1G : 4 4

FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCL OSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e same a s o n St a t e me n t o f Or g a n i z a t i o n )De s Mone s Co un t y J o b a n d B u s i n e s s Op p o r t u n i t y P o l i t i c a l Ac t i o n Commi t t e eI MPORTANT : I n d i c a t e b y # t y p e o f c o m( f ) S t a t e w i d e l L e g i s l a t i v e / J u d g e S t a n d i n( 4 ) C o u n t y C e n t r a l Commi t t e e ( 5 ) C o upP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) CoS u b d i v i s i o n PA C ( 1 1 ) L o c a l B a l l o t I s eCANDI DATE COMMI TTEES ONCa n d i d a t e Name

I AM F I L I NG A 1 0 /1 4 / 0 4 DR- 7

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

SI GNATURE OF PERSON F I L I NG REPORT

[ ] CHECK I F AMENDMENT TO REPORT DATED

CHHi 1BEP OF COMf 1EPCE

, R e s e t F d r m'

y o u a r e r e p o r t i n g f o r : 1 2 ,C a n d i d a t e ( 2 ) S t a t e PA C ( 3 ) S t a t e p a r t yn d l d a t e ( 7 ) S c h o o l B o a r d o r O t h e ro a r d o r Ot h e r P o l i t i c a l

TEL EPHONE

Che 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 No 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 DR- 3 i s f i l e d . )

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b eg i n ni n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amo u n t MUST b e t h e s ame a s t h e c a s h o n h a n d a t t h e e n do 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Ca 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 Sc h e d u l e A ) ( ' a l s o s e e I n - k i n d b e l o w) . . . . . . . . . . 8 6 5 . 0 0Sc h e d u l 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 Sc h e d u l e F ) 0Sc h e d u l e H : T o t a l Sa l e s o f Ca mp a i g n Pr o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

( Sc h ed u l e H a pp l i e s t o Ca [ d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . S 8 6 5 . 0 0

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B) ( - ' a l s o s e e d e b t s a n d l o an s b e l o w) . . . . 4 14 , 6 5Sc h e d u l e F : L o a n Re p a y me n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

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 mus t 4 5 0 , 3 5b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

CANDI DATE COMMI TTEES ONL Y :CONSUL TANT BREAKDOWN ( Sc h e d u l e G At t a c he d ?)VALUE OF CAMPAI GN PROPERTY ( F r o m Sc he du l e H - A t t a c h Sc h e d u l e H) $

1 7 1 1 5 752 5454 F . 0 1

FORMDR- 2( Re v 0 7 1 2 0 0 4 )

DI SCL OSUREREPORT

F o r Of f i c e Us e On i vComm, #L o g g e dS c a n n e dCompu t e rA u d i t e d

L a t e r e p or t s a r e s u b j e c t t opo s s i b l e c i v i l a n d c r i mi n a lpe na l t i e s .

REPORT FOR ( 1 ) ELECTI ON 1 ( 2 ) NON- E LECT I ON YEAR .I n d i c a t e b y # d]L o c a l C o mmi t t e e s , e n t e r Da t e o f E l e c t i o n

Co u n t y & L o c a l C o mm i t t e e s , e n t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

0 . 0 0

YES -J NO

" UNPAI D BI L L S ( F r o m Sc h ed u l e D - A t t a ch Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0' I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E- A t t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0" OUTSTANDI NG L OANS ( F r o m Sc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0

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O~ 7 - 1 4 - 2 0 0 4 1 6 : 4 4 CHPNEER OF C OM" I E R CE

F o r I n s t r u c t i o n s , Se e B a c k o f F or mCONTRI BUT I 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)De s Mo i n e s Co un t y J o b O p p o r t u n i t y a n d B u s i n e s s P o l i t i c a l Ac t i o n Commi t t e e

1 7 1 3 7 57 2 6 4 5 4 P . 0 2

STATE CANDI DATES NOTE: I F A CONTRI BUT I ON I S RECE I VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE ) . L I S T THEPAC I DENT I F I CAT IONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GND I SCLOSURE BOARD .CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) . I o wa C o 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 pi 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 nt r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h e 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 .

SUB- TOTAL

TOTAL ( I f l a s t p a g e o f t h i s s c h e d u l e )* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t 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 ny 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 l o n s h l p mu st b e s h own 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 o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b ymama g e ) , I f s u r n a me 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 e r e i s no 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 - no t a p p l i c a b l e " i n t h e r e l a t l o n x h i p c o l u mn .

$ 8 6 5 . 0 0S 8 6 5 . 0 0

1 1of~( f o r S c h e du l e A)

SCHEDUL EA MONETARY

( Re v . 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI 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 ) RAI SER

NUMBER I NCOMEI D# C a r o l H a i n e s $4 0 . 0 00 5 / 0 7 / 0 4 CK# 1 1 3 9 7 Wes t wood h i l l s Dr i v eWe s t B u r l i n g t o n , I o wa 52 6 55I D# Ka r e n Ha l e

5 1 1 8 / 0 4 CK# 2 1 1 9 Hi g h l a n d Avenue 5 0 . 0 0b u r l i n g t o n , I o wa 5 2 6 0 1I D# K e n n i t h As p e l me i r9 / 2 2 1 0 4 CK# P . O . Bo x 4 2 5 4 0 . 0 0Me d i a o l i s , I o wa 5 2 6 3 7I D # U n i t e r n i z e d C o n t r i b u t i o n s 7 3 5 . 0 0CK#

I D#CK#

I D #CK#I D #CK# I~III D#CK#I D9CK#I D#CK#

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r J CT- 1 4 - 2 0 0 4 1 6 : 4 5 CHAf 1EER OF COh i f I ERCE

THI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :

1 . J 1E ^ 52 5 4 P . O-

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 mu s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H . ( R e f e r t o S c 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 t l 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 mu s t a l s o b e d e t a i l i t e mi z e d o nS c 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 made 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 oS c 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 Code 6 8 A . 4 0 2 ( 3 ) ( 1 ) . )

( f o r S c h e d u l e B )TOTAL P . O~

FOR I NSTRUCTI ONS, SEE BACK OF FORM R e ' s e t F i i r i n SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 7 1 0 3 ) EXPENDI TURES

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 CATI ON NUMBER I N THEDESI GNATED COLUMN AND THE CHECKTHI S BOX1 FPAC CHECK NUMBER FOREACH EXPENDI TURE, A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE 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 )De s Mon es Co u n t y J o b Op p o r t u n i t y a n d B u s i n e s s P o l i t i c a l A c t i o n Co mmi t t e e

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI 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( MMI DDr YR) AND PACCHECKNUMBERI D# Co mmi t t e e t o E l e c t Bo b Be c k Camp a i g n c o n t r i b u t i o n0 6 / 0 1 %0 4 CK#39681 1 9 3 7 1 R o o s e v e l t s t r e e t $ 2 0 0 . 0 0D a n v i l l e , I o wa 5 26 23I D # D a v i d M i l l e r f o r S u p e r v i s o r Camp a i g n c o n t r i b u t i o n

0 6 / 0 1 1 0 - 4 CKi 8 9 6 8 2 . 0 . Bo x 7 7 1 200 . 0 0u r l i n g t o n , I A 5 26 01I D# i d we s t On e Bank Ch e c k b o o k0 6 / 1 4 / 0 4 0 BOX 459 1 4 . 6 5CK4Bank Ad j B u r l i n g t o n , I A 52601- 0459I D#CK#I D#CK#I D #C K#I D #CK#D#CK#

SUB- TOTAL $ 4 1 4 , 6 5TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ 4 1 4 . 6 5