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FOR I NSTRUCTI ONS,SEE BACKOF FORM

DI SCLOSURE SUMMARY PAGEC011 WTTEE NAME ( MW be Same as on SYed aMON d OVe n & a t i m)

F el l o ws f o rS t a t e R c p r e s c n t e s i v e

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CANDI DATECO~I TTEES ONL Y :

Ca n d i d a t eNa me Pol l " P a r t yB r e n t F e l l ow s R bl i c an

O f f i c es o u g h t D i s t r i c t( i tS en a t eo r H o u s e )

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~ n i o nf i l i n gt h i sI s " t ) TE L EPHONE DATE SI GNED

L at e f i l e ds p o r t s e r a s ub j e c tt o p oe s l bl o d o l la n d c r i m i n a l p e n a f t J e s.

SEE I NSTRUCTI ONSON SACK AN COMPL ET E THE F OL l OWI N GSENTENCE:

I AM F I L I NGA O e t o b t r2 6t h ' 2 0 0 0 REPORT FOR ANI A 1 ELECTI ON1( 2) NOM- ELECT10NYEAR .

I n t r i c a t eo n e El( r e p a r td i t t o )

CHECK I FAMENDMENT TO REPORT DATED Nov em b e r2 n d , 2 0 0 4

[ ~C h e c k i t t h i si sf 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 hN o t i c eo f Da a ol u l i o nF a r mDR- 3 .( Y o umus t c o n t i n u eb f i l er e p o r t su n t i la N o t i c e o fDi s s o h l b o ni s I l l e d. )

a r r. mmm"

ST ATEMENT OF CASH ON HAND

~ - 3 1 9 5 a d- 1 r ' 1 1 l 2 ) 1 - ( - Q- 6 4

CASH ON HAND a t t h eb e g i n n i n go ft h er e p o r t i n g p e r i o d. ( T h i si s t h et o t a lo fa l lmo n l o sh e l db y t h ec o mmi t t e e. T h i samou nt MUST b e t h es ame ®s t h ec as h o n h an de t H i se n do f t h ef e a tr e p o r t i n g Pe r i o d , o rmus tb e z e r oi tI NSi s f i r s tr f i l e d.

ADD TOTAL MONEY TAKEN I NT HI SPERI OD

Nov ember 2 n d , 2 0 0 4

S c he d u l eA: C a s h C o n t r i b u t i o n st o t a l( A t t a c hS c he d u l eA ) ( " a l s os e e i n 4 u n db e l o w) 8 7 3 6. 0 0

1 6 0 0. 0 0S c h e d u l eF : L o a n s R e c e i v e dt o t a l( A t t a c hS c he d u l eF ). .. . .. . . . .. . . ... . .

. . . . .. . . . . . . . .. .. . . . . . .. .. .. . . . .. . . ..

S c he d u l eH: T o t a lS al e so f C a mp a i g n P r o p e r t y( A t t a c hS c h e d u l eH ) . . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1 f h s du l a H a o g l l a sb Ca n d i d e I M' CQMWr s s S k I t3 d

SUB- TOTAL.. _ - S 1 1 4 8 1. 7 1

SUBTRACT TOTAL MONE Y SPENT T HI S PERI OD

S c he d u l eB: E x pe n d i t u r e st o t a l( A t t a c hS c h e d u l e8 ) (- a l s oSe e d e b t sa n d b a n s b e l o w). . . .

S c h e d u l eF: L o a nRe p a y r n a n b t o t a l( A t t a c hS c he d u l eF ). .. . . . . . . . . .. .. . . . . . . .. .. . . . . . .. . . . . . . .. .. . . . . . ... . . _ _

7 3 8 5. 5 3

FORM

DR- 2( Re v. 0 7 1 2 0 0 3 )

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S c a n n e d

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Cc s s h t y3 L o c a l C o mn r r o s o s . snw Cowr y t o

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DI SCLOSUREREPORT

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Fo r I n e f o ' t r c t l On a/- ~~~

CONTRI BUTI ONS - MONEY TAI MN I N( I n c k dk Vr b n d l d r l a ' sp e r s o n a l F u n d s )

COI I WI T TE ENAME ( Mu s t b e sa me a s o n Sf a t e r n er r t o f Or g a n a s 6 o n )

F e l l o w sf o rS t a t eR e p r e s e n t a t i v e

ECKLAh=1DPI CTOPS PAGE 0 3

STATE CANDI DATES NOTE : WA CCNMWTI ON I SRECER+FDFROM A STATE PAC ( P( LMCAL ACTI ONCOkWI TTEE) ,UST THE PAC I DENTI FI CATI ONNUMBER AND THE PAC C1 f OI NUMSM e +THE DE9I (: MATED OOLULOLA U6 T OF 1 0 NI LAMERS1 8AVA I L AI K EFROM THE I OWAETHI CHAND CAMPAI GND19MOQi l 1AIPBOARD .

CAUTI ON : Se c t i o n6W . 3 2A( 8 ). I o YaaCode . p r oNbi l s t h eL o s o f i r r b r n wt i o no o pl e df r o mr e p o r t a nd wwn n e n t s f o r s ol d un p aon Wbu dona o rf o r an y o o mma r c i a l p u r p o s eby an y p a r s o no t h e r Ul a n s t a t u t o r yp ot f a l c o r n me l s u s.

SCHEDULE

A( Ro w. e 7 . W)

MONET ARYRECEI PT3

CHECK TWI SBOX I FAMENDI NG FORM

DATE PA C I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I FFORRECEI VED ( i fa p p a o ab l u ) TO CANDI DATE' RECEI VED FUND-

( MMI DD1YR) AND PAC CHECK ( I fa pp l k a bl s ) RAI SERNUMBER I NCOME

I BMR e p u b l i c a nP a r t yo f l o ws

$ 7 5 0 0. 0 01 0 / 2 0 / 2 0 0 4 CK# De s Momes , I o wad ir e c td e p o sit

I p #

Ga l e n a n dJ ams Ec k l a n d1 0 1 2 3 / 2 0 0 4 CK# # 3 Ca r r i a g eGr ams f a mi l y 1 0 0. 0 02410 K e o k u k. I o wa52632

I NJ o h na n dC a r l aDw l a p

1 0 / 2 6 / 0 4 CK# 3 6 75 I o waRoad 50. 0 06 6 7 4 K e o k I o wa 5 26 3 2

I D 1tF l i n t& J u d i t hP e y t o n

1 0 / 2 & 20 0 4 CK# 3307 Mi d d l eRoad 5 0 - 0 0 LLJ4974 K e o k I o wa 5 26 32I DM

DogmaC o f f t e l dl 0/ 2 6 / 2 0 0 4 CK# 1 0 3 1Gr a n dAv e 5 0. 0 0

2876 K o o k u k , l o ws 5 2 6 3 2I DM

b e v e ~l 0 / 2 t ( 2 0 0 4 CK# 3490 AT g y kRoad 2 5. 0 0

3799 k k

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1 1/ 0 8/ 2 00 4 0 0 : 12 31 952 41001

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 m

CONTRI BUTI ONS - MONEY TAKEN I N( I n e l u d k Vc a r d i d a l o ' sp e r e o n a l k i n d s )

COMMI TT EE NAME ( Mu s t b e s ame a s o n S f a f e ma MOf f a n l z a Wn )

F e l l o wsf o rR e pr c s e n t a t i v e

ECKLAND P10TOR5

STATECMI DI DATES NOTE : I FA CONTRI BUTI ON 1 8RECEI VED FROMA STATEPAC ( POL I T I C ALACTI ON COMMI TTEE) , L I S TTHE PAC I D EN TI F I C AT I ON

NUMBER AND THE PAC Cr ECK NUMBER 1 NTHE DE81GNATm COLUMN . A UST OF I DNU MB I SAVA I L A B L EFROM THE I OWAE T HI C SA RI DCAMPA) GN

DI SCL OSURE BOA RD,

PAGE 0 4

CAUTI ON- S ec t i o n 6 86 . 3 2 A ( 6 ) ,l o ws C o d e , p r at i N( s t h e u s e o f h f a ma 6 o n o o p l e d f r o mr e p om a nd s t a t e me n hl f o rs oNc Ong c o n i t Ab u bo n ao r

f o ra n y oomms r da l p u r p o s eb y a n y p e n wn o b e r t h an s t a t u t o r yp o l h l c a lc ommt hmm .

DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RE L AT I ON S HI P AMOUNT I F FOR

RECEI VED ( i fa p p i mb l a ) TO CANDI DATE' RECEI VED FUND-

( MMI DDYR) AND PAC CHECK ( i fa p p l l c a b b) RAI SER

NUMBER I NCOME

I D#Cl y d eM i t c b e l l s 1 0 0 . 0 0

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I D #S t a c y a n d S c l i s s aWeb e r 2 5. 0 0 EE1 0 1 2 6 / 2 0 0 4 C K# 2 7 Ce da r

5 8 0 0 M c o t r o s e ,I o wa5 2 6 3 9I D#

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Dav i dan d F r a o c c sS p r u o g e r2 5. 0 01 0/ 2 0 2 0 04 C K# 2 0 3 8 P a r kL a n e

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c t ~ h K c o k u k. I o wa5 2 6 3 2I DS

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c a s h K c o k u k. I o wa5 2 6 3 2I D#

J e r r yCr amerRoad 5 0. 0 0 E l1 0 1 2 6 / 2 0 0 4 C K# 2 1 5 3R i v e rc a s b K e A * u ) c ,I o wa5 2 6 3 2

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1 1/ 0 8/ 2 00 4 0 0 : 1 ' 2 3 1 9 5 2 4 1 0 0 1 ECKLAND ~ 1 0 TI 3 R5 PAGE 0 5

FOR I NS T R UC T I ONS ,SEE BACK OF FORM ® SCHEDUL E

EXPENDI TURES - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 ) 0 3 )I I A ONE TTU

EXPENDI TURES

STATE PA C COAALI r TTEES- NOTE:

FOR CONTRI BUTI ONSMADET O STATEWI DE OR L E OI S L AT n r E

HECK T HI SBOX I FCANDI DATES. L I S TTHE CANDI DATE I DE NT I F I CAT I ONNUMBER I NTHE DESI GNATEDCOL UMN AN D TH EPACCHECKNUMBER FOR EACH EXPEND1TURE. A L I S TOF 10 NUMBERS I SAVA I L A BL EFROMTHE I OWA AMENDI NGFORME T HI CS& CAMPAI GN DI SCLOSUREBOAJ W .

C011 " I I T TEENA ME ( Mu s t b e s ome a s o n S t a t e me n t o f Or g a n i z a t i o n )

Fc I I o wzf o r S t a t eRe p r c a e ma l i v e

CANDI DATE NA ME AN D ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBE R EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED o f a p al c a c l s ) ( D4 t n v * W1 x Vt ) WAS MADE( MM1 D p I Y R) AN D PAC

CHECKNUMBE R

I D# QKQ r a d i oa d s1 0 / 1 5 / 2 0 0 4

CK# 1 0 1 32 8 5 0Mt . Pl e a s a n tS t 8 9 2. 5 0D a r l i n g t o n. I o wa 5 26 01

I D#Gear Cb a r mc lRa d i o - .r a d i oa d s

1 0 / 2 0 / 2 0 0 4CK#1014

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CK#1015 K e o k u k ,I o wa 5 26 32 - ` °

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1 0 1 7 K e o k u k. I o wa 5 26 3 2

I D#KBKB r a d i oa d s

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1 1/ 0 9/ 2 00 4 0 0 : 1 2 3 1 9 5 2 4 1 9 0 1 E CK L A P I D t ,- 1 0 TOP 5 PAGE 0 6

FOR I NS T RUCT K) t r c s ,SEE BACK Oi FFORM

C OI I MT I T E L -NAME ( M u s tb e s a me a s o n S Fe mn f s md Ou p wt i r a b o n )

Fe l l o ws f o r St a t e Re pr e s en t a t i v e

SCHEDUL E

E I NVI N D( R ev. OBWB COI Y TR I 9 t J T I ON B

CHECK THI S BOX I FAMENDI NG FORM

DATERECEI VED

RNAME AND ADDRESS

OF CONTRI BUTOR

R EL AT I O NS HI PTO CANDI DATE

' a i c Ab l e

DESCRI PTI ONOF I NK I N D

CONTRI BUTI ON

ESTI MATEDFAI R MARKE T

VALUE

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CONTRI BUTI ON

'I 0 11 3! 2 0 04

Rc p u b l i c a nP a r t yo f I o wa6 2 1 E a s t 9 t h StDe s Mo i n e s , I o wa 5 0 3 0 9

p r i n t i n g 2 . 2 50. 0 0

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p os t a w 2 . 2 50 . 0 0

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FORM TRUCTONS,SE E BACX OF FORV

COMMI TTEELNYE( M* b e e a r n sa s o nS t e k a n x n td Cr 9wdmWn)

F e l l o wsf o rS U b eR v t

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TOTALUNPAI DL. OAk 8 FROM LM RSPORTV$OPERI OD$ 3 39 2 , 7 8

PART t - MONETARYLOAN$ R E CI PAWI M REPORTI NOPERI OD( D Z Wn e tsowm o fk e n , s u drs e ab e a k ,r t r u e tb e s h o w X aE h v dp a r t y! r1 n w h v d k v k A d ak m r s skm wx G d a t ss p r wwn a rkmda)

TOTAL( PARTt ) $ 1 6 0 0. 0

' Df s d o wr el a wr e g Wm c a n d d A e c w w# f e s t o d i a d os e t h er a Wi o n s h i po fa n yr s 4 a Mm e k r n ga t o t h ea a r t t n i t ' x s. R e i a t i a i a h pm u s tb e s h o w nb t h eCwd d e g r e eo Sc o n s e r V A i f t y( b l o o dr e t a t i v m )e nd a t i k y( r e l e t f v v sb y me n l a g s ). ! i s u r n a m eo fa o n b r l b A n rf st h esame s e wd i d a t s , b u tt h e r ei sn o t am r e M i o n s h i p ,a n t i -n o ts p p l i r a b i e- i nt t i er e i a t b n s t t l pc o l u m nwhen k e p p 4 w.

PART I - YDWTARY LOANREPAYLENTEMADE I = REPORTI NGPERI OD( L , & , l b r g i v a nmuaf b e r e p or t e d o nS d wd i A E - t n a r k wOo n h t r r E k n i )

TOTALCASHREPAYMENTS( PARTd )

F r o mS c h e d u l eE - TOTALLOANSFORGI VEN

4 9 9 2 78TOTALOUTSTANDI NGLOANSEN DOF REPORT PERI OO

p Ke I a tI-

( f o rSd e d u i e F )

SCHEDUL E

F LOAMRev. OTl t ) 3 ) RSCEVE0

l R! ! AD

CHECK T HI SBOX I FAMENDI NG FORM

DATERECEI VED

A r J J 1' R

NAME AND ADDRESSOF LENDER( I n c l u d eE n d o r s s t aName,t fAWk a b i e )

RELATI ONSWTO CANOMTE

AMOUNTOF LOAN

I f a r 1 6 l 2 0 0 4

B r e n tF e l l o ws2 3 0 0Gmd Av eKe" I owa 5 2 6 3 2 Ca n d i d a t e

S

1 6 0 0. 0 0

DATE PAI D( MMMD1YR)

NAME AND ADORESSOF LENDER( I n c l u d eE n do r s e r ' sNi n e , I fAp p f k mb k )

RELATXX49HPT OCANDI DATE'

( I fA pp i l c a b l e )

AMOUNTREPAI D

S

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1 0/ 2 8/ 2 00 4 2 3 : 4 1 3 1 9 5 2 4 1 0 0 1 ECKLAND MOTORS PAGE 0 1

FOR I NSTRUCTI ONS, SEE a4CK OF FORMDI SCLOSURE SUMMARY PAGE

[ 7C h e c k I ft h i si s f i n a l( t e r mi n a t i o n )r e p o r ta n d a t t a c hNo t i c e o fD i s s o l u t i o nFo r mDR, 3.( You m u s t c o n t i n u e1 DT a l er e p o r t su n t i la No t k a eo f D i s s o l u t i o ni s f i l e d. )

L at e f l i e dr o p o r t t ta r e s u b j e ct t o p os s i b l ec i v i la n d c r i mi n a lp s n a k l a.

SEE I NSTRUTI ON$ON BACK AND COMPL UE THE FQL L OI MNGSENTEI NC '

I AM F I L I NGA Oc t o b e r 26 t h. 2 0 0 4REPORT FOR AMA ( 1 ) ELECTI ON I ( 2 ) NOWELECTI ON YEAR .

( mW d s r ) I n dk = Mo n e

[ CHECK I F AMENDMENT TO REPORT DATED

STAT EMENT OF CASH Q" HAND

CASH ON HI ND a t t h e b eg i n n i n g o f t h er e p o r t i n gp e t i o d. ( T h i sI s t h et o t a lo f a l lmo n l e s h el db y t h ec o mmi t t e e. T hi sa m o u n t MUST b e t h es a m e n f t c a s h a nh a n d a t t h e e n do f t h el a s t r e p o r t i n gp e r i o d. o r mu s t b ez e r o i f t h i si s f i r s tr e p o r tf l i e d. ) . . .. .. .. .. . . . .. .. . . . . .. ... . . . . ... 1 <

Ap p TOTAL MONEY TAKEN I NT HI S PERVO,

L or i !Co mmi t b a s , e n t e rDeb o f E l e c d o nNov embe r 2 n d , 2 0 0 4

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1 1 4 5. 7 1

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DR- 2 DI SCLOSURE( Re v. 0 7 1 2 0 0 3 ) I REPORT

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1 0/ 2 8 / 2 00 4 23 : 41 3 1 9 5 2 4 1 0 0 1 ECKL AND MOTORS PAGE 0 2

F o r I n s t r u c t i o n s ,Sa e B a c k o f F o r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c k r f c o nc i l d o b ' sP e r s o n a lf u n d s )

COMMI T TEE NAME ( Mu s t b o s ame a s o n St a t e r n ew o f Ay e ni z e t b n)

F el l o ws f o r St a n Re pr o s e nt a t i v a

STATE CANMDATRS NOTE: I FA CONTRI BUTI ON I SRECEI VED FROM A STATE PAC ( POL I T I CA LACTI ON CCMMPREE) , L I S T THE PAC I DEI i T I RCAT mNUI uBER AND THE PAC CHECK NUMBQt I N THE OESKI NATED COL UMN . A L I ST OF I D I S AVAI LABLE FROM T HE I OWA ETHI CS ANDCAMPAI ONDI SCLOSURE BOARD-

CAUTI ON : Se ct i o n W9 . 3 2 A( 6 ). l o ws ( ) o d e ,p r o h i b i t st h e u s e d I n f o e na t b n o o pl e d f r o m r e p o r t san d s t s t e r n en f s f o rs o l l d Mt p c o n4 1b u 11 o nso rf o ran y p o r n me r t WI p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r yp ol i d eMocmmi t wee .

SCHEDULEA MONET ARY

( Ro v. 0 7 M3 ) RECEI PTS

Q CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRECEI VED ( i fApW0m) T O CANDI DATE' RECEI VED FUND-

PAM/ DDf YR) AND PAC CHECK ( Ma p 0 1c a b l e ) RAI SERNUMBER I NCOMEI D#

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CK# As s b l o i o os , I o wad i r e c t t

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1 0 2 3/ 2 0 04 CK# # 3 Ca r r i a g e Onmn s f a n c i l y 1 00 . 0 0 E f l2 4 1 o I o wa 5 2 6 3 2

I n*J o h n an d Ca t i s Du n l a p

1 0/ Z 6 J 0 4 CK0 3 6 7 5 I o wa Road 5 0 . 0 0

6 6 7 4 I o wa5 2 6 3 2I D#

F l i n tA J u d i t hP a y t o n1 Q > 1 6 ( 2 0 0 4 CK# 3 3 0 7 Mi d dl eRoad 5 0 . 0 0

4 9 7 4 Keok I o wa 5 2 6 3 2I Dt

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1 0/ 2 8/ 2 00 4 2 3 : 4 1 3 1 9 5 2 4 1 0 0 1 ECKLAND MOTORS PAGE 0 3

F o rI n s t r u c t i o n s ,Sa e Ba c ko fF o r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n a u d i n gC an d k f a l e ' sp e r s o ne l f u d s)

C ON I MI T T E ENAME ( Mu db e s a m e a s o n St a t e me n t o fOr p a n i z e t i c n )

F e l l o wsf o rR e p r e s e n i a a v e

STATE CANDI DATES NOTE . I FA CONTWBUTI ON I SRECENEDFROM A STATE PAC ( P OL I T T GI LACT10N0 0 6 Wt T T E E) ,UST THE PAC I D ENT I F I C AT I ONMMER AMO THE PAC CHECK NUMBER I NT HE DESKMaATEDCOLl MN . A UST OF I DMJ Mt i i E R1 9I SAVAI LABLEFROM THE I OWAETHI CS AND CAMPAI GNDI S CL OS L I f E BOARD .

CAUTI ON : Sedbn 8 B8 . 9 2 A( S ) ,I o t w Co d e ,p r o h i b i t st h e u s e o f I n i o r ma t i o no op l e df r o mr e p o r t sa nd s t a t s a r e n t sf o rsoNdpnp c o n Mb u t l o n so rf o ra n y c o mme r c i a lp u r p o s eb y a ny p e r s o n o t h er t h an s t a t t i e o r yp o l l Mc a lc a , l mi t ew .

SCHEDULE

A MONETARY( R e v _ 0 7/ 0 3) RECEI PTS

0 CHECK T HI SBOX I FAMENDI NGFORM

DA' r F PAC I DNUMBER NAME ANDADDRESSOF CONTRI BUTOR REL ATMSMI P AMOUNT - J I FFORRECEI VED ( i fa pp i c a bl e ) T O CANDI DATE' RECEI VED FUND-

( MN I I D LWR ) AND PAC CHECK ( i fa p p l i c a b l e ) R AI SE RNUMBER I NCOME

I D#Cl y d eMi t c he l l

$ 1 0 0 . 0 01 0 / 2 6 / 2 0 0 4 CK t k 3 7 5 3Ma i nS t r e e t6 2 7 8 K e o k u k ,I o wa 5 26 32

I D#S t a r ry a n d S c J i s s aWe b e r

1 0 1 2 6 / 2 0 0 4 C K # 27 C e d a r 2 5. 0 05 8 0 0 Mo n t r o s e ,I o wa5 2 6 3 9

I DS

Da v i da n d F r a n c e sS p r t m ® e rl OR f i J 2 0 0 4 CK O 2038 P a d sL a n e 2 5 ' 0 07 1 9 6 a u k , Io w a5 2 6 3 2

I D#Mi k e, F f i c k e y

I Oi 2 6 J 2 0 0 4 CK O 1 1 2 1Or =dAve4 0. 0 0

c a s h Ko o k u k , I o wa 5 26 32I D#

Ri c kB r y a D t1 0 / 2 6 / 2 0 0 4 CK# 6 29 Ma i nS h e e t 1 0 0. 0 0 E E Ic a a b

Ke o k u k , I o wa 5 26 32

I DN J c r r yCr amer1 0 / 2 6 ( 2 0 0 4 CK# 2 1 5 3R i v e rR o a d 5 0. 0 0

c ep K e o i a L k ,I o wa 5 2 6 3 2I Q#

U n i t i m i a e d 1 2 1 0 0

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1 0/ 2 8 / 2 00 4 23 : 4 1 3 1 9 5 2 4 1 0 0 1 ECKLAND MOTORS PAGE 0 4

FOR I NSTRUCTI ONS, SEEBACK OF FORM SCHEDULE

EXPENDI TURES B N- - MONEY SPENT FROM COMMI TT EEACCOUNT ( Ra w - OT / 0 0 )

XPEE NES

DI T UR

STATE PAC COMAI ETTI IE6 : NOTE : FOR CONTRI BUTI ONSMADE TO STAT EWI DE OR LEGI SLATI V ECANDI DATES,L I ST T HE CANDI DATE I DENT I F I CAT I ONNLA4ER I NT HE DESI GNATEDCOL UMN ANDTHE El CHECK T HI SBOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE. A L I STOF I DNUMBt R8 I SAVAI LABLEFROM T HE I OWA AMENDI NGFORMETHI CSA CAMPAI GN DI SCLOSUREBOARD .

COI I BYI I T TEENAME ( Mr j Mb e same a s o n S t a t mn o n to fOr g a n i z a Wn )

F c l l o wsf o rS t a t eR a p t t i w n t s d v e

CANDI DATE NA ME AND ADDRESS T O WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( Ea p p l i c a b l e ) ( Db b un t a r n an r )WAS MADE( MMMDr YR) AND PA C

CHECKNUMBER

I D# QKQ r a d i oa d s1 0 1 1 5 / 2 0 0 4

CK# 1 0 1 32850 Mt . P l e a s a n t S t

S8 9 2. 3 0

B u r l i n g o o ,I o wa5 2 6 0 1

I D I tCl o yCh eo t t dRa d i o r a d i oa d s

1 0 / 2 0 / 2 0 0 4CK#1014

B u r l i n g t o n ,I o wa5 2 6 0 1 3 00 . 0 0

ADO D a i l yGa t eC i t y a d s1 0 / 2 0 / 2 0 0 4 1 0 1 6Ma i n S t r e e t 8 85 . 5 5CK#1015 K e o k u k ,Io wa 5 2 6 3 2

I D#PAwb a r dB r o a d c a s t i n gKQ92 r a d i oa d s

1 0 / 2 5 / 2 0 0 4CK#1016

B u r l i n g t o n ,I o wa $ 2 6 0 1 2 3 6 2. 6 0

I D#D a i l yGa t eC i t y a d s

1 0 / 2 5 / 2 0 0 4CK#

1 0 1 6Ma i AS t r e e t 8 6 5. 3 0

1 0 1 7 K e o k u k ,I o wa5 2 6 3 2

I D# KBKB r a d i oa d s1 0 I 2 6 f 2 0 0 4

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1 0/ 2 8/ 2 00 4 2 3 : 4 1 3 1 9 5 2 4 1 0 0 1 ECKLAND MOTORS PAGE 0 5

FOR I N ST R UC T I ON S,SEE BACK OF FPM

COMMI TRE NWE ( A f u a tb e some e s o nS t mt e me Wd z a N o n )F ol l o wsf o r S t a t eR a p r e s e n t e t i v e

SCHEDULEE I NK I ND

( Re v. OB I B7 C ON T RI B UT I ON S

Q CHECK T HI SBOX I FAMENDI NG FORM

DATERECEI VED NAME AND ADDRESS

OF CONTRI BUTOR

R MAT I ON S HI DT O CANDI DATE

DES CR I P T I ONOF I NK I ND

C ON T RI B UT I ON

EST I MATE DFAI RMARKET

VALUE

I F FORF UND- RAI SERC ON T RI B UT I ON

1 0 / 1 3 / 2 00 4 Re pu bl i c anP a r t yo f I o wa6 2 1E a s t9 1 hS tDes Mo o m, I o wa5 0 3 0 9

m i n t i n g $ 2 , 2 5 0. 0 0

1 0 / 1 3 / 2 0 0 46 2 1P a r t yo f I o wa

PAN 9 t hDe s Mo i n e s ,l o ws5 0 3 0 9

p o s t a g e 2 , 2 5 0. 0 0 r

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FOR MTRUCT11 0APA SEE BACK OF FORM

Cai r n= KAMPi mr 6s mm a s c " S AWe e w r r ta c me r AMWON

F el l o ws f a r St a t eRA p a r a mms i v e

NUM :Th e

s dr d r i e mpof mon ey l u s as d b t o c o n r r d pe ew h i o hI s d e po s i l e dI nt o a u me r l b e s o o o u n L

TWAL UI PAD LDAW FROM LW NBVRTEf 0 Pl Ri M S 3 3 9 2 , 7 8

PART 1 - t 110WTARY L OA l t sRWEM= REPORTM P t l 9 l I O D

( 0 t * W w e v ~ e o f l o o n. a u a h s a a b a o A mW b o a i + v s nwa f d p a r t ykI r w oMd , i n c t: a f eb o n a f i o mo a a d i t ib ' s p s r a o" W wi d e )

TOTAL ( PART 0 $ 1 6 0 0 . 0

' Dl s d ae u ml a wn a q u i l a sc a n di d a t eo o r r n f s se t o d h d o s e t h er e l m6 mr e h i po fan y r s b dv ema l d n p a o o on b t h eoa mmf e_ Rd s d o n s h l p n e a t b e s h o w n b on o t h i dd e g r e e o fo mr s w g u l n i t yI b i o s dr s t s t l n t s )an d a" ( mb l h e a b y r r u s yWg e). I f su mmnr o o f c v MA b u t o ri st h es a me as a s r d k i s t e ,b u t I h smI s n o f am W mi s d o n a h l p ,e n t e r̀ n o ta p pi a e b r s ' i n t h e

o a l u r n nw h e n t a p pl e s _

PART I - N OWTARY L OAN REPAYMl 9M MADE I M REPORTM PEI MOD( L o a n s f b r * e nmL W b e n p mt e d an S d wd t d aE - r n a dn dOon t r t a f m)

DATE PAD NAME AND ADDRESS OF L ENDER t i E L AT 1 0 NS i HP AMOUNT( MMI DDYM ( I n c l u d e E nd o r s e r ' sNems, I fAp pk s b r s ) ~ O C AN Dt g AT E '

TRE PAI D

( I tA Pp f O ab t r J

S

TOTAL CASH REPAYMENTS { PA RT1 1 ) E

F To m S o h e d WsE - TOTAL L OANS FORGI VEN E

TOTAL OUTSTANDI NGL OANS END OF REPORT PERI OD $4 9 9 2' 7 8

1d

( f a rS af i s d ul eF )

SCHE DULE

F L oms( Ra . 07m) n t i x En t ®

a RI ? AD

CHECK T HI S BOX I FAMENDI NG FORM

DATER F - C E I V E D

N1W - ANDAODRESSOFL ENDER( I n d ad e E n d o n wi sN a ms , 11 A pp t l c s b h )

RELATI ONSWTO CANDI DATE

AMOUNTOF L OAN

1 0 11 6 1-1.. 0 1 1 4

Smt F t l l o ws

2 3 0 0 Gr a n d Av e

K e ok u k , I o wa 5 2 6 3 2 f t

s

1600 . 0 0