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FOR I N ST R UC T I ON S,SEE BACKOF FORM

DI SCL OSURE SUMMARY PAGECOMMI TT EENAME ( Mu st b es a m e a s o n S t a t e me n to f O r g a n i z a t i o n )

C AN DI DAT E C OMMI T T E E SONL Y :

L a t er e p o r t sa r es u b j e c tt op o s s i b l ec i v i la n d c r i m i n a lp e n a l t i e s.t h ec a n d i d a t e ,f o r ac a n d i d a t e ' sc o m m i t t e e ,a n d t h ec h a i r p e r s o n ,f o ra ` ni n d i v i d u a lr e s p o n s i b l ef o rf i l i n gt i m e l ya n d a c c ) O a t er e p o r t s.

l ~ f ~ _ w lI GNATUREOF PE HUNG REPORT

IAM F I L I N GA

( r e p o r td a t e )

[ ] CHE CK I FAMEI CMENT TOREPORTDATED

C h e c k i ft h i si s f i n a l( t e r m i n a t i o n ) r e p o r ta n da t t a c hNo t i c e o fD i s s o l u t i o nFo r m DR- 3.( Yo u mu s tc o n t i n u et of i l er e p o r t su n t i la DR- 3 i sf i l e d. )

I MPORTANT: I n d i c a t eb y #t y p eo fc o mm i t t e ey o ua r e r e p o r t i n gf o r:( 1) 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 eS t a n d i n gf o rR e t e n t i o nC a n d i d a t e( 2 ) S t a t ePA C ( 3 ) S t a t eP a r t y( 4 ) C o u n t yC e n t r a lC o mm i t t e e( 5 ) C o u n t yC a n d i t o ( 6 ) C i t yC a n d i d a t e( 7 ) S c h o o lB o a r do rOt h e rP o l i t i c a lS u b d i v i s i o nC a n d i d a t e( 8 ) C o u n t yPA A ' r . PAC ( 1 0 ) S c h o o l B o a r do r O t h e rP o l i t i c a lS u b d i v i s i o nPA C ( 1 1 1 L o c a lB a l l o tI s s u e J E

I o waC o d e s e c t i o n6 8 B. 3 2 A ( 7 )t h e rt y p eo f c o mm i t t e e ,i s t h e

REPORTFOR ( 1 )E L E CT I ONI ( 2 ) NON- EL E CT I ONYEAR .

I n d i c a t eb y #I 0

STATEMENT OF CASHONHAND

CASHON HAND a t t h eb e g i n n i n go f t h e r e p or t i n gp e r i o d. ( T o t a lo fa l lf u n d sh e l db y t h ec o m m i t t e e. T h i samount MUST b e t h es a m e a s t h ec a s ho n h an da t t h ee n do ft h e l a s tr e p o r t i n g p e r i o do r must b e z e r oi ft h i si s f i r s tr e p o r tf i l e d. ) . . . . . . . . ... . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . .. $

AD DTOTALMONEY TAKENI NT HI SP E RI OD

FORM

DR- 2 I DI SCLOSURE( R e v. 1 2 / 2 0 0 5 ) REPORT

F o rO f f i c eUs e O n l yComm . # )6 7L o g g e d I nS c a n n e d

Co mp u t e r

A u d i t e d -

F i l ew i t h:I o waE t h i c sa n d Ca mp a i g nD i s c l o s u r eB o a r d5 1 0 E. 1 2 " ' ,S t e. 1 ADe s Mo i n e s , I o w a5 0 3 1 9

Fa x: 5 1 5 - 2 8 1 - 3 7 0 1

I s i s a t e = ~ 1q s 1 1 0 ~ oTELEPHONE DATESI GNED

L o c a lC o m m i t t e e s ,e n t e rD a t eo f E l e c t i o n

Co u n t y& L o c a lC o mm i t t e e s ,e n t e rC o u n t yi nw h i c hE l e c t i o ni s h e l d

9 5 0 00

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9 5 0 00

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

CONTRI BUTI ONS - - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' s p e r s o n a l f u n d s )

COMMI TT EENAME ( M u s tb e s ame a s o n S t a t e me n to fO r g a n i z a t i o n )

R e s e tF ar m SCHEDULEA I MONETARY

( R e v. 0 7 1 0 3 ) RECEI PTS

CHECKT HI SBOXI FAMENDI NGFORM

S TAT E CA NDI DAT ES NOT E: I F A CONTRI BUTI ONI SRECEI VEDFROMA STATE PAC ( P OL I T I C ALACTI ONCOMMI TTEE) ,L I S TTHE PAC I DENTI FI CATI ONNUMBERAND THEPAC CHECK NUMBER I NTHE DESI GNATEDCOL UMN . A L I S TOF I DNUMBERS I S AVAI LABLEFROM THE I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

NOTE : ANY PERSON, OTHER T HAN AN I N DI V I DUA L ,THAT CONTRI BUTES MORE THAN $ 7 5 0 T O YOUR CAMPAI GN MAY HAVE F I L I N G

R ES PON SI B I L I T I E SAND SHOULD I MMEDI ATELY CONTACT THE BOARD .

CAUTI ON : Se ct i o n6 8 B . 3 2 A ( 6 ) ,p r o h i b i t st h e u s e o f i n f o r mat i o nc o p i e d f r o mr e p o r t sa n d s t a t e me n t s f o rs o l i c i t i n gc on t r i b ut i o nso r f o ra n y

c o mme r c i a l p u r p o s e b y a n y p er s o n o t h e r t h an s t a t u t o r yp o l i t i c a lc o mmi t t e es.

DATE P ACI DNUMBER NAMEANDADDRESSOF CONTRI BUTOR R EL AT I ON SH I P AMOUNT J I FF ORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D / Y R )A ND PA CCHECK ( i fa p p l i c a b l e ) RAI SER

NUMBER I NCOMEI D#

CK# p , v. 3 a k 1 1 v os h ~ ~ ! I = SU y 3I D#

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FOR I NSTRUCTI ONS,SEE BACK OF FORM R e s c t o n n SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENTFROM COMMI T T EEACCOUNT ( Re v. 0 7 / 0 3 ) EXPENDI TURESSTATEPAC COMMI TT EES: NOTE: FORCONTRI BUTI ONSMADE TOSTATEWI DEOR L EGI S L AT I V E

CHECK T HI SBOX I FCANDI DATES,L I S TT HECANDI DATEI DE NT I F I CAT I O NNUMBERI NT HE DESI GNATEDCOLUMN ANDT HEPA C CHECKNUMBERFOR EACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWA AMENDI NG FORMETHI CS&CAMPAI GNDI SCLOSUREBOARD.

COMMI TTE E NAME ( Mu s t b e s a m e a s o n S t a t e me n to f Or g a n i z a t i o n )

Z e E . c ; ~ - r i . UCANDI DATE NAME AND A DD RE S S TOWHOM PURPOSE AMOUNT

DATE I DNUMBER EXPENDI TURE ( DE SCR I B ETRANSACTI ON) EXPENDEDEXPENDED ( i fa pp l i c a bl e ) ( D i s b u r s e me n t )WAS MADE( MWDDI YR) AND PA C

CHECK

NUMBER

I D# / h ~3 N ~ c a S S ~ l r r l 7 i n c i Cy - S

/ U / / q / 6 6CK# l v a q 9 0 3 I t J -a ~ ~S - I - , -$ l y ~ ~ )rl - 9 0l ~ , ~~6 1 0

I D# / L o &J ~

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Sa o H J

1 D# A' 4 , c Hi f c o o l - e C)C)1 3 0 1 Xh PL C~. c. ~ ~Y ~~ ~c a ~ s e r `

CK#

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F OR I NSTRUCTI ONS,SEE BACKOF F ORM R e s e tF o r m SCHEDULE

EXPENDI TURES B MONETARY- MONE Y SPENT F ROM COMMI TT EE ACCOUNT ( R e v. 0 7 / 0 3 ) EXPENDI TURESSTATEPA C COMMI TT EES: NOTE: F ORCONTRI BUTI ONSMADE TOSTATEWI DEOR L E GI S L AT I V E

CHECK T HI SBOX

I FCANDI DATES,L I S TT HECANDI DATEI DE NT I F I CAT I O NNUMBERI NT HE DESI GNATEDCOLUMN ANDT HEPAC CHECK NUMBER FOREACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROMT HE I OWA AMENDI NG F ORMETHI CS&CAMPAI GNDI SCLOSUREBOARD.

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n to f Or g a n i z a t i o n )w o \

CANDI DATE NAME AND ADDRESST OWHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i fa pp l i c ab l e ) ( D i s b u r s e me n t )WAS MADE( MMI DD/ YR) AND PA C

CHECK

NUMBER

I D# ' -

I D#

CK#

I D#

CK#

I D#

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I D#

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FOR I NSTRUCTI ONS,SEE BACK OF FORM

COMMI TT EENAME ( M u s tb e s a m e a s o n S t a t e me n to f O r g a n i z a t i o n )

R e s e tF o r m

SCHEDULEE I N- K I N D

( R e v. 0 6 / 9 7 ) 1C ON T R I B UT I ON S

O CHECK T HI SBOX I FAMENDI NGFORM

DATERECEI VED

( MMI DDI YR)NAME AND ADDRESS

OF C ON T R I B UTO R

RELATI ONSHI PT O CANDI DATE' ( i fa p p l i c a b l e )

DES CR I P T I ONOF I NK I ND

C ON T RI B UT I ON

ESTI MATEDFAI RMARKE T

VALUE

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FOR I NSTRUCTI ONS,S EE BACKOF FORM

COMMI TT EENAME( Mus tb e same a s o nS t a t e m e nto f O r g a n i z a t i o n )

NOTE: T h i ss c h e d u l er e p o r t smoney l o a n e dt o t h ec o mmi t t e e w h i c hi sd e p o s i t e di nt h ec o m mi t t e ea c c o u n t.

TO TA LUNPAI DLOANSFROM L AS T R EP ORT I N GP E RI O D$ ,: ~ * OO

PARTI - MONETARY LOANSRECEI VEDT HI SR E PO RT I N GPERI OD

( O r i g i n a ls o u r c eo fl o a n ,s u c ha s a b a n k ,mu s t b e s h owni fa t h i r dp a r t yi si n v o l v e d. I n c l u d el o a n sf r o mc a n di d a t e ' sp e r s o n a l f u n d s. )

TOTAL( PARTI ) $ ^" U

* D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec o mmi t t e e st od i s c l o s e t h er e l a t i o n s h i po fa n yr e l a t i v ema k i n g ac o n t r i b u t i o nt o t h ec o mmi t t e e. R e l a t i o n s h i pm u s tb e s h o w nt ot h et h i r dd e g r e eo fc o n s an g u i n i t y ( b l o odr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb y m a r r i a g e ). I fs u r n a meo f c o n t r i b u t o ri st h esame a s c a n d i d a t e ,b ut t h e r ei s n o f a m i l i a lr e l a t i o n s h i p ,e n t e r" n o t a pp l i c a b l e "i nt h er e l a t i o n s h i pc o l u mnw h e n i ta p p l i e s.

R e s e t F o r m

PART 1 1 - MONETA RY LOAN REPAYMENTSMADE T HI SR E P ORT I N GPERI OD( L o a n sf o r g i v e nmust b e r e p o r t e do n S c h e du l eE - - I n - k i n dC o n t r i b u t i o n s. )

TOTALCASHREPAYMENTS( P A R T / / ) $"

U U

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Page( f o rS c h e d u l eF )

SCHEDULE

F LOANS( R e v. 0 7 / 0 3 ) RECEI VED

& REPAI D

[ ] CHE CK T HI SBOX I FAMENDI NG FORM

DATE PAI D( MMI DD/ YR)

NAME A ND A DD RE S S O FLENDER( I n c l u d eE nd o r s e r ' sName,I fA p p l i c a b l e )

RELATI ONSHI PT O CANDI DATE*

i fAp p l i c a bl e )

AMOUNTREPAI D

DATERECEI VEDMM/ DDI YR

NAME AND ADDRESSO F L E N D ER( I n c l u d eE nd o r s e r ' sName, I fA p p l i c a b l e )

RELATI ONSHI PT O CANDI DATE

I fA pp l i c a b l e *

AMOUNTO F L O AN

$