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R I NSTRUCTI ONS, SEE BACKOF FORMDI SCLOSURE SUMMARY PAGE

S c 5 - 2 4 1 s77. z. . J oI GNATUREO REASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHO E DATE SI GNED

L a t e f i l e d r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l ~nd c r i m i n a lE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG 3 NTENCE :

AM FI L I NGA 46 j t q [ Oq REPORT FORAN I ( ELECTI O Z ) 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 a

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] C h 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 a n 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 D~ - 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 . )__

STATEMENT OF CASH ON LANDON 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 l o f a l l mb y t h e c o mmi t t e e . T h i s a mo 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 2o 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 l e d . ) . . . . . ,

mi e s h e l dt t h e e n d. . . . . . . . . . . . . . . . . . . . . . . . . $

( S c h e d u l e H a pp 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 )OUB- TOTAL . . $

SUBTRACT TOTAL MONEYSPENT T HI S PER I ODSc h e d u l 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 Sc h e d u l e B ) ( " a l s o s e e d e b t s a n ~ l o a n s b e l o w ) . . .Sc 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . .

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 tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . j . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 I DI SCLOSURE( Re v . 0 3 1 2 0 0 3 ) REPORTF o r O f f i c e Us e O 1Comm . # _ .

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t o . 430=1" UNPAI D B I L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $` I N K I ND CONTR I BUT I ONS ( Fr o m Sc h e du l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . . . . . . $- OUTSTANDI NGLOANS ( 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 ) . . . . . . . . . . . . . . , . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . . . . . $ICANDI DATECOMMI TTEES ONLYCONSULTANT BREAKDOWN ( Sc h ed u l eGA t t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( Fr o m Sc h e du l e H - A t t a c h Sc h e d u l e H) $

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ADD TOTALMONEYTAKEN I N T HI S PER I OD 60Sc h e d u l e A : C a 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 l ~ d b e l o w ) . . . . . . . . . 11%n " `Sc h e d u l e F : Lo a ns 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H: T o t a l S a l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . ~ . . . . . . . . . . . . . . . . , . . . . . . . .

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F o r I n s t r u c t i o n s , Se e Back o f F o r mCONTRI BUTI 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 ( M u s t b e s ame a s o n S t a t e m e n t o f O r g a n i z a t i o n )7AaA S OC ( C T ' 1 d P 4A I ES" ESI ( Ot o 6M' c I NC PAC A6y ISTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED F ROM A STATE PAC ( P OL I T I C A I. ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S A VAI L ABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 68 6 . 3 2 A ( 6 ) , I o w a 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 m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t a n s o rf o r any c omme r c i a l p u r p o s e b y any p er 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 .

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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 o mm i 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 an y r e l a t i v e ma k i n g c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p mus 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 o d r e l a t i v e s ) a n d l 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 ) ( S e e Page 2 o f f o r m s p a c k e t . ) . I f s umeme o f c o n t r i b u t o r I s t h e s ame a s c a n d i d a t e , t a u t t h e r e i s nof a mi l i a l r 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 u mn . ,

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

FOR I NSTRUCTI ONS, SEEBACK OF FORM SCHEDULEEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT B MONETARY( R e v . 0 7 1 0 3 ) EXPENDI TURES

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CANDI DATE NAMEAND ADDRESS TOWHOM I PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE OESCRI BETRANSACTI 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( MMI DDI YR) AND PACCHECKNUMBERI D# t y qM NAaY Wr ERr l u (

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T HI S BOX APPL I ES TO CANDI DATES' COMMI TTE ES ONLY :Pu r c has e s o f c e r t a i n campa 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 m u s t a l s o b e i n v e n t o r i e d o n Sc h e du l e H . ( R e f e r t o Sc h e du 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 l e n t h 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 must 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 amoun t , p u r p o s e , an d d a t e o f e a ch 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 oSc h e d u l e G i n s t r u c t i o n s an d I o w a Co d e 6 BA . 4 0 2 ( 3 ) ( i ) . )