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FOR I NSTRUCT I ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARYPAGE

COMMI TT E NAME ( Mu s t b e

e a s o n St a t e me n t o f O r g a n i z a t i o n )

l=7i r i 2 i A J G

A t L l PA%6 k )

s

I MPORTANT: I n d i c a t e t y p e o f c o mm i t t e e youa r e r e p o r t i n g f o r :

( 1 ) S t a t e m d e / L

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

my P

l o t I s s u e / F r a r ~ y h i s

o y ~ n i t t Q 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

l a t

f C a n d

_

7 / 2 - / 3 6 ( f - 1 - r z R 3

S I N

URE O TREAS

ER ( o r p q f s A ( n f i l i n g t h i s r e p o r t )

TE EPHONE

Ro u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Re p or t s R a n g e f r o m $ 2 0

SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :

I AM FI L I NG A

+d rUA4 1 1 1 ,

2cw~

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

E] CHECK I F AMENDMENT TO REPORT DATED

REPORT FORAN/ A ( 1 ) ELECTI ON / ( 2 ) N

I n d i c a t e o n e

El 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 No t i c e o f D i s s o l u t i o n Fo r m DR- 3 .( Y ou m u 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 No 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 HAND

FORM

DR- 2

DI SC LOSURE

( Re v . 0 1 / 9 8 ) REPORT

F o rOf f i c e Us e

On l yComm . #

I n d e x e d 42--

A u d i t e d

-

Comp u t e r

, <2 : - -

/ - / 1 6 .eo

DATE SI GNED

$ 1 ~ 0 ( t /

i 1 . 7 1

4 . . x . 77 . ~ 1 3

J AN 2 2 1 0 0 1

N- E L EC TI ON YEAR .71( L E D

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 n

C o u n t y & L o c a l C o mmi t t e e s , e n t e r C o u n t y i n

wh i c h E l e c t i o n i s h e l d

CASH 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 l

o 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 hi s a m o u n t MUST b e t h e

sa me a s t h e c as h o n h a 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 mus 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 . )

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

7 w

9 .

ADD TOTAL MONEY TAKEN I N T HI S PERI OD

Sc h ed 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 A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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Sc h ed u l e 7 Z- J '. 0

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

CONTRI 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 ( M u 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 )

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I V E D FROM A STATE PAC ( P OL I T I C A L ACT I ON C OM MI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .

CAU T I ON : S e c t i o n 6 8 B . 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 a n d s t a t e m e 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 a n y c o mme r c i a l 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 a n s t a t u t o r y p o l i t i c a l c o mm i t t e e s

SCHEDULE

A MONETARY( R e v 0 6 / 9 7 ) R EC E I P T S

0 CHECK T HI S BOX I FAMENDI NG FORM

D A T E PAC I D NUMBER NAME AND ADDRESS OF CON TRI B UTOR R EL A T I O NS H I P AMOUNT J I F FORR E CE I V E D ( i f a p p l i c a b l e ) TO C A N DI D A T E ' R E C E I V E D F U N D -

( MM I D D I Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R A I S E RNUMBER I N C O ME

I D #

_ _ 7 SQL ~L CL l i : 7 y Z ~ a u t 3 t I CAN ~ J Q f v ( i - f v

CK #

I D #6 06 ` I s c F 1 ~ u i t 4 t ~ i 4 r 7 i 2 f C

CK# 8 S - 2 - S l ~ " t o g ) OL S Au e , 4 81

a 3 c ~ l v 0 e S o i v t e ~ > 2A 03ZZ , d

< I D # GZEG f ~r ~7Ci 2

CK# ` c t ZMAP4 0 ~C i T ._~00

CK# i 6o c c t s ~ Gt u 6 t b Av e S - ` V e t c o~0 6 6 ' Z! 3 - ; SO c

r I D #z ~ - 7 S~ C - e f 1 1 i t , t ~ - ° ! a I L I c w ~ r ( t ; ~ r - s

CK# ( 4S ` / - 3 0 ' 1 ~ ' S t t e e f Sv e 2C/,

f ' ~ 3 n0 Q, - a . ' e . Rc kh es s A 5CZ( - _S d ~ , C lI D #

C D2 3 l q c t i SAt UTZ ) Cd I T i 2 - 4 - g - ' 5 1 Y i r - )

CK#0 ) o p ,

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FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDUL E

EXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VE

CANDI DATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THECHECK THI S BOX I F

PAC CHECK NUMBER FOR EACH EXPENDI TURE. A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPA I GN DI SCL OSURE BOARD.

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

~~i l Wf ~ j l ~ ( } > t 1 , I t ~ f i l

CANDI DATE NAME ANP ADDRESS WHOM PURPOSE AMOUNT

DATE I D NUMBER PE RE ( DESCR I BE TRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s eme n t ) WAS MADE

( MM/ DD/ YR) AND PAC

CHECKNUMBER

I D # - Z - r 3 , 4 CDi i r u Ty C u c ~ e : ' r ? r f 2

CK# $1 7 3

I D # ~ 7

CK#

1 ` I D # ` , / / ' o t u T f ) w i t ) ORl 6 r 2

CK#

a 1 7 . ) ' e 4 ~ H ~ 4 f ~ n ~ O. D6

I D#

CK# ~ _

I D#

CK#2 - r - 00 i 77 ; ' e l 1 9

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FORI NSTRUCTI ONS, SEEBACKOFFORM SCHEDULE

EXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TT EE ACCOUNT

( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI SLATI VE

CANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COL UMN AND THE 0 CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS b CAMPAI GN DI SCLOSURE BOARD .

COMMI TT EE NAME ( Mu s t b e s a m e a s o n St a t e me n t o f O r g a n i z a t i o n )

( Z e p r l ~ tF7 ` r r , R / I U m i Ga 0CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MMI DD/ YR) AND PAC

CHECKNUMBER

I N LAKE U ( r u i i ~ ZSc '

P T -

CK# $7 6

2 6 0 / 6 V ) . 0 1 6 )I N

CK#

I N

CK#

I N

CK#

I N

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FOR I N S TRUCT I ONS , SEE B AC K O F FORM

COMMI TT EE NAME ( M u s t b e s am e 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 )

r r 7 f = Qf u 6 Gamed

NOTE : T h i s s c h e d u l e r e p o r t s mo n e y l o a n e d t o t h e c o mm i t t e e w h i c h i s d e p o s i t e d i n t h e c o mm i t t e e a c c o u n t .TOTAL UNP AI D LOANS FROM LAST REPORT I NG PER I OD$

70 0 . _ ©b

PART 1 - MONETARY LOANS RECEI VED_TH I SREPORT I 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 , m u s t b e s h o w 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 o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

T OT A L ( P AR T 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 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 a n y 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 o mm i t t e e . R e l a t i o n s h i p mu s 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 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 a m e 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 , b u t t h e r e i 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 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 m n w h e n i t a p p l i e s .

PART I I - MONETARY LOAN REPAYMENTS MADE_TH I SREPORT I NG PERI OD( L o a n s f o r g i v e n m u s t b e r e p o r t e d o n S c 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 ( P ART 1 1 )

$

F r o m S c h e d u l e E - T O T A L L OANS FORGI VEN

$

TOTAL OUTSTAND I NG LOANS EN D OF REPORT PERI OD

$ r D l o o - 0 6

P a g e o f

o r S c h e d u l e F )

SCHEDULE

F LOANS( R e v 0 8 / 9 6 ) RECE I VED

& REPA I D

El CHECK T HI S BOX I F

AMEND I NG FORM

DATE P A I D( M M/ D D / Y R )

NAME AN D ADDRESS OF LENDER( I n c l u d e E n do r s e r ' s Name , I f A p p l i c a b l e )

RELAT I ONSHI PT O CANDI DATE'

I f A p p l i c a b l e )

AMOUNTREPA I D

DATERECE I VEDMM/ DD I 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 PT O CAND I DA T E

I f A p p l i c a b l e * )

AMOUNTO F L OA N