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FOR I N S T RU CT I ON S , SEE BACK OF FORMDI SCLOSURE SUMMARY PAGE

( r e p o r t d a t e )[ ) C HE CK I F AMENDMENT TO REPORT DATED

COMMI TTEE NAME ( M u s t b e s a m 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 )Q O ~QU R C ! l UM.I MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g 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 PA C ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l Ca n d i d a t e( 5 ) C o u n t y PA C ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e 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 u p p o r t S l a t e o f C a n d i d a t e s b i z - P 1 ? 5 ' _ 3 9 0 . 2S I GN URE OF TREASURER ( o r p e r s o n f l i n g t h i s r e p o r t ) TEL EPHONE

OC 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 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 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 HAND

I n d i c a t e o n e

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 lo 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 h i s amoun t MUST b e t h es ame a s t h e c a s 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 must 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 du 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 du l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .`.Sc h e du 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 du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H : T o t a l Sa 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 du l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p 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 )SUB - TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT THI S PERI 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 du l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2( R e v . 0 1 1 9 8 )

DI SCLOSUREREPORT

Fo r O f f i c e Us e On l yCo mm . #I n d e x e dA u d i t e dCo mp u t e r

6 - O. . JDATE S I GNED

Ro u t i n e Pe n a l t i e s Du e Fo r L a t e F i l e d Re po r t s R a n g e f r o m $2 0 t o $ 8 0 0$EE I NSTRUCTI ONS ONBACK AND COMPLETE THE FOL L OWI NG SENTENCEI AM FI L I NG A ' 7 " Y - D5 REPORT FOR A N/ A ( 1 ) E LE CT I ON / ( 2 ) NON- E L EC TI ON YEAR .1 9

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

UNPA I D B I L L S ( Fr o m Sc h ed u l e D - A t t a c h Sc h e du l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I ND CONTRI BUTI ONS ( F r o m Sc h e du l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG L OANS ( F r o m Sc h e du l e F - A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY ;CONSUL TANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H) $

Pa g e 1 0 C 3

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Fo r I n s t r u c t i o n s , Se e Back o f Fo 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 ( Mu s t b e s ame as o n St a t emen t o f O r g a n i z a t i o n )

/ ) ' ! o n t oMer r t e ' i c , 1 2 t t ' ud WaMeASTATE CANDI DATES NOT : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI 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 THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROMTHE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code, 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 and s t a t e me 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 any commer c i a l p u r p o s e b y any 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 mmi t t e e s .

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 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 e m a k i n g a 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 m u 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 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 a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Pa ge 2 o f f o r m s p a c k e t . ) . I f s u r n ame 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 Pa g e o ff a m i 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 ( f o r S c h e d u l e A )

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h ed u l e )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT V 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 SERNUMBER I NCOMEI D# ~r ~t . t ~ 1 / e 5 t e r n5~31~p 5 CK# , 2 / t 7 U dmmer Ce Re- C ) DQ- KZ ` . ~~ l 3 0~ oS

I D# ~~ W e _ j t ~ e r r i Dc Ak . ~ 7 EDCK# 2 1 0 0 w~mPNLae r Pe d OakI D # 0CK#CK#I D#CK#I D#

aCK#I D #CK#I D#CK#I D# _CK#I D#CK#

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Fo r I n s t r u c t i o n s , Se e B a c k o f F o rCONTRI 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 )NAME ( M u s t b e same 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 )

~nf o j p z e r ~ou~ k ' u b l e' c t ~ Wan4 4 gSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CAT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me 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 ny 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 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 .

' 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 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 n y 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 i o n s h i p must b e s h o w n t o t h e t h i r d d e gr 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 a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( Se e P a g e 2 o f f o r ms p a c k et . ) . 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 n d i d a t e , b u t t h e r e i s n o P a g e 2 o f _f 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 . ( f o r S c h ed ul e A)

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 )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

[ ] / CHECK T HI S BOX I FAMENDI NG FORM

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 SERNUMBER I NCOMEC1 _ 3 1 , 6 ) 5 I D# Gr ea i We5Ee - r n bawk- $ F - 1CK# z i o o t ? , mme r c e - e e d e a k , ,Mo - 2 8 - 0 6 I D#

CK# ' L t v i 7: , 1 7 ,