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    FOc? I NSTRUCr ?ON5, 8FF I BACK OF FCRMDI SCLOSURESUMMARYPAGE

    COMMI TT EE NAME l u l u s ! b s a r n e a s o n S t a t e me n t o f Or g a n ; z z a # o n ) :` P a t C l i r t ` f o r S t a t e RL T r e s en t a r i v e

    I MPORTANT : i n t i t c a t e t y p e o f c o r n n r i t p e e y o u a r e r e p o r t r o g %;f ) S t s t e t r d e : L c , i s i a L V e C a n d , d a t t ; ' 3 ) S t a t e v A d e PAC ( 3 , S t i t e P a r t y ( - 0 ; ~ C u t : r i t y t L a c a l C a n d v d a t e{ S : I Go u n_ y Pk: i 6 ) 3 0 3 0 * r S y t r e ' ( ' r a n c h i s c Ca n " md t e o . ~ 7 , - 7 } ~ ? u c t i ; ~ r : C r t ; : : r r r t r a l C a a r n n i t t e e

    GANDJ DATE COMMI TT EES ONLY : 'Ca r d i d a t e Na meP a t r i c i a Cl i n eO f f i c e S o u g h 'S t a t c R .-- p r e s en t a t i v e

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    f 7 CHECK I F AMENDMENT TO REPORT

    DATE0TELEPHONE DATESI GN

    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 os s i b l e c i v i l a n d c r i mi n a l p en a l t i es .SEE I NSTRUC7 1ONS' ON BACK' AND COMPLET E THE FOLL OWI NG SENTENCE :

    I AMF LI NG Oc t o b e r 1 5 t h r o u g h O c t o b e r 2A - ~ REPORT FOR A I V J F , ( 1 ) E LECT I ON l ( 2 ) NON- EL ECT I ON YEAR( r e p w r i d a t e ) I n d i c a t e o n e

    P a = t yi t o p u b ) c a r tDi s t r i c t ( i f Se n a t e o r H o u s e

    Il : Ch e ,* i f t h i s i s f i n a l ; t e - mi n ab on ) : r e p u r t a n d a t t a c h No t c e o f Ui s s o l u t o n F c r m : DR- 3( Y o u r 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 a N o t ,~ e o f D i ~ s c l u t i c n i s f i e d )

    SUBTRACT TOTAL MONEY SPENT T HI S PER I ODS~ d u l e S ~ E x p e n d i t u r e s =a i ( A t t a c R Sc n e 3 ul e B) t " " a l s o ?Sc - e d u l e F : L o a n R e p a y m e r r t s t o t a l / A t t a c h Sc h e d u l e F ) " . , . . . . . . . . . . . . . . . . . . , . . .

    GASH ON HAND E t t h e e n c o f t h r 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 i 7 n U S t

    " * UNPAI D BI 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} : . . . . . . . . :

    ST ATEMENT { } F CASH 4NHANDCASH ON HAND a t t h e t a g i r m i t i g o r t h e r e p cMn 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 mo n i e s h e r db y t h e c o mmi t t e e . T I - i s a r n a u n t MUST b e t h e s a m e a s t h e c a s h a n h a n d a t : h e e n co 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 ~ ) e z e r o i f t h i s a f i r s t r e p o r t f l e e . ) . . . : . : . . . . . . . . . . . . . . . .

    ADD TOTAL MONEY: TAKENWT HI S PER I ODSc h o d u l e A ` Cash Cowr ; h t r t i o n s t o t a l ( 4 , , t a c h S o r r e r i u l e A ) ( " a l s o s e e m- k i n d b e l o wS ~Wc r l e F : L o a n s R e c ~ p i v e d t o t a l 1 A t t & r h Sc h e d u l e F ) . . . . . . . .Sc h e d u l e H : T o t a l S a e s o f Ca mp e i g n ? 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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    : C L > [ a a ma n b T 4 c: ye Ut T D e T O - . a 4 e 3 . _ . WC d 3 Wd 1 7 : C . . S t ) O Z / 9 /

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    FOR ; NS TRt } CT; ONS . - SEE f 3ACKOF FORM' COMMI TTEE NAME ( Mu s t b e 5 a- o r r s a n SWemen t ~ f t ~ . g a r n a h a n ~

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    : 0 / 2 9 / 2 0 0 - 0 1 1 : 0 3 FM - ~ M : F 3 t r i c i a Cl i n e An t i q ue - e k TO :

    FOR I NSTRUC7I OONS, SEE BACK OF FORMDI SCLOSURE SUMMARYPACE

    COMMI TT EE 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 o n )P a t C l i n e f i x ; S t a t e R r p r t s e u t a i v ~

    I A I PORTAN7 : i " I d a r e t y p e o f c o m m i t t e e y o u a r e( 1 ) S t a e wi d et ~ :; b t i v e C a n d i d a t e { 2 ) S t a t e w i & P( S) CoumPAC ( 6 ) a.

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    STATEMENTOFCASHONHAND

    Sc t i o du l e F L o a n Re pa y me nt s t o t a l ( A t t a c h S ch e du l e 1 7 ) . . . . . . . : . . . . , . . . : . . . . . . . , . . .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 r Y d l r e p o r t ; b a l a n ce mu s t

    b e z e r o ) ( A t t a c h D R - ~ 3 ) . . . : : . . . . . . . . . . . . . . . . . . . . . . . . , . . ." " UNP AI D BI LLS ( F r o m S c he d u l e f ) - A t t a c h Sc h e d u i e D . . . . . . . . . . . : . . . . . . . . . . . . . . . . .` I N K I ND CONTRI BUT I ONS ( F r a r r Sc h e d u l e - E A t t a c h S c l e c u l e E ) . : . . . . . . . . . .- OUTSTANDI NG LOANS ( F r o m S c h e d u l e F - A t t a c h - S c h e d u l e F ) .CANDI DATE COMMI TT EES ONLY ;CONSULTANT BR EAKDOWN ( S c h e d u l e GA t t a c h e d ?VALUE OF CAMPAMPROPERTY 1 F m r r n , R c h e i f l u l c; ~ - l - Af t n o t t S c h e d u l e H i

    1 5 1 5 2 8 1 1 1 ' ) ,

    CASH ON HAND o f t h e b eg i n ni n g o r 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 : e s h e l dp ' . ? h e e D i n m i t 1 e e . T h i s a r n o u n z MUST b e t h e s a f e a s t h e c a s h o n h a n d a t t h e e n do s t h e l a s t r e p o r t i n g p e r i o d , o r m u 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 i l e d . ) . . . . . . .ADDTOTAL MONEY TAKEN I N T H I S PER I ODS c h a d t i l e A : G a s h C o n t i i o u t i o n s t o t e ( A t t a c h S c h e d u l e A ) ( ' a l s o s e e i n - k i n d b e l o w ) . . . . .S c h e d u l e F . L o a r s s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . .S c h ed u l e - H , T o t a l S a l e s o f C a r t i p a i g . 1 P r o p er t y ( A t t a & S ch e du l e H) ,.. . . . . . . . . . .

    t h a d t i i e ' I 4 a pp l i es t o Ca nd i d a t e s ' Co mmi t t e es On l y )

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    I , 4 - A Z -S I RE OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNED

    La t e f i l l e d r epo r t s a r e s u bj e c t t o p os s i b l y c i v i l and c r i mi n a l p ena l t i es .SEEI NSTRUCTI ONSONHACKANDCOMPLETETHEFOLLOWINGSENTENCE:I AMF [ L i NG, 4 Gk ' i o bc r 1 3 $ x i o u g h + Oc t o t u r ? 6 _ ` _ . REPORT FORANI A 1 1 ) ELECTI ON : ( 2 ) N ON - E L ECT I ON YEAR

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    It yadwmt t o p t r wn t wi f t s pmv i d i ng o o r , 3u mn , a d v e r t i s m i g , f u n d - f a I s i n g , p o i f i n g , ma n a g i n g , o r g a n i z i n g s e t v ~ c e x mu s t a l s o b e d e t a i l i t e m i z e d c n,04 h e d d t 0 b y t h e i 4 mo u n t , i w r p o s a , a n d d a t i t o f e a r h t y p e o f e x p en o d ur e me" ; ? y t h e p e wn l e n f t o n b l e h a i f o f t h e c a n d i d a t e ' a c o mmi t t e e ; R e f e r t oSa e d u l e C. i n s h u c t i r x i s Fnd I o wa C o d e 6 8 A . 4 3 2 r - ) { ! ) . )

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