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.,DISCLOSURESUMMA - YPAGEMMI TTEE NAME ( Mu 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 )

h e Co mmi t t e e t o El e c t Da v i d Co l b er t

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

) 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 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) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mm i t t e e) S u p p o r t S l a t e o f C a n d i d a t e s

NATURE 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

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 po r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

I NSTRUCT I ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :

F I L I NG AJ a nu a r y 2 2 , 2 0 0 2

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

HECK I F AMENDMENT TO REPORT DATED

Kr i s t i ne A . Br e n n e r 7 1 2- 8 8 3- 2 9 06

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 F o r m DR- 3 .

( Y o u mus 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 . )

REPORT FORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- ELEC

STATEMENT OF CASH ON HAND

I n d i c a t e o n e

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 h i s amoun t MUST b e t h e

s 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 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

DR-2 DI SCLOSURE

( Re v . 0 1 / 9 8 )

IREPORT

F o r O f f i c e Us e On l y

Comm . #

I n d e x e d -

A u d i t e d

Co mp u t e r

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

J u n e 2 , 1 9 9 8

C o u n t y & L o c a l C o mm i 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

ADD TOTAL MONEY TAKEN I N THI S PER I OD - 0 -

Sc h ed u l e A : Ca 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 ed u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h ed u 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 ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0

Sc h ed u 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 ed u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - 0 -

( Sc h ed 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 )

SUB- TOTAL . . . . . $SUBTRACT TOTAL MONEY SPENT THI S PER I OD

Sc h ed 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 ed u l e F : L oa n Re p a y me n t s t o t a l ( A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 t

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

DATE

1 - 1 8 - 0 2

6 9- 3 5

69 . 3 5

- 0 -

0 . 0 0

I ~ 2 - L

6 9 . 3 5

AI D BI L LS ( F r o m Sc he du l e D - A t t a c h Sc h ed u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

KI ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h ed u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a . . . . . . . . . . . . . . . . $ 1 , 4 00 . 0 0

I NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0

NDI DATE COMMI TTEES ONLY :NSULTANT BREAKDOWN ( Sc he du l e G A t t a c h e d ? ) YES X NO

OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h ed u l e H) $ 0 . 0 0

JAN2 4 200

1 7 \

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BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :

o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g 5 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )

t o p e r s o n s / e n t i t i 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 mus t a l s o b e d e t a i l i t e m i z e d o n

G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h 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 o

G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

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

I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULE

' EXPENDI TURESB MONETARY

- - MONEY SPEN i r ROMCOMMI TTEE ACCOUNT( Re v . 0 9 / 9 7 ) EXPENDI TURES

PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VEDATES, L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I F

NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMS & CAMPAI GN DI SCLOSURE BOARD.

MI TTEE NAME ( Mu s t b e s ame 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 )

Th e Commi t t e e t o El e c t Da v i d Co l b er t

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

DED ( 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

DD/ YR) AND PAC

CHECK

NUMBER

I N Do na t i o n

- 1 5 - 0 2 Ci t y o f Dan bu r y ( Ba l a n c e l e f t i n a c c tCK# 1 0 3 5Gene r a l F u n d Di s so l u t i o n o f Co mmi t t e e )

$

6 9 . 3 5

I N

CK#

I D #

CK#

I D #

CK#

I D #

CK#

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CK#

I D #

CK#

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CK#

S U B - T O T A L $ 6 9 . 3 5

TOTAL ( I f l a s t p a g e o f t h i s s c h ed u l e ) $ 6 9 . 3 5

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I NSTRUCTI ONS, SEE BACK OF FORM

MMI TTEE NAME ( Mu s t b e s ame as o n S t a t e me O r g a n i z a t i o n )

Th e Co mmi t t e e t o El e c t Da v i d Co l b er t

r e l a w r e q u i r e s c a n d i d a t 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 n i n k i n d c o n t r i b u t i o n t o t h e

mi t t e e . R e l a t i o n s h i p mus t b e s h ow 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 ) an d a f f i n i t y ( r e l a t i v e s

ma r r i a g e ) . ( Se e Pa g e 2 o f f o r ms p a c k e t . ) i f s u mame 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

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 .

FSCHEEE

( Re v . 0 8 1 9 7 )

I N

CONTRI Bk

p CHECK T HI S BOX I IAMENDI NG FORM

Pa g e 1 o f I

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

DATE

CEI VED

I DD/ YR)

NAME AND ADDRESS

OF CONTRI BUTOR

RELATI ONSHI P

TO CANDI DATE

' ( i f a p p l i c a b l e )

DESCRI PT I ON

OF I N K I NDCONTRI BUTI ON

ESTI MATED

FAI R MARK ET

VALUE

J I F FOR

FUND- RAI SER

CONTRI BUTI ON

1 - 1 5 - 0 1 Da v i d Co l b e r t s e l fL o a n Fo r g i v e

Di s s o f Comm)

S

1 4 0 0 . 0 0

JSUB- TOTAL S

1 40 0 . 0 0

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 )

S

1 4 0 0 . 0 0

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

T h i s f o r m i s n o t a p p l i c a b l e t o 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

Not i ce of Di s sol ut i on

E v e r y N o t i c e o f D i s s o l u t i o n s h a l l b e a c c o mp a n i e d b y a

c o mp l e t e d D i s c l o s u r e R e p o r t Fo r m c u r r e n t t o t h e d a t e o f

d i s s o l u t i o n

COMMI TTEE NAME

E f f e c t i v e d a t e o f d i s s o l u t i o n

J anua r y 1 8

S i g n a t u r e f T r e a s u r e r

J anua r y 1 8 , 2 0 0 2

Da t e S i g n e d

FORM ( R e v 0 2 1 9 6 )

F o r O f f i c e Us e O n l y

DR-3

NOT I CE OFDI S SOLU T I ON

Comm. # f 2 :I n d e x e d

A u d i t e dComp u t e r S

C e r t i f i e d Da t e o f D i s s o l u t i o n

x ' 9 - 20 . Q 2

OWWWWBOA

J AN 2 4 200

T HI S BOX APPL I E S TO CANDI DATES ' COMMI T T EES ONLY :

1 , t h e c a n d i d a t e , c e r t i f y t h a t my c a n d i d a t e c o mm i t t e e ' s c a s h b a l a n c e i s z e r o , a l l d e b t s , o b l i g a t i o n s a n d l o a n s h a v e b e e n p a i d o r s a t i s f i e d i n a c c o r d a n c e

w i t h l a w a s s h o w n o n my c o mm i t t e e ' s f i n a l r e p o r t a n d a l l c a m p a i g n p r o p e r t y a n d l e f t o v e r f u n d s h a v e b e e n d i s t r i b u t e di n a c c o r d a n c e w i t h my

c o mm i t t e e ' s l a s t f i l e d S t a t e me n t o f O r g a n i z a t i o n .

WHEN TO FI L E :T h e N o t i c e o f D i s s o l u t i o n mus t b e f i l e d w i t h i n t h i r t y ( 3 0 ) d a y s o f t h e c o mm i t t e e ' s d i s s o l u t i o n , w i t h a c o p y o f t h e

f i n a l b a n k s t a t e m e n t a t t a c h e d

O f f i c i a l Name o f Commi t t e e

The Commi t t ee t o El ect Dav i d Col ber t

S t r e e t

4 6 1 4 320 t h

C i t y , S t a t e , Z i p Co d e

Danbur y I Owa 51019

Ar e a T e l e p h on e

C o d e

7 1 2 ) 883 - 2023