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FOR I NSTRUCTI ONS, SEE BACK OF F dJ AN 2 2 2 ~WI S1CLOSURE SUMMARY PAGE

C~ I AMI 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 )T 3 a t o I SYS I n =AV- . ~ e b i z . 4 ~ - ' 2I 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 C a 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 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 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 sSI GNATUREOF TREASURER ( o r 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

I AM F I L I NG A

Ro u t i n e Pe na l t i e s Du e F o r L a t e F i l e d Re p or t s Range f r o m $ 2 0 t o $ 8 0 0

[ ] CHECK I F AMENDMENT TO REPORT DATED( r e p o r t d a t e ) I n d i c a t e o n e

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 F o r m DR- 3 .( Y ou 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 . )

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b eg 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 amou n 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 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 i l e d . a

ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc h e d 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 e du l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o an s 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 Sa l e s o f Campa i g n Pr o p e r t y ( A t t a c h Sc h e du l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e du l e H ap pl i e s t o Ca n di d at e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e du l e B : Ex 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 yme n t s t o t a l ( A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 7 . 6

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

FORMDR- 2( Re v . 0 1 / 9 8 )

F o r O F f i a e Us e On l yComm . #I n d e x e dA u d i t e dCompu t e r

DI SCLOSUREREPORT

U_ L )G. CJ

y~< : ~ . 4 1 1, i ; ~

SEE I NSTRUCTI ONS ONBI LKAND COMPLETE THE FOLL OWI NG SENTENCE :_ I . 0zDe c _ e , mh e r I / REPORT FOR A N/ A ( 1 ) ELECTI ON I ( 2 ) NOWELECT I ON YEAR .nL 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

Co 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

UNPAI D BI L L S ( F r o m Sc h ed u l e D - A t t a c h Sc h e du l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ l l o Qz -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 LOANS ( 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h e du l e G A t t a ch e d? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e du l e H - A t t a c h Sc h e du l e H) $ -

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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKE

( 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 a s o n S t a t e me n t o f Or g a ni z a t i o n) 0 CHECK THI S BOX I FAMENDI NG FORM

SCHEDULEA I MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS 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 pi e d f r o m r e p o r t s a nd 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 i o n s o rf o r a ny c omme 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 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

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

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 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 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 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 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 umn . ( f o r Sc h e d u l e A)

DATE ( - PAC 1 1 5 NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FU( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NC

/ U - 4 - O/ CK# OY, L: G " 7~ i o - J - . 0 CUI D# A a s k . e r -CK# ~U 6 " J C 3 t --L ' z Q ' v rI D#

I D# ~Oie~ . f c ea -o - J -7 -. z49 7 0 , E g yp

D# SF~ ~o " : ~ i C / s o - ~CK#D# T/ ~ " ~ l ~ e e r ~ /C~OmrnNhJL, l x e ~ ~ r ! / n __D# ~r L ,

I D#CK# 39J d , / Y 3 o y J ~' ~f l 7 r fL Z2 ~- z v / o o ~L~ . 5 ~1 a% : J~aJD#CK# obi y aye = ~ 5 = " - . r 1 s ' t t . _ , , _ / fw6z c x X ,CK# 0 e 7 / 0; 7 44 0 99 Al W

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T HI S BOX APPL I ES T O CANDI DATES' COMMI TTEES ONLY :P u r c h a s e s 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 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H ( R e f e r t o S c h e d u 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 / 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 er 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 mu s t a l s o b e d e t a i l i t e mi z e d o nS c h e d u l e G b y t h e a mo 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 mm i t t e e . ( R e f e r t oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 5 6 . 6 ( 3 ) ( i ) . )

Page 4 , o f

( f o r S c h e d u l e B )

FOR I NS TRUCT I ONS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOT E : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T T HE CANDI DATE I D EN TI F I CA T I ON NUMBER I N T HE DESI GNATED COLUMN AND T HE 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 FROM T HE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu 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 )

a l - s ur e - 0 6 or 1- r -6. k / 11 C_ -CANDI DATE NAME ANDADDRESS T OWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI 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( MM/ DD/ YR) AND PAC

CHECKNUMBER

1 D # - L , 3 6 _ S . G.~ f ~ ? - q . r E . J 7 r - . nV ` f v2Yl ' Z%CK#D#CK#I D #CK#1 D #CK#D#CK#1 D #CK#1 D #CK#

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) $ 7 r 3 d ~ s - 7

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FORI NSTRUCTI ONS, SEEBACK OF FORACOMMI TTEE NAME ( Mu s t b e s ame as o n St a t eme n t o f O r g a n i z a t i o n )~4h~~bSo- ~ ~r S~ww ~pt ~3 e ? iNOTE : De b t s p r e v i o u s l y r e p o r t e d t h a t r e m a i n u n p a i d mu s t b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a n y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

DEBTS/ OBLI GATI ONS REMAI NI NG THI S REPORTI NG PERI OD( DONOT I NCLUDE LOANS - - SHOWLOANS ON SCHEDULE F )

- i f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i ma t e d " b e s i d e t h e f i g u r e .

SCHEDULED I I NCURRED( Re v . 0 8 f 9 8 ) I NDEBTEDNESSQCHECK THI S BOXI F AMENDI NGFORM

An " i n c u r r e d d e b t " i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f w h e t h e r a n i n v o i c eh a s b e e n r e c e i v e d .

Pa ge-/o f1( f o r S c h e d u l e D)CANDI DATE COMMI TTEES NOTE:* I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o r d e n t i t y w i t h wh om t h e c a n d i d a t e ' s c o mmi t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e . E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s 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 ro r g a n i z i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e a n d t h e e s t i ma t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o ns u l t a n t .

DATEI NCURRED( MMI DDI YR) NAMEANDADDRESS OF PERSONTO WHOM DEBT OR OBLI GATI ON I S OWED

DESCRI PTI ON OF GOODSORSERVI CES PROVI DED ORPURCHASEDBALANCE OWED ATCLOSE OFREPORTI NGPERI OD*

~ 4r ~ i e - ~Or ~ ~oSt v / t i c , ~ 60A 71e e - $

LG G~ ~ . 3o d

SUB- TOTAL $

TOTAL DEBTS OWED BY COMMI TTEE AT THE END OF THI S REPORTI NGPERI OD $