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FORI NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PACOMMTEE NAME ( Mu s tobt same aeon S ( a ( e s n e ~ t f o ' &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 2 1( 1 ) S t a t e w l d e N _ e g l s t a t N 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 ( 8 ) 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( 8 ) S u p po r t S l a t e o f C a n d i d a t r p

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 ) TEL EPHONE

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 o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ON BACK AND COMPL ETE THE FOLLOWI NGSENTENCE :

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

[ ] CHECK I F AMENDMENT TO REPORT DATED

0 C h e c k i f t h i s i s f i n a l ( t e r mi 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 .( Yo u mu s t c on 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 e gi 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 a mo u n t MUST b e t h es a m e 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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

( S c he d 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 v lSUB- TOTAL . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODS c he d u l e B : Ex p e nd i t u r e s t o t a l ( A t t a c h S c he d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he d u 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 S ch e du 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 ce mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ .

1172Vd~DATE S I GN D

I AM F I L I NGA t %CL e r ' 4 o r , 3 I l Z C 1 0 > REPORT FOR A N/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL E CT I ON YEAR.I n d i c a t e o n e

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 nCo u n t y & L o c a l C o mm i t t e e s , e n t e r Co u n t y i nw h i c h E l e c t i o n i s h e l d

2 3 z " 3 3%351 , . o e

t i t 8 , o q . i -z rUNPAI D BI L L S ( F r o m S c he d u l e D - A t t a c h S c he d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m S c he d u l e E - A t t a ch S c he d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ OOUTSTANDI NGLOANS ( F r o m S c he d u l e F - A t t a ch S c he d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY:CONSULTANT BREAKDOWN ( S ch e du l e G At t a c he d ? ) YES V" ' NOVALUE OF CAMPAI GN PROPERTY ( F r o m S ch e du l e H - A t t a c h S c he d u l e H) $ t '. >


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Fo r I n st r u c t i o ns , SeeBack o f Fo r mCONTRI BUTI ONS- MONEYTAKENI 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 TTEENAME( Mu s t be same a s on St a t e me n t o f Ot y a ni z a t i o n)

ors 4C-4c-4STATECANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ONCOMMI TTEE) , L I S T THEPACI DENT I F I CATI ONNUMBER AND THEPACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S TOF I D NUMBERS I S AVAI LABLE FROM THEI OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 66B. 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 ma t i o n c op 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 c omme r 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 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 aw r e q u i r e s c a nd i d a t e commi 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 an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must be s hown 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 bym a r r i a g e ) ( Se e Page 2 o f f o r ms p a ck e t . ) . I f s u r n ame o f o o n t r i b u t o r i s t h e same as c an di d a t e , b u t t h e r e i s nof 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 umn .

SUB- TOTAL

TOTAL ( i f f a st page o f t h i s sch ed u l e )S

Pag e Of-( f o r Sc h e d ul e A)

SCHEDULEA MONETARY

( Re v . O6 / 9 7 ) RECEI PTSQ I / CHECK T HI S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT + 1 I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOM

cK#, 2yg3 4 1 . 3 2 . 6 ? s w r 1 ~ ; - t omDe3 wt - o , v t r - s . 3 1 ' 3I D # C, -ML c e n U. e h I , n~ .CK# 2 7 o f t L-w" e r " . i n e~ t ZS~. v c )

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Fo r I n st r u c t i o ns , See Back o f Fo r mCONTRI BUTI ONS-MONEYTAKENI N

( I n d 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 ds )COMMI TTEENAME( Mus t b e s ame a s o n St a t e me n t o f Or g a ni z at i o n)

/ 74I t -4STATECANDI DATES NOTE: I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P O L I T I C AL . ACT I ON COMMI TTEE) , L I S T THEPACI DENT I F I CATI ONNUMBER AND THEPACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S TOF I D NUMBERS I S AVAI LABLEFROMTHEI OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 68B. 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 ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c omme r c i a l p u r p o s e b y an y 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 es .

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

SCHEDUL EA MONETARY( Re v . =97) RECEI PTS

CHECK T HI SBOXI FAMENDI NGFORM

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 ommi 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 r an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p mu s t b e s hown 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 b yma r r i a g e ) ( Se e Page 2 o f f o rms p a c k e t . ) . I f s u r n ame o f c o nh i b ut o r i s t h e s ame as c a n di d a t e , bu t t h e r e i s n of 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 umn . ( f o r Sc h e d u l e A)P a g e

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MMI DD/ YR) AND PACCHECK ( I f a p p l i c a b l e ) RAI SENUMBER I NCOMI D* ~Lt v/ r6/ $ ' rCK#

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I D# 5 K 5 , ` - e f , t - rw. u r n ,CK# >- Wu ~- t- t sseI D# Ji mwn l i e ij U . CK# 6 I s L ~u M4 k i n l ` y ! ~ P ' Y I - cI , ~ c5 / 1 ? v i nt S . 0 3 J - ICK# 3~v 5~~ ~ T l ~ - ya m l f r l l s v ~ ~y I . . ~f ? e r _, n s . 3 2 1

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Fo r I n s t r u c t i o ns , See Back o f FoamCONTRI BUTI ONS-MONEYTAKENI 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 TTEENAME( Mu s t be s ame a s o n St a ) e me n t o f Or g a n i z a t i o n)

SCHEDULE

( Re v . W97)A MONETARY

RECEI PTSCHECK THI S BOX I FAMENDI NGFORM

STATECANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THEPAC I DENTI F I CATI ONNUMBERANDTHE PACCHECKNUMBER I N THEDESI GNATED COLUMN. AL I S T OF I D NUMBERS I S AVA I LABLEFROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c omme r c i a l p u r p o s e b y an y 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 .

PageD 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 ommi 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 an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p mu s t b e s h own 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 ) and 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 ) ( Se e Page 2 o f f o r ms 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 same as c a n d i d a t e , b u t t h e r e i s nof a m i l i a l r e l a t i o n s h i p , e nt 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 Sc h e du l e A)Of

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MMI DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMi 0 1 1 l o f I D# ~ r r ~ i 3ook NCK# 7 o d r , $ / DUDAr s mor es, S- D3 C,v ( I D# 6610 / . T p w , - t e e u , " / ' r s F c ~

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Fo r I n s t r u c t i o n s , Se e Ba c k o f F o 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 TT E NAME ( Mus t b e s ame n S t a t eme n t o f Or g an i z at i o n)

J f i C sv

SCHEDULE( R ev - 0 6 1 9 7 )A MONETARY

RECEI PTSaCHECK THI S BOXI F

AMENDI NGFORM

STATECANDI 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 THEPAC I DENT I F I CATI ONNUMBER ANDTHEPAC CHECKNUMBER I N THEDESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Sec t i o n 66B . 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 ma t i o n c o pi e d f r o m r e p o r t s and 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 ns o rf o r any c omme r 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 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 es .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h e du 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 commat 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 an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p mus t be s h o w n t o t h e t h i r d d eg 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 bym a r r i a g e ) ( Se e P a g e 2 o f f o r ms 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 di d a t e , b u t t h e r e i s n of a mi l i a l r e l a t i o n s h i p , e nt e r ' n ot 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 u I s A)

P a g e __4 o f

DATE P AC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D#c K# L t w 4v 9 ( nwi - e _ $ / 5 Z ) . 0 0I D# Zvh e r } 5

, "f . SZ~LiI D# e 4r ~ c I I G 4 , ! l e t il l ~ a L v . v CK# ~ ZZ ho . ~ - c l o o , v~K i % - - 6 L I i b l ,~ ~ 5fM

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c K# 3 g ~ Fr k i ~ ~ l 4 ~~ I ZG' A tI D# z t n tCK# 3G + - nv . 1 i ~ f -26' YuToa n '


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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 F o r mCONTRI 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 TT EE NAME ( Mu s t b e s a 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 C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E PAC ( P O L I T I C A L A CT I O N C O MM I T T E E S L I S T T HE PAC I D EN T I F I C AT I O NNUMBER AND T H E P A C CHECKNUMBER I N T HE D E S I G NA T E D COLUMN. A L I S T OF I D NUMBERS I S A V AI L A B L E F R OM T H E I OWA E T H I C S AND C A MP A I G ND I S C L O SU R E BOARD .CAUTI 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 ma 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 mmi t t e e s .

SUB- TOTALTOTAL ( N l a s t p a g e o f t h i s s c h e d 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 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 P a g e 2 o f f o r m s p 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 am e 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 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 )

SCHEDUL EA MONETARY( R e v - O B / 9 7 ) RECEI PTS/ ~ CHECK T H I S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL ATI ONSHI P AMOUNT + 1 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ D D / Y R ) AND PACCHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM1 1 - ~, u I D # a e 4 / j A ? - Aj u , i r j t 2 K~ s I v f v

CK# i - 7 1 6 't " . v - r II D # r _CK# q l v l ~I D #CK# S - 7 ~ ` l - ~ N ' t " v v k - c 3 r iI D # " ,V4- 0 I UYGr 4 a t 8 ' - ' ~ - ,CK# y l x . - _ 3 0 v_3


7/13

Fo r I n s t r u c t i o n s , See Back o f FonnCONTRI BUTI ONS-MONEYTAKENI 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 T ENAME

STATECAND I D I I-TdNOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEES L I S T THEPACI DENT I F I CATI ONNUMBERAND THEPACCHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THEI OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s and 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 any c omme r c i a l p ur 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 .

TOTAL ( i f l a s t page o f t h i s s c hed 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 nd i d a t e commat 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 st b e s h own 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 f l y ( r e l a t i v e s b y

m a r r i a g e ) ( Se e Pa 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 an di d a t e , b u t t h e r e i s n of 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 .

SUB- TOTAL

SCHEDULEA MONETARY( Re v . =97) RECEI PTS

~ / CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI S ENUMBER I NCOMI D# " y Z t i I ~~. ~ h C'J l - ~ 1

~L5 / ~ d oGo+c ' S 5 t i 3 !I D# R e - n

O - C, e l i t vf i t . r _ S _ L(I D# 1v~ l h ~r f - , 4 3 ~ f , ~ / J ~ " w- l ox t /0 1 CK# 6 7 1 1 4 D~ ' 1 - 2l h , _ II D# ~v J o s s L 4 ~ l0/ CK#I D#

Y r t iI D# U. r~Ct c e A k a ~ ' l 3, h f 7 -CK# / S- z30 - ' - l P L . nUl p~$ ~" 3I D# h J 4 " t Gam r ( So r t~2 P~ ' ~~ . si s ~2 0 r f cCK# 0 - , - n - n S . S ~ ' v 3 D 6I D# pc r t AoU4 - At gULhI . C " ' J zi i r e t ' 1CK# 1 - t 1 bs 6r&y. e - ~rv0 1 +t jI D# I D c t v % LA) I N49c r r r - Re- - .

) 2-40 - G~ f 2 Ui ' 1 - P I / 6VcK#1 , 6 - > Dr ~ l Svgs

~1I D#

CK#~aa

sv


8/13

Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN 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 be same a s o n St a t e me n t o f Or g a n i z a t i on )

STATECANDI DATES NOTE: I F ACONTRI BUT I ON I S RECEI VED FROMASTATE PAC( P OL I T I CA L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBERAND THEPACCHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CSAND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se 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 ma t i o n c o pi 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 on t r i b u t i on s o rf o r any c omme r 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 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 es .

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 ommi 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 wn 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 ) ( Se e Pa ge 2 o f f o r ma p a c k e t . ) . 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 sa me a s c an di d a t e , b u t t h e r e i s n of 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 .

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

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECE I PTSQ/ CHECKT HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D#CKS 2 - 2 - ZUI D#CK#I D#CK#I D#CK#I D#CK#I D#

CK#I D#CK#I D#CK#I D#CK#I D#CK#


9/13

T HI S BOX A PP L I E S TO 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 m p 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 m u 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 n x t i o n e . )E x p e n d i t u r e s t o p e r s o n s l e n d f 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 m u s t a l s o b e d e t a i l i t e m i z e d o nS c h e d u l e Gb 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 mmi t t e e . ( R e f e r t oS c h e d u l e Gi n s t r u c t i o n s a n d I o w a C o d e 5 6 . 6 ( 3 ) ( i ) . )

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

STATE PAC COMMI TTEES : NOTE : FOR CON T RI B UT I ON SMADE TO STATEWI DE OR L E G I S L A T I V EC A ND I D A T E S , L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND T HE 0 CHECKTHI S BOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMENDI NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu 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 )

1 ` - C - - cCANDI DATE NAME AND ADDRESS TOWHOM 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 m e n t ) WASMADE( MMI D DI Y R ) AND PACCHECKNUMBERa t I D# 4 i oc~ S - ( u = ~ n S

CK # 3S . = r . 5 ~ r s ~~ l $ 2 ) 1 = Oe - )I I D V k l . a " ` 5 ' 7 ~ 5 r L- u t I D # j t t , ~ i " ' t x < . . = , F= . ~ , . < < . / r r. / , t - ' 7 i c v v ~ r y wt = / . e , / . / o c ~ t z ' J ~ , U( . %47CK #. U l I D # A4 t d WX1 f { - - SVCS I cum ~ e r c r ^ ( , 0. c 1 uJ ~ d ; L f ~ iCK #

L~ao 5CK # I - DSUB- TOTAL $ / 3 ~S Z p d

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 ) $


10/13

T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEE S ONLY :P u r c h a s e s o f c e r t a i n c a m p 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 l 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 m u s t a l s o b e d e t a i l I t e m i 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 m m 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 l a m C o d e 5 8 . 8 ( 3 ) ( 1 ) . )

P a g e-2- o f :2 41( f o r S c h e d u l e B )

FOR I N STRUCT I ONS , SEE BACK OF FORM SCHEDUL EEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCON TRI B UT I ON S MADE TO STATEWI DE OR L E G I S L A T I V EC A ND I D A T E S , L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COL UMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMEND I NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTE E NAME ( M u s t b e s am e a s o n t a t e m e n t o O r g a n i z a t i o n )/ I l , k t

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACT I 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/ D DI Y R ) ANDPACCHECK _NUMBER _14 l t e S

3 i ~ -1 D# - ( Z C~ J ~ L S " a r s ~~fCK #I D#i o , 1 6 0 - ,CK # ~ - ~ - S v 3 + ~I D# i 1 u &c v t 1( , u t c , vx v, Sc K# S' Z ' ~ r k ~ o3t (

t 1. L. U 1 I D # j , ( ~ c c - ~ c f c l S C. & rc~. . - t + ~

I D # t S , Pd S f u S- f . ~ V / 0 , s r ~ g . u iCK # ~~ I ` L ~ O r u c ~ r ~h S e r i fI D # l t i Gr r t t o v ~ ~=>t 3U t . c . w . v c v s ~ _CK #CP W l a , 5 v 3 ~ y s

WP " - - t - L 0 17 - 0TOTAL ( N l a s t p a g e o f t h i s s c h e d u l e ) $


11/13

T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEE S 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 m o r e m u 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 n w n s t e n t l 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 a 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 m u s t a l s o b e d e t a i l i t e m i 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 Io wa C o d e 5 8 . 6 ( 3 ) ( 1 ) . )

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

FOR I NSTRUCTI ONS , SEEBACKOFFORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . = 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E G I S L A T I V EC AN DI D AT E S , L I S T THE CANDI DATE I D E N T I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND THE 0 1 CHECK THI S BOX I FPA C CHECK NUMBE R FOR EACH EXPENDI TURE. A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMENDI NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD.COMMI TTE E NAME ( M u s t b e s am e a s o nStoY ~enf~wn

CANDI DATE NAME AND ADDRESS TOWHOM 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 ) WASMADE( MMI D D I Y R ) AND PACCHECKNUMBERI D #CK #

/ U fI ~ / t i D f ) A ot Wr r , ~ n u u- { vdL x . c lCK# 572 8

0 1 I D # Lc K# 2 0. . s 4 y 7 a r n " SI D # p v g y n S Tc v p ~ ' ~ 7 uS ~- oCK # 5 3 ( 6 L l n I v . ~ r s ~I D #CK #I D #CK #I D #CK #I D #CK #

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


12/13

T HI S BOX APPL I E S TO CANDI DATES' COMMTTEES 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 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 e r t i s i n g , f u n d - r a i s i n g , p o l f 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 m i 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 ma d e 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 nd I o wa Co d e 5 8 . 8 ( 3 ) ( 1 ) . )

FOR I NS TRUCT I ONS , SEEB&4CKOFFORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . =97 ) EXPENDI TURES

STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE ORLEGI SLAT I VECANDI DATES, L I ST T HE CANDI DATE I DENTI F I CAT I ON NUMBER I N THE DESI GNATEDCOLUMN AND THE 0CHECK 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 THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTA. g NAME b e asat ement o f_(Must Or g a n i i o n )

CAN&DATE NAME ANDADDRESS TOWHOM 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/ DDI YR) AND PACCHECKNUMBERI D # r J ~L~S7 r t ~~ ~u~ S ~ L 1 ~vACCCK# 7 2 &. - g

7 A0 Ib< - 0 bi ov i t ~ w l

I D #CK#D#CK#D#CK#I D #CK#I 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 )


13/13

FORI NSTRUCTI ONS, SEEBACKOF FORMcoM~NAME ( Mu s t b e sawa s a n nWWon)NOTE: 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 ma i n u np a i d r u s t b e i n c l u d ed a n t h i sS c h ed u l e , a s w e l l a s a n y new o b l i g a t i o n s I n a x r o d i n t h i s p e r i o d .

SCHEDULED I NCURRED( Re v . 0 8 1 9 8 I NDEBTEDNESS

CHECKT HI S BOXI F AMENDI NGFORM

M' i n c u r r e d d e b t i s a d e b t f o rDEBTSI OBLI GATI ON8 REMAI NI NGT HI S REPORTI NGPERI OD g o o d sas e r v i c e s o r d e r e da( DONOT I NCLUDE LOANS - SHOWLOANS ON SCHEDULE F ) r e c e i v e d , b ut no 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 wh 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 .

' I f a c t u a l f i g u r e i s unknown , s h o w " e s t i ma t e d ' b es i d e t h e f i g u r e . par . / o f( f o r S c he d u l e D)

CANDI DATECOMMI 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 N e n t i l y wMh whom 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 eac o n t i n u i n g p e r f o m r a r r c e . E nt e r t h e name o f t h e c o n s u l t a n t who p r o v i d e s ap r o c u r e s s e r v i c e s f o r I t e ms s u c h a s a d v e r t i s i n g , f o r d - r a i s k q , p o l l i n g . manag i n g , o ro r g a n i z i n g s e r v i c e s . R e po r t o n S c h e du l e G t h e n a t u r e o f p e r f o r ma nc e a nd t h e e s t i ma t e d p e r f o r ma nc e r e a s o na b l y e xp e l l e ddt h e c o n s u l t a n t .

DATEI NCURRED( MM/ DD/ 1 ' R)

NAME ANDADDRESS OF PERSONTOWHOMDEBT OR OBLI GATI ON I S OWED

DESCRI PTI ON OF GOODS ORSERVI CES PROVI DEDORPURCHASED

BALANCEOWED ATCLOSE OFREPORTI NGPERI OD'

~ 2 - 3 - U~ C rI ? 3 9 C J r a - , c YDI - 4 : 3 K40 1 wA 4 ' ~ S1 3 ) 6

P . ~ , KA - , ~ . 7

S U B - T O T A L $TOTAL DEBTSOWEDBY COMMRTEE AT THE ENDOF T HI S REPORTI NGPERI OD

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Hatch Jack__1304__scanned

Hatch Jack1304scanned

Hatch Jack1304scanned