independent insurance agents of iowa pac6052scanned

8/7/2019 Independent Insurance Agents of Iowa PAC__6052__scanned

1/19

FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURESUMMARYPAGE

COMMI 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 )I n d e p e nd e n t I n s u r a n c e A ge n t s o f I o wa PACI MPORTANT : I n d i c a t e b y # 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 : =( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PA C ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PA C ( 9 ) C i t y PA C ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PA C ( 1 1 ) L o c a l B a l l o t I s s u eCANDI DATE COMMI TTEES ONLY :Ca n d i d a t e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

O f f i c e S o u g h t D i s t r i c t ( i f Se n a t e o r H o u s e )

SI GNATURE OF PERSON F I L I NG REPORT

I AM F I L I NG A( r e p o r t d a t e )

K I F AMENDMENT TO REPORT DATED 1 0 / 1 9 / 2 0 0 4

TELEPHONE

F - 1 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 D R- 3 .( Y o u mus t c o nt i n u e t o f i l e r e p o r t s u n t i l a D R- 3 i s f i l e d . )

REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- EL E CT I ON YEAR .I n d i c a t e b y # F1

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 o t a l o f a l l f u n d 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 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 do 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 ODSc h e 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 Sc 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) . . . . . . . . . .Sc h e 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 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 Ca mp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H ap p l i e s t o Ca nd i 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 d u 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 d u l e B) ( * * a l s o s e e d e b t s a n d l o a n s b e l o w ) . . .Sc h e 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 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 al a nc e mus tb e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * 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 d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N KI ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h e d u 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 At t a ch e d ? )VALUE 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) $

FORMDR- 2 DI SCL OSURE

( Re v . 0 7 / 2 0 0 4) REPORTF o r Of f i c e Us e O r l l yComm. # I b 1 0 5 2L o g g e d I n 0 1 6S c a n n e dCo mp u t e rA u d i t e d

L at e r e p o r t s a r e s u b j e c t t op os s i b l e c i v i l a n d c r i mi n a lp en a l t i e s .

_ f i b 6 2 - . 1 ( o " 'DATE SI GNED

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

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

1 8 , 6 5 7 . 2 1

5 , 2 9 0 . 0 0

1 7 , 5 8 0 . 0 0

6 , 3 6 7 . 2 1

YES NO


2/19

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 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 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 , m a 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 m o 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 G i n s t r u c t i o n s a n d I o w a Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

Pa ge 9_ _ _ _ _ _ _ _ _ _ o f 9- - - - - - - - - -

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

FOR I NSTRUCTI ONS, SEE BACK OF FORM R e s e t F o r m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE P A C COMMI TTEES : NOTE : F OR CONTRI BUTI ONS MA DE T O STATEWI DE OR L E GI S L AT I V ECANDI DATES, L I S T TH E CANDI DATE I D E NT I F I C A T I O N NUMBER I N TH E DESI GNATED COL UMN AND TH E RI CHECK T HI S BOX I FPA C CHECK NUMBER F OR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A V AI L A BL E F ROM TH E I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCL OSURE BOARD .COMMI 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 )

I n d e p e n d e n t I n s u r a n c e A g e n t s o f I o wa PACCANDI DATE NAME A ND ADDRESS TO WHOM 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 ) WAS MADE( MM/ DD/ YR) AND PA CCHECKNUMBERI D # Ma r k S h a c k e l f o r d S i l e n t A u c t i o n - B i d I t e m9 / 1 5 / 2 0 0 4 5 2 0 0 M e t c a l f A v e n u e I n c o r r e c t amou nt o n o r i g i n a l $ 4 8 0 . 0 0C K # 2 8 0 4 O v e r l a n d P a r k KS 6 6 2 0 1 r e p o r t - s h o w n a s $ 2 4 0 . 0 0

I D #CK#1 D #CK#1 D #CK#D#CK#D#CK#I D #C K#I D #C K#

SUB- TOTAL $ 4 8 0 . 0 0TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) $ 1 7 , 5 8 0 . 0 0


3/19

OCT . 1 9 . 2004 4 : 1 4PM 515 222 0610FOR I NS ' r RUC7 7 0 N S, SEE BACK OF FORMDI SCL OSURE SUMMARY PAGE

COMMI TTEE NAME ( M u s t b e s ame e s o n S t a t e m e n t o f Or g ar ~ e t i o a)

I MPORTANT : I n d i c a t e b y * t y p e o f o o mf o l t e e y o u O r e r e p o r t i n g f o - , - =( i ) S t a f w i d e / L e g l s l a t l v a i j u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PA C ( 3 ) S t a t e p a r t y( a ) C o u n t y C e n t r a l C o mm i t t e e ( 5 ) C o u n t y C a n d l d a t e ( B ) C l a y Ca n d i d a t o ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d Me l o n C a n d i d a t e ( Q ) C o u n t y PA C ( 9 ) C4 PA C ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B e g o t I s s UOCAN DI DAT E C OMMI T T E E S ONLY:C a n d i d a t e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

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

] CHECK I F AMENDMENT T O REPORT DATED[ ] Chec 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 O { ! . ~ . -( 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 DR4 i ` s f i l e d . )

D l s a i d ( f S e n a b o r H o u s e )

1~; I - t o o t . o 0TEL EPHONE

STATEMENTOFCASHONHANDCASH 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 ome o f a l l ( a n d s h e l d b y t h er n m m i t t i e e . T h i s amou nt MUST b e t h e s ame a s t h e c a s h o n h a n d e b b s an do f t h e l a s t r e p o r t i n g p er i o d o r mu s t b e t a 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 MONEYTAKEN ( N THI S PERI ODS c h e d u l e A: Cash 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 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 n 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 e d u l e H : T o t a l S a l e s o f Camp a i g n P r o p e r t y ( A t t a c h S c h e d u l e H ) , . , . . . . . . . . . . . . , . , . . . . , . . . . . . . t S~ . h e d u l e H a Qn l l e s mC a n d l d a t e t t , Gamml ~s o n l y ) ,SUBTOTAL , . . . . ;

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODS c 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 S c h e d u l e B ) ( ' " a l s o s e e d e b t s an d b a n e b e l o w ) , . S c h e 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 c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASHON HAND a t t h e e n d o ! 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 mu s tb e z e r o ) ( A t T w c h DRS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ." UNPA I D BI L L S ( F r o m S c h e d u l e D - A t O s o h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " I N KI ND CONTRI BUTI ONS ( F r o m S c h e d u l e E - A t t a c h S c h e d u l e E ) . . . . . . , . . . . . . . . . , . , . . . . . . . . . . . , . ,- OUT S T ANDI NG

OUTBTANDI NG L OANS ( F r o mS c h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

CANDI DAI CO M11TEESONLY:CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? )VALUEOF CAMPA I G N PROPERTY ( F r o m S c h e d u l e H - A t mc h S c h e d u l e H) S

N0 . 4 7 3 P . 2 i 1 8FORMDR-2 o l s c L Oa u RE( R e v . 0 7 / 2 0 0 4 ) REPORT

F o r 0 1 ` 1 1 2 1 We O n l yC o u n m. SL o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

L a t e r e p o r t s a r e s u b j e c t t op o s s i b l e c i v i l a n d c r i mi n a lp e n a l t i e s .

\ o - I ~ t . o ~ fOATS SI GNED

' 6 P ORT" F OG ' R ( ELECTI ON / 2 NON- . E CT I ON Y EA R,EDL o c a l c o m m i t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y & L o c a l C o r n ml t t s a s , s n e 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

1 ' 1 , r 3 _ ~ t O. Oo

U, Le - S0. c~oYES ~NO


4/19

OCT . 1 9 . 2 00 4 4 : 1 5 PM 5 1 5 2 2 2 0 6 1 0Fo r I n s t r u c t i o n s , Se e B a c k o f Fo 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 )COMM) T TEE&AME ( M u s t b e s o m e a s o n S t s f e me V f O r g a n l z e b o n )+ i . r s ~ r . i o . C a e m A o ro \ : S r 1 ~ . l~ c % C-

NO . 4 7 3 P . 3 i 1 8

STATECANDI DATES NOTE : I F A C ON T RI B U T I ON I S R E CE I V E D FROM A 6 T A T ~ PAC ( P O L I T I C A L A C T I O N C OMM I T T E E ) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER ANDTHB PAC C" ECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLEFROM T HE I OMUHCS AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 8 . 9 2 A ( 0 ) . 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 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 a o l l c f l 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 ny p e r s o n o t h e r t h e 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, Of l a s t p a g e o f M l t r s d h e du l e )

" b l s c l a s u r e r 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 a l a l l o n s h l p o f I t n y r e l s i l 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 mml a e e . R e l a t i o n s h i p m u 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 r a o n s a n a u l n l t y ( b b o d T e i g l b e s ) a n d a f t i n l g q ( r e l a t i v e s b yma r r i a g e ). 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 ome e s c a n d i d a t e . b u t t h en I f n o Page o ff a m i l i a l r e l a t i o n s h i p , e r r 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 )

SCHEDULEA MONETARY( Re v . 0 7 / 0 0 ) RECEI PTSCHECKTH I S B OXI FAMEND I NG FORM

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTR I BU TOR RELA T I ON SH I P AMOUNT"

I F FORRECEI VED Of a p p l i c a b l e ) TOCAND I DAT ' RECEI VED FUND-AND PAC CHECK O f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D#~ ' a $ CK# p o , r 42~1 1 0 NF $I DNC KI t

0t "~~9 \ a a t 1 ~~o~~ ~I D f f

Q-~g- 0 2 OC T Wet v. A+ - 0 -"kAQEdo1C K I N

CKO ' e y 1 S~( WGC~' H~Y~ ~~ ` 7l . J e r 7 l~. s ~ c t i . m~ . Z ' A S ~a ~ l ~CKS 1 ~a S. 2 1~ 1 a W3 eI D# c ~_at i , C K i R L 4Ar , ~O0 3 1 1 7I D O _ _

t o ~ I l e~ ~ ' l SI D#C K A II D I I I

S 4 s s c oI D l i tCK# Son j - 0 r C4L' . S


5/19

OCT . 1 9 . 2 00 4 4 : 1 5 PM 5 1 5 2 2 2 0 6 1 0F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRIBUTI 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 )COzMNJ j T TEE ME( Mu s t b e s ame a s o S t e l e e n t p r a a n l z e d o n )

NO . 4 7 3 P . 4 i 1 8SCHEDULEA MONETARY( R OV . 0 7 1 0 3 ) I RECEI P T SaCHECKTHI SBOXI FAMENDI NG FORM

STATE CANDI DATES NOTE, I F A CONTRI BUTI ON 1 8 RECE I VED FROM A BTATB PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER ANDTHEPAC CHECK NUMBER I N THEDESI GNATED COLUMN. A L I S r OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 08B . 8 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 a nd s t a t e me n t s f o r s o l i c i t i n g o on t r i b ut i c hs o rf o r a n y c omme r o l a l p u r p o s e b y s h y p e r s o n o t h e r t h e 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 p a l e s t page o r t h i s a eh e du l s )

D i s c l o s u r e l o w r e q u i r e s o a n d l 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 l l y s mak i n g a c o n t r t b u t i o n t o t h e . . r r.~,. ec ommi t t e e . R e l a t i o n s h i p mue l 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 e a n g u l 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 ) . I f s ume r n e o f c o n t r i b u t o r t o t h e so me 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 mi l i a l r e l a t i o n s h i p , e n t e r " h o t a p p l i c a b l e ' I n t h e r l a t i o n e h l p c o l umn . ( f o r Sc h e d ul e A)

DATF PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( W a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND"( MMI DP I YR) AND PACCHECK ( i f a p p l i c a b l e ) RA I S ERNUMBER I NCOMEI D# ~aS1 c ~~~Pf

L- c . , oa t CK#'~t s ~ . Lr y + : ~

I D# i SCK f e w a s k - 0 r G t t i l " " i r l Cs s ~~c 7I DSCK# 1 9 r Dot . Aew. ~se e s T - , 1 4,~R , t L 4I DS _ _

-e Yl I ' D4' Cu t e h. a - l o f - , ~ r ~H ,~oOao 1I D#f CK#

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I DS _r y a 1 . - 1 a . . x A ~ i o r 3 ~I D# ~ r V ap . a l

CK# r 3 t c t A c uw S k + ` 6e-Q; t " a~t e a ` tI DS t ~ral

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6/19

OCT . 1 9 . 2 00 4 4 : 1 6 PM 515 2 2 2 0610Fo r I n s t r u c t l on s , See Back o f Fo r mCONTRI BUTI ONS - MONEY TAKEN I N

o n c f 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 on St a t e m PPOr l g a n i x a d o n )=SL - r Cv kCv - Ue j e e ^ 1 - s -~1:~~

61 " - l ; , . - A l Aw- L i a + " Ct : b t w r . : A%Qe-

NO . 4 7 3 P . 5 i 1 8SCHEDULEA MONETARY( R e v , 0 7 r o 3 ) I RECE I PTS[ ] CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE ; I F A CONTRI BUTI ON I B RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON C O MMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROMTHE I OWA ETHOS AND CAMPAI GNDI SCLOSURE BOARD .CAUT I ON : S e c t i o n BHB . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f I n I b r m a t i o n c o p i e d r mm r e p o r t s an d s t a t e m e n t s f o r s o l l o l t i n g c o n t r i b u t i o n s o rf o r an y c o mme 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 e 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 .

S U B - TOTA L .

` ~195

TOTAL ( 7 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 i 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 m ml n s e s t o d l s e o s e t h e r e l a t i o n s h i p o f a n y r a l a f i v p 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 m r n l n e e . R e l a t i o n e A l p mu s l 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 ) a n d a f f i n i t y ( r e l a t i v e s b y I ]m a r r i a g e ) . I f s uma r n e 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 H t a r e I s n o Page o f `_f 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 m n . ( t o r S c h e d u l e A )

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI 13UT OR RELAT I ONSHI P AMOUNT 4 I F FORRECE I VED( MMI DDf YR) O f a p p l i c a b l e )AND PA C CHECK TO CANDI DATE'( I f a p p l i c a b l e ) RECE I VED FUND-NUMBER RA I SERI NCOME04 I A # ~ rr r t ~ ` . , s~t 1 L

_

CK# - - I $ - - t wa 0 - . t . a . . + t 100~ ` v - ~ a~ at e . ~R ~00(I DSg T

CK# Sa I L PI D I # C~~j - l ` de ha. U~ .W. a ~ - a t e CK# \ t \ ~ Mme t/s~A . , rxR s t y a i t o oI D#CK# l a e v t o e , 3 1 tI D# -. - , M ( t i 4 c C J , ' ~ r. 4o aCK# 4 0 k 4 1 Ce - h I 00L - t a ~ t 4 6o wI L , =A St 0 31I D #CK#I D#

I D # ~ , r 1 o / L , C i ~ . l ~ ew+C t 4a ~t ~~


7/19

OCT . 1 9 . 2 00 4 4 _ 1 6 PM 515 222 0 6 1 0F 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 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 ame a s o n S t a t a n t o r O r g e n l z a 6 o n )

NO . 4 7 3 P . 6 i 1 8SCHEDULEA( R e v . 0 7 1 0 3 ) MONETARYRECEI PTSaCHECKTHI SSOXI FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECOVEP FROM A STATE PAC ( P OL I T I C A L ACTI ON C O MMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PACCHECK NUMBER I N THE DESI GNATEDCOLUMN, A WST OF I D NUMBERS I S A V AI L A B L E FROMTHE I OWA ETHOS AND CAMPAI GNDI SCLOSURE BOARD.CAUT I ON : S e c t i o n 6 9 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 I b r m a 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 me n t s f o r s o l l o l l 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 e n i b t u t o r y p o l i t i c a l c o mmi t t e e s .

SUBTOTAL S LO So f t h i s s c h e du l e ) S

TOTAL ( I f l e a t p a g e" D l s t a o a u r e l o w r e q u i r e s c a n d i d a t e e a mm l t t e s s t o d i s c l o s e t h e t a l a t l n n s h l p o f a n y r e l a t i v e ma k i n g a o o n t r i d u t l o n t o t h eoommh r oe . R e l a t i o n s h i p moat b e s h o w n t o t h e t h i r d d e g r e e o r c o n s a n g u i n i t y ( b l o o d I a l a t l v e s ) a n d a f f i n i t y ( r e l e l i v e s b yma r r i a g e). 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 a me a s c a n d i d a t e , b ut t h e r e I s n o Pap a (4 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 " h 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 d ul e A)

DATE PAC 1 0 NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORRECEI VED ( I f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DDI YR) ANDPAC CHECK Of a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D#- a 9- 0 ' f CK # I 0 e Cc l l e r ga ; , ~ ,

I D S 1 " C u s s SQO( ' e fCK S El. . , Vw Sa s 1 1 0I D # [ ]D/ NCPr ~ hGs i 6 t i ~Ch# TAI D# -~CK# e l l PI D SCK # P O, Qox ~SSVl nbZI D #CK # C ) . l a c x 1 l a 4I D SC K # ~ . , ~ 3 o t cI DS - _

I S -~CK # x ' 7" 7 I L o o ~ " t p ' . ~I DS _CKO . o , , ^ . I ~I D #CK# PoGVM. a~ %!~N 1--N So 5 3 1 0


8/19

OCT . 1 9 . 2 00 4 4 : 1 6 PM 5 1 5 2 2 2 0 6 1 0Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N

( I n o l u d i n g c a n d i d a t e l s p e r s o n a l # L i n d a )COM TTEE N " E Mus t b e s ame a s o n S t a t e m e n t o f ~ r g t a t f f o n, ~ev 1 4 1 4 2 0 0 s t ,

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON 1 8 RECEI VEDFROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , UST THE PAC I D EN TI F I CA T I ONNUMBER AND THEPACCHECKNUMBER I N THEDESI GNATEDCOLUMN. A L I S T OF I D NUMBERS I S AV AI ASL I : FROMTHE I OWA ETHI CSAND CAMPAI GNDI SCLOSURE BOARD,

' D i s c l o s u r e l o 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 l r l b u t i o n t o t h ec o mmi t t e e . R e l a t l o l m h i p mus t b e s h o w n t o t h e I h l 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 o l g l N 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 ) . 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 ome a s c a nd i 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 l o e 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 .

NO . 4 73 P . 7 i 1 8

CAUTI ON: Se c t i o n t 3 9 . 3 2 A ( 6 ) , I o wa Co 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 op i e d f r o m r e p o r t s an d e t a t e me n t s f o r s o l l o l t l n g c on t r i b ut i o n s o rf o r an y c o mme r o l 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 .

S( J B- TOTALI _ $ - - - )0O

TOTAL ( i f l a s t page o f t h l a a t : h ed u l s ) I$~aoP a g e -S S

g ar Sc h ed u l e A)

SCHEDULEA MONETARY( Ra v . 0 7 1 0 3 ) RECEI PTS0 CHECKTH I S BOX I FAMENDI NG FORM

DATE PACI D NUMBER NAMEAND ADORE880F CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I F FORRECEI VED ( i f a p p l l c a b l a ) TOCAN D I DATE' RECEI VED FUND-( MMf DDf YR) AND PAC CHECK Of a p p l i c a b l e ) RA4SFRNUMBER I NCOME4 . . f . o ` f I D# 1 M L A ) sCK# ~D. Q. p k ~XN~oS3~o 1 ' u C0

I D# I a l r d /~ ~ck l r r yCK# A ~~U t J c~. - ~ ~~ sosasI D#

- _CK#I D#CK#I D#CK#1 0 0CK#

I D#CK#

CK#

CK#_I D # -

CK#


9/19

OCT . 1 9 . 2 00 4 4 : 1 7 PM, 515 222 0610 NO . 4 73 P . 8 i 18

Pegs - _~ -I

( t o r 8 e h e d u l a t 3 )

FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES - MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( R e v . 0 7 1 0 3 ) EXPENDI TURESSTATE PAC COMMI TTEES ; NOTE ; FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I DE NT I F I CA T I O N NUMBER I N THE DESI GNATED COL UMN AND THE CHECK T Hi 6 BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OFETHI CS I D NUMBERS& CAMPAI GN I SDI SCLOSURE I OWABOARD . AVAI LABLE FROM THE AMENDI NG FORM

COMI 1~TT EE I V MI : ( Mu s t b e s a me A i s o n s t a t e me n t o f Or g z aN o n

DATE CANDI DATEI D NAME ANDADDRESS TOWHOM PURPOSE AMOUNTEXPENDED NUMBER( I f a p p l i c a b l e ) EXPENDI TURE( O l s b u m e r n e n r ) WAS MADE, ( DESCRI BE TRANSACTI ON) EXPENDED( MM/ DD/ Y2 ) AND PACCHECKNUMBER

CK# 3 t ' F ` 7

f C~wCK# ~o . ~ . t a ~ ' Q o a . I SO Vuw` i r l l o. wl " I C~Y1i LQ1 t 1~5~~~I D #Rt e $ , ~ c a r wr a ~> 1CK# aa~. o I SOI D# 4 1 4

Qe 3\ r l+o~~r ~~ewpv~, rCK# Q^ I %: ~ k IQa>. ' , 1 L sOo

I D # g a y - _ 3 3 c ~ -r Cz w~ + ' , ~CK# C. N 1 L , . Un ~ . 4Z l " ~DQ 1 0 - o . . , ' Z N SooI D # 9 1- 1 ~ - ' JCK#

( Qo, . . + k o a , ' L q

c~ ~ ; . Y , ~( , D~ s me l l aI R# ~S~ ' ~. . 4 r s z ~ k v - n_CK4 -2 . ? - 1 99

Sa " ' I l p lSUBTOTAL $

TOTAL ( i f 1w( page o f t h i s s c h t l t d U l e ) $T HI S BOX APPL I ES 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 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 a mu s t a l s o h 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 i n r c t l o n s . )E x p e n d i t u r e s t o p a r s o n s l e n t i t l e sS c h e d u l e G b y t h e 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 mu s t a l s o b e d e t a i l I t e r n b c e d o nS c h e d u l e a mo u n t , an d d e bG I h s t r u c t l o m p u r p o s e , o f e a c h o fa n d I o w a t y p o mad eCode 8 8 A , g 0 2 ( 3 ) ( I ) . ) e x p e n d i t u r e b y t h e p e r s o N n t k 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 o


10/19

OCT. 19 . 2004 4 : 17PM 515 222 0610

THI SBOXAPPLI ESTOCANDIDATES' COMMI TTEESONLY:

NO . 473 P . 9i 18

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 a t i n g $SOD o r mo r e mu s t a l s o b e l n v a n f o d 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 l t u r e s t o p e r s o n s l i a n t i t l e e 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 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 mode b y t h e p e r s o n l e n t l 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 G I n s t r u c t i o n s a n d I o w a Co d e B 8 A , g 0 2 ( 9 ) ( p . )


FOR I NSTRUCTI ONS , SEEBACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEEACCOUNT ( R e v . 0 7 1 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FCR CONTRI BUTI ONS MADE TQ STATEWI DE OR LEGI S LAT I VE CMECKTPECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N T I - I r DESI GNATED COL UMN AND TH E BOXI FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM TH E I OWA AMENDI NG FORME1HI CS E CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE' ~NAME ( Mu s t b e s ame a s o n S t a t e t t ~ e n t o P C k T a r t i z e l r ~ ' o n ) )~+h . . ~' ~+ k ~ 5 u ~ a + ~ w cG ~' . e r . S o

l [ v i c " o \ p nk i , LZ ~rCANDI DATE NAMEANDADDRESS 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 l s h u r a e me n t ) WAS MADE( MM/ DD( YR) ANDPACCHECKNUMBER

I D# k344 C ~ ~ + ' s ue . . _ _CK#

.; t : ; Lb

f r ' A MVLF ' ~ R L a m '

I ~CK# , ~I D#CK# r.-, t 7V1 ( ~ Qw k r t L~- o vI DO C"

r C. f l ' . e ~ l ~g 1 , h C l \ ~ . a c ~ i ~ ~ r ~ P ( a ~ C +c ~eG~

CK# eDTT$3 ~ ~' ~So ~St i f~a, C~sKCK#

QSo, ms s ~awr ~~ ~ u 3 v C o

SUB- TOTAL $\ SexesTOTAL ( i f JaSt pags o f 9 0 1 4 Schedu l e ) $


11/19

OCT . 1 9 . 2 00 4 4 : 1 8 PM 515 222 0 6 1 0 NO . 4 73 P . 1 0 i 1 8

T HI S BOX APPL I E S TO CANDI DATES ' COMMI TTE ES ONLY :P u r c h a s e s o f c a r t a l n c a mp a i g n p r o p e r t y c o a t i n g $ 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 r u c t i o n s . )E x p e n d i t u r e s t o p o r s o n e / e n i f 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 . n m n a g l n g , o r g a n i s 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 ma d a b y t h e p e r s o n / e n t i t y o n b e ha l f o r 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 G I n s t r u c t i o n s a n d l o ws Co d a 6 8 A . g 0 2 ( 3 ) ( q . )

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

FOR I N STRUCT I ONS , SEE BACK OF FORM F ~ SCHEDULEEXPENDI TURES B- MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( R e v . 0 7 1 0 3 ) EXPENDI TURESS T A T E PAC COMMI TTEES , NOTE : FOR CONTRI BUTI ONS MADE TO STAT EWDE OR L E GI S L AT I V ECAND I DATES, L I S T THE CAND I DATE I DE NT I F I CA T I O N NUMBER I N T i l t DESI GNATED COLUMN AND THE L . J CHECK T H I S EOX I FPAC CHECKNUMBER FOREACH EXPENDI TURE . A L I S T OF I D NUMBERS I s AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .M

COMMI TT~E E~~ " MEj . P . a e HG a ' ~ ' ! ( Mus t be s omes ame a sa s onyt o t e me n t o f Ot ft a ~ ap l u n~ ( a + 1es oCAND I D ATE NAME ANDADDRESS T O WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DE SCRI B E TRANSACT I ON) EXPENDEDEXPENDED ( 1 f a p p l i c a b l e ) ( D l a b u r s e r n e n 0 WAS MADE( MM/ D" ) AND PA CCHECKNUMBERI D # S L 4 LQ~m?F4F - l v ~ 1 e C ~ . L " d ~r r V' ~t ~~ " K

CK# $ o ao~ r3a c ~; ~~- aI D# S~, I ~ , r S~vt c t k Cl -10Ot 5 6CK#I D# _ GS t pCK#

~CK# 0~7 Q ( a . . ~ , . t e a a~$I D# I % . t

Cs a + r 1 r o>^C?Q, . . c a \ ' ~k T A r m.s o 3

I D # 1 x 5t p e I t d ~~, r . l ~ a ~ nc ( 0 0 VZO%- % ' \t o m , , s c , 1 wc, CA ~~01~ l a lI D# r y ~ , c b 1 . I r , l l o e ~ ~ 2 , J ? v t 00. E e y 1 e~Q .l 0 _ \ a , E U4 ~kl~ oCK# 5a3 I

- - SUB- TOTAL $ ~ a t a l , t DTOTA L ( I t l a s t p a g e o f M19 s c h e d u l e ) S


12/19

OCT . 1 9 . 2 00 4 4 : 1 8 PM 5 1 5 2 2 2 0 6 1 0

THI S BOX A PP L I E S TO CANDI DATES' COMMr i TERS ONLY . ,

NO . 4 73 P . 1 1 i 1 8

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 a h a c t l o n s , )E x p a n d i t y r e a t o p e r s o n s l 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 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 eS c h e d u l e GG b y t h eI h e t r u c t l o n aamo u n t ,a n d l am a n d d a t e o f t e c h t y p o o f e x p e n d i t u r e m a d e b y t h e p e r s o n / e n t f t y o n b e h a l f o f t h e C an d i d a t e ' s c o mmi t t e e . ( R e f e r t oo wa Code 8 8 A . 4 0 2 ( ; I ) ( I ) . )

P a g e L + ' f -3


FOR I NS T R UCT I ONS , SEE BACKOF FORM SCHEDULEEXPENDI TURES B- MONEY SPENT FROM COMMI TTEE ACCOUNT MONETARY( R e v , O 7 1 0 9 ) EXPENDI TURES

STA TE PAC COMMI TTEES : NOTO : F OR CONTRI BUTI ONS MADE TO STA7El MDE OR L E GI S L AT I V ECANDI DATES, L I S T TH E CANDI DATE I DE NT I F I C AT I ON NUMBER I N TH E I WSI GNATED COLUMNAND TH E L . J CHECK T H I S B OX FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS 1 5 AVAI L ABL E FROM TH E I OWA AMENDI NG FORME TH I C& 3 CAMPAI GN DI SCLOSURE BOARD .COMI TTEE NAME ( Mu s t - b e s ome a s o n S t a t e me n t o f

GJ~~a ~ CL , \ ~~a~, r^MI +1TSCANDI DATE NAME AND ADDRESS T O WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DE S CRI B E TRANSACTI ON) EXPENDEDEXPENDED O f a p p l i c a b l e ) ( D l s b u r s e me n Q WAS MADE( MM/ DDI Y R) ANDPA CCHECKNUMBER

5 6 b- c ~ w a ~ C~+~ RLCK# P! .I D# 1 Lv 3 ?.CK# a o - 2 1 3 - s

q - ' x _ 0 4 ( " , K # - Q%S5 Vk~?

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C 1 - 4 F - 1 0 4 " aI D # ( 1 I S ~ ~ d m a w . r S+ . a 0 1 x 1 ~ * - , ~ F M3 Cg x h( - ; , ~ t iCK # %S4

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TOTAL ( I f l a s t p a g e o f Ws s h e d u l s ) $


13/19

OCT . 19 . 2 00 4 4 : 1 8PM 51 5 222 0610

THI S BOXAPPLI ES TOCANDI DATE-2 1 COMMI TTEES ONLY :

NO. 4 73 P . 12 i 18

Pu r c h a s e s o f c e r t a i n e a mp e l g r i 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 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 . )E x pe nd i t u r e s t o p e r s o n s l o n t i t i e s p r o v i d i n g c o ns u l d n a . 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 nWn 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 mi z e d o nSc h e d u l eGb 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 en di 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 r 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 oSc h e d u l e G I n s t r u c t i o n s a n d I o wa Co d e B8A . 4 0 2 ( 3 ) n . )

( f o r So he d ul e B)

FOR I NSTRUCTI ONS, SEE BACKOF FORM SCHEDULEEXPE NDI TURES - MONEY SPENT FROMCOMMI TTE E ACCOUNT 1 3 MONETARY( Re v . 0 7 1 0 3 ) EXPENDI TURES

STATE PACCOMMI TTEES, NOTE : FORCONTRI BUTI ONS MADCTOSTATEWI DEOR LEGI SLATI V ECANDI DATES, L I ST THECANDI DATE I D ENT I F I CATI ON NUMBER I N THEDESI GNATEDCOLUMN ANDTHE CHECK THI S BOX I FPACCHECKNUMBER FOREACHEXPENDI TURE. A L I STOF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NGFORMETHI CS &CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t be s emo a s o n St a t e me n t p f e ni z a t i o n)C r , , Q C e c - D ' s . + ~ h 9 v A c R ~. ~ r ' a

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE - - AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D* p r semehd WAS MADE( MMI DONR) ANDPACCHECKNUMBER

I D# (,~4d 4 P c ' " ~ , r y k t q cCK# r; ~1j q v n ~4o4 r ~ t s o531 r , $ O

ek n 9 , q 1 1 9 - AQ- POJ -CK#

CK# ~g~ l r e- . _ _~Q~~ S l o r 3 C~ ~ . , 1 r

`~ot,sAI D ! # t 3R- 7CK#' D83c

I D# t Ak 4 t o

CK# Q- , Ra

CK# a%' a ' F ~1aoF~~P1uRe 4~ , r~ s 4I D#

CK#rd1el 3~CFAa ~r t l t i $ 9~~0~0

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


14/19

OCT . 1 9 . 2 0 0 4 4 : 1 9 PM 5 1 5 2 2 2 0 6 1 0

T H I S BOX A P P L I E S TO C AN I D I D A T E S ' COMMI TTEES ONLY :

NO . 4 7 3 P 1 3 i 1 8

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 man 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 l t u r e n t o p e r s o 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 - f a i e l n g , p o l l i n g , m a n a g i n g , o r g a n W n g s e l v i c e e m u e t a l e 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 m o u n t , p u r p o e e , e n d d a t a 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 m o r d 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 he 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 8 8 A . 4 0 2 ( 3 ) ( I ) . )


FOR I NSTRUCT I ONS , SEE BACK OP FORM SCHEDULEEXPENDI TURES S- MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( Re v . 0 7 1 0 3 ) EXPENDI TURES

STATE P AC COMI HI T TE h b : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LATI V ECANDI DATES, L I S T THE CANDI DATE I D EN T I F I C AT I ON NUMBER I N THE DES I GNATED COLUMN AND THE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COM EEI$AME( Mus t b e some a sQn S t a t e me n t c f f f 8 ni z et l on)

~ t

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( f f a p p l i c a b l e ) ( DJ s b u r s & MAWWAS MADE( MMI DD/ YR) AND P ACCHECKNUMBER1 0 # < =4 = ' r n ' N- ANM 4M l bt 4ac*g" 1 ~- o V L l a o ~CK# d 1 . " I %U $4 " t ~ + ~ , a n o r 3 ( a .

I D# t 3 t . , 41 sS~~~e ~ a y F 3 . e r v 4110- ' AC~ Sn~ l 1 a a - Sa oCK# DES%

I D# ~3a U v t ~ -a ~ - a * CK# L AI g ao~,s r g~ , ~ ~ s~3( a

I D# ~ r S g~ r Ga s ~ . 4 : ' v - ~ Q - R f . C v t ~ ~~CK#~~a( CDC

k nww~e; a Z t ~ , . ~s, ~X0311I D#

C . R , e t 4 K t t ~ ' N o ' e m .- L4- . I n , ~ a b r - -- _

1 . 1 7 . 4 ~ - t l S j % s omI Q#CK# go t l u k x as4~~I s

SUB- TOTAL $ qSSOTOTAL ( ( t l e s t p a g e o f t h l s s c h e d u l e ) Ls


15/19

O C T . 1 9 . 2 0 0 4 4 : 1 9 P M 5 1 5 2 2 2 0 6 1 0 N O . 4 7 3 P 1 4 i 1 8

T H I S B O X A P P L I E S T O C A N D I D A T E S ' C O M M I T T E E S O N L Y ;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 $ 3 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 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 / a f es 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 p 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 m i z e d OnS 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 o r s an / e n t l t y o n b e h a l f o f t h e c a n d i d a WS 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 6 0 A . 4 0 2 ( 3 ) ( I ) . )

P a g e o f .


.FOR I NSTRUCT I ONS, SET : BACK OFFORM f . . m . , . . SCHEDULEEXPENDI TURES B- MONEY SPENT FROM COMMI TTE E ACCOUNT MONETARY( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TOSTATEWI RE OR LEGI S LAT I V ECANDI DATES, 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 LJ CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EX( PENDI TURE . A L I S T OF 1 0 NUMBERS I S AVAI LABLE FROMTHE K: WA AMENDI NG FORMETHI CS & CAMPAI GN DI SCL OSURE BOARD .COP41J I TTEE NAME( Ms t be a r y l owo n S t e t e n r t o Or g a n i z a t i o n )

CANDI DATE NAME ANDADDRESS TOWHOM P UR POa r f t AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( 1 1 ' a p p l i c a b l e ) ( D l s b u r s e m e n g WAS MADE( MMI DDf YR) AND PACCHECKNUMBER

I D# Vl o Z) a 77 - a P r OL 4 4 21 - - _~r~w. x QA%j ' ZAuC' t I Ot a

I D# ~~ ~ n v ~ - Rs l -o ~a` r I WSYaw ~ _~, - t `C K, # ' c 1 91 8 ks ~ C l o 1 :Is e " " C~. , i r ' t 1 a . ~ y = . o r . o~Cx ~9w~~~A 5 0 1 9 uY4I D# f l o g \ wa r o c r _& A~, ~~ . ~ 0~ 1 38

I D# l 4 ~- r ~ ~ ? s S ~ " ~ a -~y t u%\ 04 . S Z 6Awc ) AC~% Pr a Q7 - 1 3 &I D# , a a a c ~, M7Nee . 4 - 0 P \

. SA $ oI D# 1 41 \ 0

CK# ' a l

g , o K CK#a g a r ~ ~ ' a ~ 3 (C Q ~ a t ~ - ~ p i ~ s ~ S A ~ ~ 9 c {~ , a $ v c ( ~ 4 I L o t i I ~ v ~C K #

S U B T O T A L $ 1 , dT O T A L ( i f l a s t p a g e o f t h i s s o h e d u l o ) $


16/19

OCT . 1 9 . 2 00 4 4 : 2 0PN 515 222 0610 NO . 4 73 P . 1 5 i 1 8

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Pu r c h a e s e 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 4 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 he d u l e H . ( R e f e r t o S c he d u l e H I n s t r u c t i o n s . )En p en d l t u r e s t o p e r s o n s / a n t l t l e s p r o v i d i n g c o n s u h l 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 must a l s o b e d e t a i l I t a r n l z e d o nS c he d u l eGb y t h e amo u n t , p u r p o s e , a n d d a t a o f t e c h t y p e o f a x pe hd i t u r e mad 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 nd i d a t e ' s o o r n n l t t N s . ( R e f e r t oS c he d u l e G I n s t r u c t i o n s an d I o wa Co d a B8A. d 0 2 0 ) ( 0 . )

Pap a

( f o r S oh s d u l e B)

FOR I NSTRUCTI ONS . SEESACK OF FORM I ' , i " :" ~r , ~ ~ '- SCHEDULEEXPENDI TURES - MONEY SPENT FROM COMMI TT EE ACCOUNT B MONETARY( Re v . 0 7 1 0 3 ) EXPENDI TURES

STATE PACCOMMI TT EES ; NOTE : FORCONTR I BUT I ONS MADE TOSTATEWI DE OR L EGI S L AT I V ECANDI DATES, L I STTWCANDI DATE I DENT I F I CA T I ON NUMBER I N THP DESI ONAT ED COLUMN AND THE CHECK T HI S BOX I FPAC CHECK NUMBER FOREACH EXPENDI TURE, AL I ST OF I D NUMSERS I S AVA I LABLE FROM THE I OWA AMENDI NG FORMMI CS A , CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE, NAME ( Mu s t be s ome es n S t s t e me r r f 1 0 e n i z e No n )L

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON EXPENDEDEXPENDED ( f f a p p l i c a b l e ) ( Di s b ui a er n en gWASMADE( MM/ DD/ YR) AND PACCHECKNUMBER

I D# N%* 34CK# a a t ' 4 $ o

~111 J WU ' ~ b ~~~0~~I D# I L +Q"CK# rc -ABaa ~,~. . . ~ Cr ' r j , 1 5 : : a i s k 1 PI D# w ,

_ CK# o 1 ' 1 a ` l 'I p #

q _ t s : - a e f CK# s a o o " - ' cx' i ~OJ d ( \ L ~, . ~ ~~c. , ~ Sw ~O ( pG~~11I D# - _

CK#ID# - _

CK#I D# -CK#

S UBTOTALTOTAL Wi se s p ag eo f Mi a so * e d0N) $


17/19

OCT . 1 9 . 2 0 0 4 4 : 2 0 PM 5 1 5 2 2 2 0 6 1 0F OR I N S T R UC T I O NS , SEE BACK OF FORM

COMMI E NAME ( M u s t b a s e i n e a s o n S M t a r n e n t o f o r g e l r l z e t l o r r )~h~end~- h Sns u ~- a r i c ~ Q y ~ " f ' s t ~2aw~.' 2 0 1 1 Wc OW Ar - f or Cor nmf - ! " t e

S U B - T O T A L

TOTA L ( i f l a s tp a g e o f t h i ss c h e d u l e )

NO . 4 7 3 P 1 6 / 1 8

SCHEDULEE I N K I N D( R e v OBm 7 C ON T R I B U T I O NS

[ ~ CHECK T HI S B OX I FAMENDI NG FORM

' D l s c l o s u m l a w r n q u t 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 eC o m m 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 l n f t y ( r e l a t N e a ( b r 8 a h e d u l e E )b Y mw Me 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 l b u l o r I s t h e a m m o a s c a n d i d a t e , b u t t h e r e i s n of a m i l i a l r e l a t i o n s h i p , e n t e r ` l e t a p p l f e 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

DATEREC EI V ED NAME ANDADDRESS RE L A T I ONS HI PTO CA N P I DA T E DESCRI P T I ONOF I N K I ND E S T I MA T E DF AI R MARKET I F FORFUND- RAI S ER( MM/ DDYR OF CON TRI B U T OR " t a p p l i c a b l e ) CONT R I B UT I ON VALUE CON TRI BUT I ONNow


18/19

OCT . 1 9 . 2 00 4 4 : 2 1 PM 515 2 2 2 061 0

FOR I NSTRUCT I ONS , SEE BACK OF FORM

n c ~ 1l 7r~M_VS~AI I Gi C e m O~ep7~ tx64N-l l t 7~- _ I '

SUB- TOTAL

TOTAL ( i f l a s tp a g e o f t h i ss 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 s t o d l e e l o s e t h e f e l a t l o n e h l p o f a n y r e l a t i v e me l d s a n I n k i n d 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 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 nd a f f i n i t y ( r e l a t i v e sb y mo n t 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 umame o f c o n t r i b u t o r I s t h e came e s c a n d i d a t e , b u t t h e r e i s n of 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 .

NO . 4 73 P . 1 7i 1 8

SCHEDULE]I N K I ND( Re v . 0 0 7 CONTRI BUT I ONS

dCMBCK THI S Box I FAMENDI NGFORM

DATERECEI VED NAME ANDADDRESS RELAT I ONSHI PTO CANDI DATE DESCRI PT I ONOF I N K I ND EST I MATEDF AI R MARKET I F FORFUND- RAI SER( MMI DDI YR of CONTR I BUTOR ( i f a p p l i c a b l e ) CONTRI BUT I ON VALUE CONTRI BUT I ON- I - ' a o a l l ( Ph i{ t i e l b b aI ~ . ~ . ~ ~ l a s d G 2 r v i i ~ 0Po~~s 5 1 1/ I Z T C 6 6 Cl L j o r ai s . 100s ~ c Y > r i 6 iai r Ge ' .~ S ~ o 2

arb_

~-~tM~l V i s~ i ~c ws .~. b a y , " ' oF ~- ' T ~ 5~b i s l I Dt l c k s-MSZ774 6Gl l ~ ! # ' v i e r , T r t e . r c - . -, g , ; , e H e r s

~ F r r k l ~ r ~ a 1~ . h t' ? 9 l e s s en l ~ PPs f ~~ . T. o . SRo . STo '

3 a ~' Cr . ~ n ds l ~ r ~p 1~A v e , ,SSo du J : So - Ff o r B c v r Q&` ~ " ' I ' B r a ce ra k _ v CL t - Ez- T ) q 5 13o I . t s ~ d l i r f r y C f u dwee w6 - e * ~- T / 0 / 1d / 14" ' . Sa o" 1S~smQ0ax- 74 . 4 - 2 bbRamt ' dt

_ ~C~Gk hU. j Z i 'a ~c. ~aI ng3~$l vCrsl t r Ave, 3G>d r ~Qr r ~ i s~~' ~hC 100EZD~3D-~L~D r r ` r

~- ` 3 ' ae l d nr I S l e 0 , Ts ~r i ae r t 9o1 P e l uh 3t ~2I W, e1 A _ 441. y6


19/19

OCT . 19 . 2 00 4 4 : 2 1PM 515 222 0610

FOR I NSTRUCT I ONS , SEE BACK OF FORMCOMMTTRR N ( Mu s t b e s ame as o n S t a t e me n t o f 0 N z a t l o. e r p - a h , o . . , k

NO . 47 3 P . 1 8i 1 8

SCHEDULEI N KI ND

( Re v . CONTRI BUTI ONS

D CHECKTHI S BOXI FAMENDI NGFORM

' Df s c t o s ur s l aw r e q u i r e s c an d k l s t s 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 ny r e l a t i v e ma i d n t a a n I n I d n d c o n t r i b u t i o n t o t h eCOMM" . R e l a t i o n s h i p mus t be shown t o t h e t h i r d d o or " o f c o ns ar y u l n l 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 ( f o r Sc h e d u l e E)b y ma r r i a g e) . ( S ee Pao s 2 o f f o r ms 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 s ame a s c a n d i d a t e , bu t t h e r e i s n or e ml l l a t 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 .

DATERECEI VEDM/ 1 3 1 3 " ) NAME ANDADDRESSOF CONTRI BUTOR

RELATI ONSHI PTOCANDI DATE" f ma l l e ab l e )

DESCRI PTI ONOF I N KI N DCONTRI BUTI ONESTI MATEDFA I R MARKETVALUE

I F FORFUND- RAI SERCONTRI BUTI ONs O c t ~ , A~, s n n ~ ` c o r k S

~a ^ 3 c f 5U. vei sl ~~~"", So3: 1

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