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DI SCLOSURE SUMMARY PAG

I MPORTANT 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 :

( i ) S t a t e w i d e i l e g i s l a t r 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 ) : o u n r y l l o c a l C a n d i d a t e( 5 ) C o u n t y PAC ( 6 ) 8 a i i o t I s s u e / F r a n c h i s e C o mmi 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 Wp o R , S l a t e o f C a n 6 d a t g s

I GN ( o r p er s o n f i l i n g t h i s r e p o r t )

Ro u t i n e P e n a l t i e s Du e F o r L a t e Fl e d Rep o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCT I ONS ON BACK AND COMPL ETE THE FOLLOWI NG SENTENCE :

I AM FI L I NG A ~~19- 1 ) REPORT FORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .

( r e p o r t d a t e ) I n d i c a t e o n e

CHECK I F AMENDMENT TO REPORT DATED

~Che 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 Fo 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 . )

CASH 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 lo f a l l mo v 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 be t h es ame a s t h e c a s h o n h a n d a t t h e en 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 ,

S (o r mus t be 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 OD ~1~

a 1~ ~ 5 , UO

9/

Sc 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 d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . t . . . - . . . . . . . . . . . . . . . .

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 S c 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 Camp a i g n P r o p e r t y ( A t t a c h Sc h e du l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ^ U

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Co mmi t t e es On l v )

SUBTRACT TOTAL MONEY SPENT THI S PERI OD

TEL EPHONE

STATEMENT OF CASH ON HAND

SUB- TOTAL . . . . . . $

Sc 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 ) . . . . . . . . . . . . . . ' 1. . . . . . . .

k3...14.'L

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 S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UNPAI D BI L L S ( F r o m Sc h e du l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . _ _ _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

I N K I ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - A t t a c h S c 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 S c h e d u l e F l . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

FORM

DR- 2 DI SCL OSURE( R e v . 0 1 / 9 8 ) REPORT

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

Comm. x -j ) r ,I n d e x e d , Qr . -

A u d i t e d

C o mp u t e r L r 2 4 - P

DATE SI GNED

L o c a l C o mmi 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 8 L o c a l Co mmr 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

CASH ON HAND a t t h e en 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 , Ba l a n c e mu s t

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

CANDI DATE COMMI TTEES ONLY :

CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YES NO

VALUE OF CAMPAI GN PROPERTY ( F r o m S c h e d u l e H - A t t a c h Sc h e du l e H ) S



Fo r I n s t r u c t i o ns , SeeBack o f Fo r m

CONTRI BUTI ONS- MONEYTAKENI N

( I n d ud mg 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( Mus t b e s ame a s o n S t a t e en t o f Or g a n i z a t i o n)

STATECANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THEPACI DENT I F I CATI ONNUMBER ANDTHEPACCHECK NUMBER I N THEDESI GNATED COLUMN_ A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.

CAUTI ON : S ec 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 u s e o f i r l o r mat i on c op i e d f r o m r e p o r t s an d s t a t e me n t s f o r s ou at i n g c on t r i b ut i o ns or

f o r an y c omme r c i a l p u r p o se by an y p e r s o n ot h e r t h a n s t a t u t o r y p o i t i c a l c o mmi t t e es .

SUB- TOTAL

STOTAL( i f l as t page o f t h i s s c h ed u l e )

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c ommi t t e e. Rd a d o ns h i p mu s t b e s hown t o t h e t h i r d d eg r e e o f c o n s a n g l i i n i 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 y

ma r r i a g e ) ( S ee o f f o r ms p a c k e t . ) . I f s u r name o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b ut t h e r e i s n o Page o f

f a mi l i a l r e l a d on 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 ch e du l e A )

SCHEDULE

A MONETARY

( Re v . GF / 9 7 ) RECEI PTS

CHECK T HI S BOX I F

AMENDI NGFORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR REL A T I ONSHI P AMOUNT ~ I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-

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- CONTRI BUTI ONS - MONEYTAKENI N

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COMMI TTEE NAME ( Mu s t b e s ame a s on St a t e me n t o f Or g a n i z a t i o n )

C noD2 s - CJ L vAS A l VI L K1

SCHEDULE

A

( Re v . 0 6 / 9 7 )

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RECEI PTS

QCHECK T HI S BOX I F

AMENDI NG FORM

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 TH E 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 A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: Se c t i o n 6 8 8 . 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 op 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 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 o mmer c i a l p u r p o s e by an 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 es .

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c o mm 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 i n i t y ( r e l a t i v e s o 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 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 b u t : h e 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 mn . ( f e r Sc h ed u l e a

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELAT I ONSH I P AMOUNT d I F FORECEI VED ( i f a pp l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a pp l i c a bl e ) RA I SE

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CONTRI BUTI ONS - MONEY TAKEf( 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 t u r n d s )

COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )

K, - I I e F, . e ` s 4 go 2 t v~Ge r v e n , , ~

STA TE C A ND I D A T E S NOTE . I F A C ONT R I B U T I O N I S R E CE I V E D F R O M A S T A T E P A C ( P O L I T I C A L A CT I O N C OMMI T T E E) , L I S T T H E P A C I D E N T I F I C A T I O NNUMBER A ND T H E P A C C H E C K NUMBER I N T H E D E S I G NA T E D C O L U M N A USTOF I D N U M B E R S I S A V AI L A B L E FROM T H E I O WA E T H I C S A ND C AMP A I G ND I S C L O S U RE B O A R D

S UB- 7 0 7 A L

SCHEDULE

A( R e v 4 6 / 9 7 )

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 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 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 r

f 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

TOTAL ( i f l a s t p a g e o f t h i s

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DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DO/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SE

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CONTRI BUTI ONS - MONEYTAKEI


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 n i z a t i o n )

~u 2 ~u. . ~ . q s d Q~2N l . x ' c UX ' r ~ ~ 9 j

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. : o mmi r t e e R e l a t i e n s n i p must o e ; h o wn t o t h e ! h e r o D eg r e e o f c o n sa n gu 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 : ) y

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CHECK T HI S BOX I FAMENDI NG FORM

SCHEDULE

A MONETARY

( Re v . D B / 9 7 ) I RE C EI P T S

S T A T E C A ND I D A T ES 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 TT EE) . L I S T T H E PAC I D EN T I F I C AT I O NNUMBER AND T H E PAC CHECK NUMBER I N T HE DESI GNATED COLU MN . A US T OF 1 0 NUMBERS I S A V AI L A B L E FROM T HE I OWA 2 T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : Se c t i o n 6 8 8 . 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 f o 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 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 r

f o r a n y c o mme r c i a l p u r p o s e by 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 es .

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r v + n + a u u a . u V +w, . + + a c u a a . n v . r - V 1 + + +

CONTRI BUTI ONS - MONEY TAKEN'


COMMI TTEENAME ( 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 )

wt L i t , t - c a " 2 - ~ d c J , 4 SA. ) 6P~1 / tP ~ r Q~

STATE CAND I DATES NOTE . I F A C ON T RI B UT I O N I S R E CE I V E D FROM A S T A T E PAC ( P O L I T I C A L A C T I O N C O MMI T T E E ) . US T T H E P A C 1 0 E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN A US T OF 1 0 NUMBERS I S A V A I L A B L E FROM TH E I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD

CAU T I ON : S e c t i o n 68 B . 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 f o 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 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 r

f o r a n y c o mm e 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 mm i t t e e s.

SUB - TOT A L

SCHEDULE

CHECK T H I S BOX I FAMENDI NG FORM

A MONETARY( R e v . 0 & 9 7 ) RECE I PTS

TOTAL ( i f l a s t p a g e o f t h i ss c h e du l e ) S t D

D i s c l c s u r e r a w r e a u j r e s - - a n d i d a t e c o mm i 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 m a k i n g a c o n t .- , b u t t o n t o t h ez o mm i t t e e ? e l a Uo n s n i p m u s t b e s h o w n t o t h e t h u 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 C 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 c ym a r r a g e l ( S e e ° a g e 3 o f ` a r m s 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 am e a s ~ : a n d j d a t e b u t : h e r e s n e P a g e c t_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 ( f o r S c n e d u l e

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT v I F FORRECEI VED ( i f a p p l i c a b l e ) T O CAND I DATE ' RECEI VED FUNO-( MM/ OD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ER

NUMBER I NCOME1 1 D # C A o ? ~ e t , e

CK# 3 t I O ' 7j (0 o " 1 k LN_

.c o

I D#( . R. Mv ~ { v

CK# 1 0 ?0 , ~~130 , 1 114 0 4~ n 1 0 > . a o ~ c ~ v

Pn !w" ~ ~ - .\~ 4 . S. t 72L

I D#

CK# 6 HI V F - 1 . 4 r u o ; ~ ' b a , . n 1 3. ( 1Q t / '

e r l o , z L . x , 1 2 Sa ' ? 2 2

f I ° / ` ' ° ~ ' f I CK#~J?~ ~ ? l t l 3r o ut f o r

SO- 0100

9 4 1 e , d o e - - 1 , a - - l 7 2 II D#

r o J5a 72

I D# .I l - ~ t i _ ~ r CK# ao ~ i ~ t 4 ~ S j v _ ' _~ N ; a . ~ P , . v ,2. l p v, G~

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Ro~,~. ~gRr s fnw

!~' ~ Ct . -G)CK# ~c /

I i p ~ J ! ' l ' . n ` s " 5 t Z j V 1 1 ,

e 14 f - L ~ J . 5 : Z 7 L t

I D# C o LA - , , e 1 3 ( , r oc

CK# 2 , ) 9 - 7 ( Y10 S 4 S S ~ , C c am, ayo. Gz ,I r

u I

I D#( ' a ~, c l 7 c r 2 aR~~i ( e y I

D f CK # C r 3 . 2 31 S- ~ Pz ` j / . l t : t Nr / UG, CbIv

C/

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~ ~ ' ~ r ? , a r l d . ~ ~r . ~ , . 1 . Sr i 7ZZ



Fo r I n s t r u c t i on s , Se e Ba c k o f Fo r m

CONTRI BUTI ONS - MONEY TAKEN 1


COMMI TTEENAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n

l v 2 OLA; A - f . S e qhU2

STATE CAND I DATES NOTE : I F A C ON T RI B U T I O N I S R E CE I V E D FROM A S T A T E PAC ( P O L I T I C A L A CT I O N C OM MI T T E E ) . L I S T T HE P AC I D ENT I F I CA T I O NNUMBER AND T HE PA C CHECK NUMBER I N T HE D E S I G NA T E D COLUMN . A US T OF I O NUMBERS I S A V AI L A B L E FROM T HE I O WA ME T H I C S AND CAMPA I GND I SCLOSURE BOARD .

CA UT I 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 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 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 r

f o r a n y c o m m e 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 m m i t t e e s .

SUB- TOTA L


s c h e du l e )

SCHEDULE

A MONETARY( R e v . 0 6 1 9 7 )

IRECEI P TS

[ ] CHECK T HI S BOX I FAMENDI NG FORM

0 i s c ' c s u r e ' a w r e q u i r e s : a n d i d a t e : o m m i r t e e s : o d l s : : 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 m a k i n g a c o n s b u h c n : o : h e, ; o m m i t t e e Re l a n e n s n i p m u s t o e s h o w n t o t h e I h i r c 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 o y

m a r r i a g e ) Se e p a g e 2 d f ' o r m s 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 am e a s c a n d i d a t e b u t " , h e r e ' s ~ o p a g ef 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 ( f u r S c n e d u i e - 1 -

DATE P AC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR R EL A T I ON SH I P AMOUNT v I F FORR E CE I VE D ( i f a p p l i c a b l e ) T O CAND I D A TE ' R E CE I VE D FUND-( MM/ OD / YR ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ER

NUMBER I NCOME

f 1- I D# S { - e v t

2 - Of CK# 3 l i t S ' f q " I A k i 0 QR' r y f ° t y e s I / -

r ' 1 - v 2 w Zr J - 5. 7 1~ C' ` 7

I O#~dNN Sl 1N~ee t o r ? VC~

z ' ~ f CK# ` 1 S7 P. x ( 1 30 T~ 1 QS , eyt Rc!

" t~ I iAv e - v o R4 x , 4-

5a v o - 1~ D#

( Z o ~ r , e , r i , e a y f A- , v l , c 42

z - -CK# q. 2 - 7&

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e e , i d o, 1 r za . 5-A7.22

I D#

00, CK# FGA y f P 3 1 C, Cf ?U« t - ^ a f e ' f 1 ? , : ? . ~0I /

13eH- P~~o . I , T . ., ~ f

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P < _ T - c u a 72

2 -I D#

h t i ~ ~ , f k l e wt , ' , r , . t l + l a h , - ~ K( 2 - -

Of CK# ~ l C o ~ C S _ 6 3 3 9 i v c . : v r ' f w TQ12 . 2 r f C P . ~ . 5 z ; ~6

P c f 6 o ~- - . 2? t

f Z_ ZI D# L r g r ?j a r L i . , , c j ~ 1 R. aa f u~ S~

Of CK } # ? 1 1 & f f I S U- 2AZkw

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CONTRI BUT I ONS - MONEY TAKEN I( I n c t u ( s i n g c a n d a a t e ' s p e r s o n a l l a n d s )

COMMI TT EE NAME ( M u s t b e s a m 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 )

C ( V~ ~ , A ~ 1 ~ ~ -

SCHEDULE

A MONETARY

( Re v 0 6 / 9 7 )

I

RECEI P TS

CHECK T HI S SOX I FAMENDI NG FORM

S TATE C ANDI DA T ES N OTE : I F A CONTRI B UT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) . L I S T T HE PAC I D EN T I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF 1 0 NUMBERS I S A V AI L A B L E FROM T HE I OWA E T HI C S ANDCAMPAI GNDI SCLOSURE BOARD

CAUTI ON : Se c t i o n 68 B . 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 f o 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 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 r

f o r a ny c omme r c i a l p ur 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- TOTAL


s c h e du l e ) I S

J P s c l c s u r e ' a w r e q u i r e s : a n d i d a t e c o mm i t t e e s t o y l s c : o s e : h e r e l a t l o n s n i p o f a n y r e l a t i v e ma k i n g a c o n s " b u t r e n t o t h eR e t a R On s n t p r n u s t o e s h o w n t o t h e t h u d d e g r e e o f c o n s a n g u i n i t y ( b l e e d r e l a t l v e s l a n d a f f i n s t y ; r e a u v e s o y

a r r i a g e ~ Se e ? a g e 2 o f ! o w n s 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 am e a s c a n d i d a t e b u t . ' + e r e : s - 1 c Pa g e o fr e l d t i o n s n i o . 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 d t t o n s n i p c o l u mn ( f o r Sc ^ . e d u i p

1 0

- DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELA T I ON SH I P AMOUNT v I F FORRECEI V ED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ER

NUMBERI NCOME

~

i Z- Zl D*

G~e1Pnr l 3 R~S t ~2

2 c u c ~ 0 ~ t _ C 1 _ 0 L c a -7

i - 2t _ I D #

Wi t r 4 . r K t . . r J i ~e

v + C K i # ) ( a ~5 ' 3 S` ~ 7 P e e k Rr F C` ~ °s ZrOo r l

wi t y o r XA . 1 - ) . 721

Of CK# T?I 3 f v v l s s e r p s e l , f ? r d ~~ Rc I - / C- a C~

7A v e - w

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r e ' ~ t / l . S~i D#

~~Ch . 1 R~ r . I LL~ r - Ke e f ' e R12-

z T

f CK* v s - s l e 03 r e i n , ; t S Z ' "~l /

"+ 7 v k v C ' ' . . A . ~ r r r . 5 _ a l S ' U

v CK#SC ~ 1

a f . ~ t do 2PZ GAK c ' 4 . S~P ( v c v(. d ( ~ r V f ' ~ i 9 5 :

a ,f , / ' I A ,

I D*CA7oi E ' q ~ e t i h z ~ ~

C > I C K # L - i f o r 1 7 3 8 I _ , v a i r S - kS ~ ~ ~ z >

C ) I eN~~~~ ~~ S~ 7 2 1

f 1 - ('

I D #< c c Z 4 S R- r g T " . "

O( C K * ( p i - I ( 3 b o a v o Rwe x 4 BARK o ? S ~ 0 0

7 i ' a v P r u _ R - I ~ . Q . Sr `

. l~1 0 #

~~P2~ . > ~ e " ~ G 2 t r J r ~ v r 7 ~/

I J i 9 . , i i l ( . b D P ~

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72 ' 1 0 0 R - e 4 o ' - f i e C+ - - r 7 s ~ w ~v

i A- 6 -1 0 #



. y r i s wuucuv ns, oee oacx o f f o r m

CONTRI BUTI ONS - MONEYTAKEN

( 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 k i n d s )

COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g a n i z a t i o n )

P ~ Ot ' Z r E ~ c . r - ' . ~ 5 1 ~ ° ~ c t 2 NHy~°~uP2v4J

SCHEDULE

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) . L I S T THE PAC I D E NT I F I C A T I O NNUMBER ANO T 1 - 4 E PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF 1 0 NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: Se c t i o n 6 8 8 . 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 op i e d f r o m r e p o r t s a n d 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 n y c o mmer c i a l p u r p o s e by a n y p er 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 es .

SUB- TOTAL


s c h e du l e ) 15

A MONETARY

( Re v 0 & 9 7 ) RECEI PTS


S 8 , 1 ? S v

O , s v c s u r e ' a w r e g w r e s : a n C l d a t e : O mmr t t e e s t o o 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 . - , o u t r c n t o t h e

m, t t e e R e l a u c n s n , p m u s t o e s h ow n t o t h e t h , r a a 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 r c a f f i n i t y r e l a t i v e s o y, S e e Pa ge 2 o 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 same a s c a n d i d a t e o u t t h e r e ! s - l c

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 ' r n t h e r e l a t i o n s n , p c o l u mn ( f o r S c n ed u i e

~a

DATE PAC 1 0 NUMBER NAMEAND ADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I F FORRECE I VED ( i t a p p l i c a b l e ) TOCANDI DATE - RECE I VED FUND-( MM/ 0DJYR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SER

NUMBERI NCOME

D# S r c , # v w v m2 Pvv t CK# dG

r4733

6 ' 1 w 1 S 4 - .

UPnJ o , P l a m . 5~~~~I D#

1 ,

t ~ - ( 7 -

i D#

~ ~c ~ n - r - 4 5 f K̀ V; A W. 4 ~ ek ) 1 + / W

c a / CK# ~G o 7 z ~~ ~ - l y s _v , f t l e y - DR- SZ j e G -- ~ v

1 CK# 1 / 7

_

i / . ~ 23 CC~ L 0 l t u . , , 4 P 2 1

,

C X ' 3 r l

Mu Coe s ~s i l ~A. S7 G~

l 4C9wJ K~ ) J O t ' ( I Pa . t r a c t , ,

CK# c . (L1 ~r?t l No f z L J ~ s ( a 0 b/ . ~ / 0 G<

o f h e ~Pt i 6, 1 X . o , 5, ) 722

i o #C4 ,V I ? ( C ( . 1

t > r CK# Y3 q ` 7 6 2 i 1 35 - Cf 7vcu U . 0 4 - 1 6 4 Z , j U r r 7 . . i

e Ps u d62 - ~ ~ SA72z

_ -I D#

W~l h 224 C44Lc4 i k e LU l - ~ ~ . v v A . vr

Gf CK# , y t . ~ / s a l / ~ ( 51 - 1 4 . u c I P+ ~ = ~ ~ ~ 1 c % P / UG, GCJ

I D#Lv I v l . e t PA~ / 4 , - z v ey,

Q t ea : c ~ c + 2 S r , 1 . 5 - , A 7 2 L

J ~ - - C - -

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Ae14P . . , d a , - ~ . t / t _ S2 7ZL



Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r m

CONTRI BUTI ONS - MONEY TAKEN 1 1 :( 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 b e s ame a s on S t a t e me n t o f O r g a n i z a t i o n )

~AA~L5 . e Re f Z . LuJd'i' 4o2t f I 3 GP* t, . o al

SUB- TOTAL


s c h e du l e )

SCHEDULE

A MONETARY

( R e v . 0 6 ! 9 7 )I

RECEI PTS

CHECK T HI S SOX I F

AMENDI NGFORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L 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 UST OF 1 0 NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .

TI ON : S e c t i o n6 8 8 . 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 p i e d f r o m r e p o r t s an d 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 ro r a n 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 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 .

v i s d c s u r e ' a w r e o u v e s c a n d i d a t e c o m m i t t e e s . o l i s =s e ; 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 r n a k i n g a c o n t ~ b u t i c n t o t h e

ommi r e e R e i a u o n s h ~ p c r u s t c e s h o w n t o t h e ' l i r a 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 u v e s l a n d a f f i n i t y r e l a t r . e s o y

n a g e ) ( S e e Page 2 ; t ` c 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 r c d at e b u t . ' h e r e s n o Page I Ti l i a l r e l a t t o n s m o 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 n e o c l e

DATE PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT v I F FORRECEI VED ( i f a p p l i c a b l e ) TO CAN010ATE' RECE I VED FUNO-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SER

NUMBERI NCOME

I D*MAI 2 K K; L t 1 ~ P~

0( CK# S` I C1 c jP. O. l 3Gu 3gv7 5 . 1 . 1 Z ~ e c x J

Die. , ;

-arzi , A SaI ~OF f

t , ~ t ~ - -l o #

R~~~~ sj ( i S. A ; PUE 1S

d I CK# I S 3 S " ' - ~ 7 / 3 S ° 1 s 4 ' . 4 , - ~ c ( CO, C2 ~

New

o r CK# '7l SS1 t - 9 , ) , O f 4 2 ~ 4 S7 0 . a)

CI A e t _ e - T , ~ 4 . 5 - ) 7 ( I S :

c ' CK#d i f ( o Ci Lew, Y '

e PN " ~ . ~ _ ~7zZ I

I _ c Q_ l o # {

o / CK# a S 3 i ? V/ - e t - 1 T ? R ` ( po . 6GI ~

c " 2 X. 1 S. ~ 7 2 2

C04 t 1 2 7 t SGc c ' E4 1+ r 4 1 ,

Ww , 2 +Y t S%t ? 2

I D# , r 1 4 f ? b i l f - - e t - -

z I Zz t v u . ~ ~ ` < ~j / r ~ 1 1 A /

JC1 ~~- -

CK#l D

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1

~/ c K#3` 1 ` ~ . , 2 1



Fo r I n s t r u c t i o n s , See Back o f Fo r m

CONTRI 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 TTEE NAME ( Mus t be s ame a s o n St a t emen t o f Or g a ni z at i o n)

STATE CANDI DATES NOTE : I F ACONTRI BUT I ON I S RECEI VED FROM ASTATEPAC ( P OL I T I C AL ACT I ON COMMI T - EE) , L I S T THE PAC I DENTI F I CAT I ON

NUMBER ANDTHE PACCHECK NUMBER I N THE DESI GNATED COLUMN AL I STOF I D NUMBERS I S A VA I L A B L E FROM THE I 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 oh i b i t s t h e u s e o f i n f o r mat i o n c o p 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 on t r i b ut i o ns o r

f o r any 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 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 .

SUB- TOTAL

- TOTAL ( i f l a s t p a g e o f t h i s

5 3 1 G ( 0 7 1 5 - 6 s c h e du l e ) $ y G '

Di s c l o s u r e l a w r e q u i r e s c a nd i d at 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 an y r e l a t i v e ma k i n g a c o n t 'n b u n o n t o t h e

c o mmi t t e e . R e l a t i o n s h i p mus 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 ) an d a f f i n i t y ( r e l a t i v e s o yma 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 a me o f c o n t r i b u t o r i s t h e s ame as c an di d at e b u t : h e r e i s n o P a g e

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 mn ( f o r S

SCHEDULE

A MONETARY

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

i ~ CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT v I F FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RA I SE

NUMBER I NCOM

I D# ( p UD y A - s 5 c ` - i . 4 h e d 6 < ' ' , P" ? r 1 1 C a , . r ' r ~ ~ ' t 1

- 7 - 6 - 0 1 0F / ~ . ~ C. . c x y / > $ / 0 00. 0 0

CK#3 ` 7 Cf . 2

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I D# C7yb ' , ( . c ~w: e l J P k ' , 1 g ,

CK#J , 2 I . 1 . ~ . ; q d U - c f Sq .

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T HI S BOX APPL I ES TO CANDI DATES ' COYMI 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 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 a r s L d 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 , mg wr i a r 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 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 mm i t t e e . ( R e f e r t o

Sc 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 ) ( 1 ) . )

Page

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

FOR I NSTRUCT I ONS , SEE BACK OF FORM SCHEDULE

EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT

( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE 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 THE I OWA AMENDI NG FORMETHI CS i £ 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 me n t o f O r g a n i Z a t i o n )

1 7, 4~ 7

CANDI DATE NAME AND ADDRESS T O WHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACT I ON) EXPENDED

EXPENDED ( 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 PACCHECKNUMBER

1 D # r "CK# W7 4 4 1 , Z 9 , 2 1

I D#CK#

I D #

CK#

I D#CK# .

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r 7CK#

I D#

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SUB- TOTAL $ ?Z 9TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) ~_~. ~ww' 4 I L~ J



ATTACHMENT B - 1

Mi l l a g e f o r I o wa ' s A t t o r n e y Ge n e r a l

Da t e Ca n d i d a t e 1 D Na me P ur p o s e Amou n t

Cheek# A dd r e s s

I D # Came r a Co r n e r De v e l o p i n g p h o t o g r a p h s f o r e v e n t

0 9 / 0 9 / 0 1 3 5 2 3 Ea s t e r n A v e . $ 1 4 . 7 3Ck # A

D a v e n p o r t , [ A 5 2 8 0 6

I D # L o n A n d er s o n

0 9 / 0 6 / 0 1 $ 3 5 . 7 9

Ck # B De s Mo i n e s , I A Camp a i g n s i g n s

I D #

0 9 / 1 1 / 0 1 VOI D $ -Ck # 1 0 0 1

I D # F a c t o r y Ca r d O u t l e t T h an k y o u c a r d s f o r c o n t r i b u t o r s

0 9 / 1 3 / 0 2 E l mo r e & 5 3 r d $ 8 . 5 4Ck # 1 0 0 2

D a v e n p o r t , I A 5 2 8 0 7

I D # U. S P o s t a l S e r v i c e P os t a g e f o r g e n e r a l u s a g e

0 9 / 1 3 / 0 1 $ 3 4 . 0 0Ck # 1 0 0 3

B e t t e n d o r f , I A

I D # MBNA A me r i c a F o r No r we s t A i r l i n e s 2 0 5 . 5 0 ; R e g i s t r a t i o n f e e f o r

C r e d i t Ca r d S e r v i c e s Re p ub l i c a n A t t ' t G e n e r a l ' s A s s o c i a t i o n c a mp a i g n s c h o o l0 9 / 2 8 / 0 1 $ 1 5 1 . 0 0 ; S t a r l i g h t V i l l a g e - l o d g i n g f o r c a mp a i g n t r i p t o De s $ 4 0 7 . 2 5

Ck # 1 0 0 4Mo i n e s $ 5 0 . 7 5

I D # Ame r i c a n B a n k P r i n t e d c h e c k s

1 0 / 0 4 / 0 1 $ 1 4 . 5 0Ck # De b i t

Da v en p or t , l A

I D # C h r i s t i a n P r i n t e r s P r i n t e d i n v i t a t i o n s t o f u n d r a i s i n g e v e n t

1 41 1 2 1 s t S t r e e t $ 6 6 5 . 6 8Ck # 1 0 0 5

De s Mo i n e s , I A 5 0 3 1 1

I D # C a p i t a l R e s o u r c e s , I n c . F e e s f o r K l e i n e f u n d r a i s i n g e v e n t

1 2 / 2 8 / 0 1 PO Bo x 2 5 7 $ 1 , 2 8 9 . 5 0Ck # 1 0 0 6

B r o o k l y n , I A 5 2 2 1 1

I D # MBNA A me r i c a L o d gi n g f o r Wa s h i n g t o n t r i p a t Re n a i s s a n c e H o t e l -

1 2 / 2 8 / 0 1 C r e d i t Ca r d Se r v i c e s # 1 1 1 8 4 5 1 1 1 6 0 - Camp a i g n S c h o o l $ 7 1 7 . 9 3Ck # 1 0 0 7

I D # U. S . P o s t a l Se r v i c e P os t a g e f o r g e n e r a l u s a g e

1 2 / 2 8 / 0 1 B e t t e n d o r f , I A $ 3 4 . 0 0

Ck#

1 0 0 8

I D# ! 5 q TOTAL

$ 3 , 2 2 1 . 9 2Ck #



~eQi ' I v v \ - , vvQ Cca~\ c v \ V\ a v ~N

T HI S BOX PPL I E S TO C D I DATES' COMMI TTEES ONLY : ~Vo ~u l 0 3 t { T-7

Pu 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 Sc 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 , 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 n

Sc 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 i e n i 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 rSc 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 5 6 . 6 ( 3 ) ( i ) . )

Pag e o f

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

FCR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDUL E

EXPENDI TURES BMONETARY

- - MONEY SPENT FROM COMMI TTEE ACCOUNT( Re v 0 9 / 9 7 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 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 THE 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 St a t e me n t o f Or g a n i z a t i o n )

_ ' 4, 4 f 2CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCR I 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/ DDNR) AND PAC

CHECK

NUMBER

1 1 D# 5 c , 1 4 r o u i v 4 n o " , 4 ) ? ; 1 4 d, a

~ C } I CK# / ~ ( 1 S S. t 9, I r. _CA. c ~ _ i r - ~ . - r r d $

0 1 ~ ' ~ ` , S - 9CK# l d G

I D #fK

sbra ( ; l f t

9

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CK# 1 1 d?

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-f 3

CK#~ r +1 2 4W

I D #

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C" V k " ~ c A V \ CMC I n~ ~ ~ ~ SUB- TOTA $ 1/ ,

YND 4 - V \ 0 L " 1~ S ~ TOTAL ( i f l a s t page o f t h i s schedu e )

s f a s " '

$



FOR I NSTRUCTI ONS, SEE BACK OFFORM

COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z a t i o n)

SUB- TOTAL

TOTAL ( i f l a s t

p a g e o f t h i s

s c h e d ul e )

SCHEDULE

E I N KI ND

( Re v . 0 6 / 9 7 ) ` CONTRI BUTI ONS


' Di s c l os ur e l aw r e q u i r e s c a nd i d at 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 any r e l a t i v e ma k i n g an i n k i n d c o n t r i b u t i o n t o t h e Pa g e

c o mmi t t e e Re l a t i o ns hi p mus t b e shown t o t h e t h i r d d e g r e e o f c ons ang ui ni t y ( b l ood 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 ( f o r Sc h e d ul e E!

b y 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 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 nd i d at e b u t t h er e i s n o

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 ap pl i c ab l e " i n t h e r e l a t i o n s h i p c o l u mn

DATE

RECEI VED

( MM/ D D / YR)

NAME ANDADDRESS

OF CONTRI BUTOR

RELATI ONSHI P

TO CANDI DATE

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

DESCRI PTI ON

OF I N K I ND

CONTRI BUTI ON

ESTI MATED

F AI R MARKET

VALUE

v I F FOR

FUND- RAI SER

CONTRI BUTI ON

l 0 2 - C9 - -

o I

1 1 , ' Ck t Mr Lo~ , { S( o i . ~P

~ e ~ e l o . s , ~ r l ~f s

. ? ~. ~ . T2_ S ' . Z L

~ C + c y d r C

c l e a s ; , . " 7 { o . ;

- R i s t r

1 I , . UG I /

t o _G . _

` ly

~~wcA, - C' r 4 r 0 20 , 4 1

E OAK P, 1, z K

Q t i J ~Ui ? ~ ~, 4 . S172Z

4eeZ

f aNj i z , a : LQZ ~ P' ZUU

I



FOR I NSTRUCTI ONS. SEE BACKOF RM

DI SCLOSURE SUMMARY PA

Cf Q ~ I G I M/I T TEE/ NAME ( Mu s t b e s ame a s n S t a t e en t o f Or g

I MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p o r t i n g f o r.

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

C3CHECK I F AMENDMENT TOREPORT DATED

CASH

ADD TOTAL MONEY TAKEN I N T HI S PERI OD

ND

t a t e w r 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 _ , j . A , ) C e u n t Y 7 C o c a l C a n d i d a t eJ C C i i n y % C ~i t y C e n t r a l C o mmi t t e e( 5 ) Co o n

( 8 ) S u S l a t e o f C n d i d a t e s

S4 j . - 3 3 ~ - 0 0 7 _ ? 3 I - / 3 ; 1 a r , ZSI GNATUREOF TREASURER ( o r p e o n f i l i n g t h i s r e p o r t ) TEL EPHONE DATE S I GNED

Ro u t i ne P e n a l t i e s Du e F o r L a t e F i l e d Rep o r t s Range f r o m $ 2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPL ETE THE FOL LOWI NG SENTENCE :

I AM FLUNGA / ' / O REPORT FORAN/ A ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .

C : ] Che 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 nd 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 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 HAND

i n d i c a t e9; M

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 amo t mt MUST be t h es a m e a s t h e c a s h o n ha nd a t t h e end o f t h e l a s t r e p o r t i n g p e r i o d , Z

6o r mus t be 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 . ) . . . . . . . - . - - . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . - S

S ch ed 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 ch ed u l e A

S ch ed u l e F L o a n s Re c ei v e d t o t a l ( A t t a c h S ch ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S ch 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 S c he d ul e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc he du l e H a mp l i e s t o Ca n d i d a t e s ' Commi t t e es On l v )

CANDI DATECOMMI TTEES ONLY :

CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )

VALUEOF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h S ch ed u l e H ) $

FORM

DR- 2 DI SCLOSURE

( Re v . 0 1 /9 8 )

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

Comm x

I n d e x e d . Q~. .

A u c i t e d

Cc mo u t e r

SUB- TOTAL . . . . . . S ~f `

YES

SUBTRACT TOTAL MONEYSPENT T HI S PERI OD

S ch 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 S ch ed u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

S ch ed u l e F : L o a n Rep a y men t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

- f & 9- - C J

CASH ON HAND a tt h e end 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 emus t

abe z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - _ - - - . . - - . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . 5 ,

UNPAI D BI L L S ( F r o m S c he d ul e D - A t t a c h S c h e d u l e D ) . - - - . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . - S a -

I N K I ND CONTRI BUT I ONS ( F r o m S ch ed u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -010OUTSTANDI NG LOANS ( F r o m S ch ed u l e F - A t t a c h S =Pd u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S

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