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2/14

CT - 1 9 - 2 0 0 6 1 2 : 3 4 PM DEEP RI VER- MI LL ERSBURG 3 1 9 6 5 5 7 3 0 0 P . 0 3

F o r I n s t r u c t i o n s , Se a Bec k o 1 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 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 ni z a t i o n)

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- - 1 . - - - . . --- . -NUMBER ANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.NOTE: ANY PERSON, OTHER THAN AN I NDMDUAL " THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI BI UTWS ANDSHOULD I MMEDI ATELY CONTACT THE BOARD,CAUTI ON : S e c t i o n 8 AB . 3 2 A ( t 3 ) , p r o h i b i t s t h e u s e o f I n f o f ma t l o n c o p l 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 yc o m m e 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

* D i s c l o s u r e f e w r e q u i r e s c 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 l n g a c o n t r l b o l o n t o t h ec o r n ml f 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 ( Wo o d r e l a t i v e & ) e 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 umame o f t x t r d r i b t d o r i s t h e sa me a s c a r t d i d s t a , b u t t h e r e I s n of a m i f i e l r e l a t i o n s h i p , h a t e r n d a pp l i c aW I n t h e r e l e d o n s h i p o o k i m n .

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3/14

CT- 1 9 - 2 0 06 1 2 : 3 2 PM DEEP RI VER- MI LL ERSBURG 3 19 6 5 5 7 3 0 0 P . 0 1

F o r I n s t r u c t l e n o , P w w A n n i r o f O n 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 )COMM E 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 )Mom+- , r os S , D' L

OCI I E DUL EA ( MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSOCHECK T HI S BOX I FAMENDI NGFORM

S TA TE CAND I DATES KOTR : 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 P A C ( P O L I T I C A L A C T I O N C O MM I T T E E ) , L I S T T HE P A C I D EN T I F I C AT I O NNUMBER AND TH E P A CCHECK NUMB ER I N T H E D E S I G NA T E D C O L U M N , A L I S T O F 1 0 NUMBERS I S A V A I L A B L E FROM T H E I O WA E T H I C S AND C A M P A I G ND I S C L O S U RE B O A R D ,NOTE : ANY PERSON. OTHER THAN AN I N DI V I D U AL , THAT r . n N TR I R I I T F S L A f 1 R F THAN f r 7 r n Tn Vo l I p C Ar u 1 P A I C N t i * A V " A \ / G P I L I N CR E S P ON S I B I L I T I E S AND SHOmf l I M M E Gi n l c l _ ~ Co u r A I c T TNI EWARD . - - - -C A I I T 1 1 QN r S o e t i o n Aa a . 9 4 A ( e ) , p r o h l b l t e t h e u t e o f I n f o r m a t i o n o o p l e d f r o m r a p o r s a O n e ) o t a t o m c n t a f o r a o l l d t l n q W j A r l h u l i v i i o v i r u i a i i rc 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 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

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4/14

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5/14


F o r I n s t r u c t i o n s , Se e Sa c k o f Fo r mCON T RI B UT I ONS - - MONEY T AKEN 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 NA ME ( M u s t b e same a s o n S t a t e m e n t o f O r g a n i z e N o n )

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A MONETARY( R e v . 0 7 / 0 3 ) RECEI PTS0 CHECK T HI S BOX I FAMENDI NG FORM

S T A T E C A ND I D A T E S wr E ; I F A CONTRI BUTI ON I S RECEI VED FROM A S T AT E P AC ( P O L I T I C A L A C T I O N COMMI TTEE) , L I S T THE PAC I DENTI FI CAT I ONNUMBER AND T HE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE B O A R D ,NOTE ANY PERSON, OTHER THAN AN I N DI V I D UA L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI B I L I T I ES AND SHOULD I MMEDI ATELY CONTACT THE BOARD .CAUTI ON : S e c t i o n t 3 8 B . 3 2 A ( 8 ) , 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 r f o r a n yc o mme r c i a l p u r p o s e b y e r r 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 l c a l c o mmi t t e e s ,

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6/14

CT- 19- 2006 1 2 : 3 5 PM DEEP RI VER- MI LL ERSBURG 319 655 73 00 P_06

Fo r ( I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N( I n d w l l n o n A 1 M l r i a t a ' s n a r a A A a 1 8 m d r 1 )OAMM17 " R I 1 1 A ME ( A l u o ! b s OATY we n n S f wr omo n ! o f L ' W g n n l s p ( i o r l )

OTATC OANO# DATCO NOTq . 1 r A GOn T N1 e U TI p N 1 0 ReGC1YCD f - ROM A OT AT G I AG ( " O L I T I G A L h ~. T I V N l . 1 J M M1 I 1 G C ) , L l t f l 1 MC YAG I U CN I I ~ I L ; A I I U NNUMBER AND T HE P AC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I $ A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .NOTE : ANY PERSON, OTHER THAN AN I NDI V I DUAL . THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVEF I L I NGRESPONS I B I L I T I E S AND SHOULD I MMEDI ATELY CONTACT THE BOARD,owuroN- n. . . 1 1 A I% r% . ~9A/ A\ . , . ~ h1 1 , 1 1 1 1 r : . . . . . . . . 1 1 . . . . . . a _ 1 r . . . . . . _ . . . . . i. . . . . 1 --.-- . . . . . . . . . , . . . . . . . r . . . . . . . . . . . __ w. . . . .c o mme r c i a l pur po se by anyp e r s o n o t he r t h a n , r . : .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 . ~'

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7/14


Fo r I n s t r u c t i o n s , Se a Back o f Fo r mCONTRI BUTI ONS " " MONEY TAKEN I N

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" D i s c l o s u r e l a w r e q u i r a 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 e 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 ow n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) 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 u r n ame o f c o n t r i b u t o r I s t h e s ame a s c a n d i d a t e , b u t t h e r e I s n 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 u mn .

SUB- TOTAL

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8/14

T - 1 9 - 2 0 0 6 1 2 ' 3 7 PM DEEP RI VER- MI LL ERSBURG

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 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 )COE1AMTTCE NAME ( Mu s t De s am e a s o n S t a t e me n t o f O r g a n / r a t i o n )

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12/14

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