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FORi NSTRUCTi ONS, SEEBACK OF FORM

DI SCLOSURE SUMMARY PAGEC . MI TT. EE NAM~ j Mu s t b e s ame aJ s o n St a t e me n t o f O r g a n i z a b v o r . ;

I ; . a c, 4 a4uL . a c t , ~I c c . . .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 po 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 Ca n d i d a t e ( 2 ) S t a t e wi d e PAC ( 3 ) S t a t e P a r t y ( 4 ) Co u n t y / L oc a l Ca n d i d a t e( 5 ) Co t y PAC ( 6 ) B a l l o t I s s u e / F r a nc h i s e mmi t t e e ( 7 ) C o u n t y / C i t y Ce n t r a l Commi t t e e

I ( 8 u p p r t f t o o f Can d t e s. l - d am -

GNATURE OF TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TEL EPHONE DATE S I GNEDRo u t i n e Pe n a l t i e s Du e F o r L a t e F i l e d Re p or t s R a n g e f r om $ 20 t o $ 8 0 0

SEE I NSTRUCTI ONS ONBACK AND COMPL ETE THE F OL LOWI NGSENTENCE :r J - , , ~ . , " c 5 ~ n . ~.I AM F I L I NG A l . 1 1 1 I BC c f " i / L REPORT FORAN/ A ( 1 ) ELECTI 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 enCHECK I F AMENDMENT TO REPORT DATED MAR 1 1 2 0 0 2

h ) - 3 . _ ~F ~ C h e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .

C{ o u mus t c o n t i n u e t o r 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 B l e d . )

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 h i s i s t h e t o t a lo f a l l mon 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 b e t h es ame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a s t r e p o r t i n g p e r i o d , 3

o r mus 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 r i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PER I ODSc h e d u l e A : Ca s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d ul e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .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 Campa 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( S c h ed u l e H a a p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )PPR. TOTAL . . . . . . 5

SUBTRACT TOTAL MONEY SPENT THI S PER I ODSc 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 Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : L o an 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 a l a n c e m u s t , , ~ Q a p * , - Ib e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . $UNPAaD Bi L LS : ( F r o m Sc h e d u l e i 7 - A t t a c h Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUT I ONS ( F r o m Sc h e d u l e E - A t t a c h Sc h e d ul 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 du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATEC- OAAMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o mSc h e d u l e H - A t t a c h Sc h e d u l e H) $

L o c a l Commi t t e e s , e n t e r Da t e o f ! E t e c t i o n

Co u n t y & L o c a l Commi t t e e s , e n t e r Co u n t y i nwh i c h El e c t i o n i s h e l d

~,I ~I~II ' "1111~~~"I I I 11 1c t 4

I a . I V


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Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )I COMMI TTEENAME( Mu s t b e same a s o n St a t e me n t o f Or g a n i z a t i o n)

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

CHECK T HI S BOX I FiAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECE I VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEE) L I S T THE PAC I DENT I F I CATI ONNUMBER ANDTHEPACCHECKNUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVA I L A BL E FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use o f i n f o r ma t i on c o pi ed f r o m r ep or 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 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 an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SUB- TOTAL

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

Di s d os u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S ee Page 2 o f f o r ms p a c k et . ) I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n di d at e . b u t t h er e i s n o P a g e I - o f _f a m i l i a l r e l a t i o n s h i p e nt er ' n ot a p p l i c a b l e ' i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h e d u l e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT " . I F FORECEI VED ! i f a p p l i c a b l e ) TO CANDI DATE - RECEI VED FUND-( I v 1 M/ DD%YR ) AND PACCHECK ( i f a p p l i c a b l e ) RAI S ER

I NUMBER I I NCOME'~ ~ a l a s l D P I D#cK#

__- D f - Q t b e ( fA. 10X~~VUl 4~nC~~VA+L ) CL. a+ N~~i l k w y ~ lI D# 1 e I e v l KI uSSrnar I

3a $ 1 ' - I t i t S~~ cK# V ~l a s w t Cf , I t ~ 1 - 5 ~- l 0 II D# + " I G Q W~

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3/17

Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g an i z at i o n )

SUB- TOTAL

SCHEDULE

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

A MONETARY( R ev . 0 6 / 9 7 ) I RECEI PTS

CHECKT HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : ' I F A CON- r R I BUTI ON I S RECEI VED FROMASTATE PAC( P OL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER ANDTHE PAC CHECKNUMBER 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: Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u se o f i n f o r mat i o n c o pi e d f r o m r e p o r t s an d s t a t e me 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 ns o rf o r an y c omme r c i a l p u r p os e by an y p er s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p must 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 b ) 1ma r r i a g e ) ( Se e Page 2 o f f o r ms p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame as c a nd i d at e b u t t h e r e i s n o P a g e-A- _ o ff a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r Sc h ed u l e A)

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD' YR ) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D# -n a~ V ,2 12 U ) 02 - CK# s r S $ _j UN i t z~~LO~

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Z I Z u ) 0 Z CK# 1` 1 5_ ~ ` 6 l - t ~ ~ t E e I - c ~ r ( , ~ m : a d 1C , c s c ~ ID r 1 SI D# ( ~ c r + 0V Or ~ , / L12 G ,H

Ic . G 1 , ,: l a y ~o z CK#

I D# KCl

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I D# C t 7 ) 1 YIJ C ~ 5 1 f I S ' + k ) WCK# 1 1 , 1 a ~ v , i 5 u Ao I


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Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e same a s o n St a t e me n t o f Or g a n i z a t i o n )

vvL ; . t

SUB- TOTAL

SCHEDULEA( Re v . 0 6 1 9 7 )

AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHEPACCHECKNUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Sec t i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e use o f i n f o r ma t i on c o pi 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 on t r i b u t i o ns o rf o r any c omme r c i a l p u r p o s e by a n y p e r s o n ot h er 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

TOTAL ( i f l a s t pa ge o f t h i s s c he du l e )

MONETARYRECEI PTS

CHECK T HI S BOX I F

' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e es t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o r n m: t t e e R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y15ma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et . ) I f s u r n a me o f c o n t r i b u t o r i s t h e sa me a s c a n d i d a t e , b ut t h e r e i s n o P a g e _Jo f _ __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 mn . ( t o , Sc h e d u l e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF 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( MMI DDI YR) AND PACCHECK ( i f a p p l i c a b l e I RAI SERNUMBER I NCOME

I D# i - L ~ y l p l l m ~ - n 0 2$wAQ ,_, o 1 0 I 1, ~ , I -T ~U I

I D# A 4 t i 1 E S S ' I r ~ t l i l U ' ) _C / l p ) U2 CK# 1 5 ( } V ) y P I O L L ` I f I e , 4 .a N So L l o 1I D# S t J L ~ w I Q V - )~ I a U1 1 ~ L z CK# q I L C~p i - J W. ~ ' ~ - ~

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5/17

Fo r I n s t r u ct i o n s , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKENI N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame as o n St a t e me n t o f Or g an i z a t i o n)

STATECANDI DATES NOTE : I F ACONTRI BU I ON I S RECEI VED FROMASTATE PAC( P OL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PACI DENT I F I CATI ONNUMBER AND THE PACCHECK NUMBER I N THE DESI GNATED COLUMN AL I ST OF I D NUMBERS I S AVA I L AB LE FROM THE I OWA ETHI CSAND CAMPAI GNDI SCL OSURE BOARDCAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e 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 or t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r 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 an s t a t u t o r y p o l i t i c a l c ommi t t e es .

SUB- TOTAL

SCHEDULE

TOTAL ( i f l as t page o f t h i s s c he du l e )

A MONETARY( Re v 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o rms p a c k e t . ) I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , bu t t h e r e i s n o P a g e 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 o r Sc h e d u l e A)

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT , I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD . ' Y R ) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME02

I D# ~ .C dYi I I ' l E ~ x ~ l ~ $ r ol k c ~o r C" ~ ~ . w 5N0 I

I D#~1 2 U 1 6 ) ZLpZv ` S~ . ( C~ - uCK# C l e 4 r L - d b 114 5~9ZA

212UI bZ - f - + Z C7 , ~ ~ X ' J t i . l l C ~ " di

CK# t h 6 S " ) 1 ~S . , I GI Y ) c 5Y 1 ,~- S0LuyI D#

~( 2 l a( bL I ~ r q t n d A , / E I i ` Z J GJCK#/ . ) 1 0 1 ) v 1 ~ + i I v , o , , ~ 1A 5231

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( 0 Z CK# ~ ~ ( I C r " t ` ` ~~- St AP+ 1l i n e 5 u ~ n C ' ( 1~ 5-DWQII D# f o i r P C- V KS -

( 2 l k ( OZ CK# i 3 - 2 I - L 7 0 ` S+ , ~ vZP. r z , k l . ~ f I I T~5U4I D# Ut t 2 ~l } - ~ P d t i r ~ k h u y c r . ~

PAC vL ' V l JL~Ja~ ( C, 2 - CK# 15u3 ~ ' - / I S = v 1 ' WCIt ~O I ~CS5 I A ~- c s)Z

I D# i 1 I C ~ V 1 l ~C; Q~ I k z c I n J t ~a12U10z X132 S~ A , / t , ~S-

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6/17

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )

J SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c h ed ul e )

SCHEDULEA I MONETARY( Re v 0 6 / 9 7 ) RECEI PTS


STATE CANDI DATES NOTE I F ACONTRI BUTI ONNS RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THEPAC I DENT I F I CAT I ONNUMBER ANDTHEPAC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCL OSURE BOARD.CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi 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 on t r i b ut i o ns o rf o r an y c omme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e R e l a t i o n s h i p mu s t b e s h 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 b 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 a s c a n d i d a t e , b u t t h er 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 o r r c h ed ul e__A

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT , I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

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7/17

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

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )

SCHEDULEA MONETARY( Re v 0 6 / 9 7 ) I RECEI PTS

CHECK T HI S BOX I FAMENDI NGFORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON/ RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEE ) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHE PAC CHECKNUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e us e o f i n f o r ma t i on 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 ont r i b ut i o ns 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 ot 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

TOTAL ( i f l a st page o f t h i s s c hed u l e)

D i s c l o s u r e l a w r e q u i r e s c a 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p must b e s how n t o t h e t h i r d d e g r e e o f c o ns a ng 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 s b yma 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 umame 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 no P a g e o f jf 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 Sc h e d u l e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT . I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

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8/17

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mus 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 )

SCHEDULEA MONETARY( R ev . 0 6 / 9 7 ) , RECEI PTS

", - , HECE : THI S BOa ! - IAMENDI NG FORM

STATECANDI DATES NOTE : I F ACONTR I BUL t ON I S RECEI VED FROM ASTATE PAC ( P OL I T I CAL ACT I ON COMMI TTEE) , L I S T THEPAC I DENT I F I CAT I ONNUMBERANDTHE PACCHECKNUMBER I N THEDESI GNATED COLUMN AL I S T 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 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e po r t s and s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r 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 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 page o f t h i s s c h ed ul e )D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p 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 ) a n d 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 e 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 a s c a n d i d a t e , b u t t h er e i s n o P a g e - o f 2_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 Sc h e d u l eA~

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ` I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE'I

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9/17

Fo r I n s t r u c t i on s , Se e Back o f Fo r m SCHEDULECONTRI BUTI ONS - - MONEYTAKEN I N ( Re v . 0 6 / 9 7 )( 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 an i z at i o n )

STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACTI ON COMMI TTEE) . L I S T THE PAC I DENTI F I CATI ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN AL I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI Gr vDI SCL OSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2 A ( 6 ) , I o wa Code, p r o h i b i t s t h e u se o f i n f o r mat i on 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 u t i o ns o rf o r an y c omme r c i a l p u r p o s e by any p e r s o n ot h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

TOTAL ( i f l a s t page o f t h i s s c h ed u l e )' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec ommi t t e e R e l a t i o n s h i p mus t 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 b yma r r i a g e ) ( S e e Page 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 , b u t t h er 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 ! 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

MONETARYRECEI PTS


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10/17

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mu s t b e same a s o n S J , a t e me n t o f O r g a n 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 du l e )

SCHEDULEA MONETARY

( Re v 0 6 / 9 7 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE ) . L I S T THE PAC I DENT I F I CATI ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD.CAUTI ON : Se c t i o n 68B . 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 ma t i o n c o pi e d f r o m r e po 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 on t r i b u t i o ns o rf o r a n y c omme r c i a l p u r p o s e b y an y p er s o n o t h er 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 .

D i s c l o s u r e l aw r e q u i r e s c a nd i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p 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 ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k et . ) I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c an d i d a t e , b u t t h er e i s n o P a g e- o f . ~f a m i l i a l r e l a t i o n s h i p , e nt e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn ( f o r Sc h e d u l e A ;

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11/17

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

( I n 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( Mus t b e s ame a s o n St y~t ement o f Or g a ni z a t i o n)

STATE CANDI DATES NOTE : I F A C NTRI BUT I N I S RECE I VED FROM A STATE PAC ( P OL I T I CAL ACT I ON COMMI TTEE ) . L I S T THE PAC I DENT I F ICAT I ON

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSQCHECK T HI S BOX I F

AMENDI NG FORM

NUMBER AND T HE PACCHECK NUMBER I N THE DES I GNATED COL UMN . A L I S T OF I D NUMBERS I S AVA I LA B LE FROM THEI OWA ETHI CS AND CAMPAI GND I SCLOSURE BOARDCAUTI ON : Se c t i o n 688 . 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 mat i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c 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 by an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

' D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e es 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 r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu s t b e s h o wn t o t h e t h i r d d eg r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y t r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r m s pa c ke 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 as 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

TOTAL ( i f l a st page o f t h i s s c h e du l e )

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12/17

For I nstructi ons, SeeBackof For . .

CONTRBUTIONS- - MONEYTAKENIN( 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 )

I COMMI TTEENAME ( Mu s t b e s ame a s o n St a t emen t of Or g an i z a t i o n)

STATECANDI DATES NOTE : I F A CONTNI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THEPACCHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Sec t i on 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f or mat i on c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r any c o mme r c i a l p u r p o s e by any p e r s o n ot h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

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

D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi t t e es 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 r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p mu st be s how n t o t h e t h i r d d eg r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t . ) I f sumame o f c o n t r i b u t o r i s t h e same as c a nd i d at e . b ut t h e r e i s no Page _ _0_c f 117 ,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 c h ed u l e . A )

SCHEDULEA MONETARY( R ev 0 6 / 9 7 ) RECEI PTS0 CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P A. MOl i NT , ; ~ =RECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE RECEI %' ED( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e )NUMBER1Lo

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13/17

Fo r I n s t r u c t i o n s , Se e Ba c k o f Fon CONTRI 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 )I COMMI TT EE 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 )AMAmbk (Oo f i g , Zt ~ SB) v k T E.

( SCHEDULE( R ev . 0 6 / 9 7 )

MONETARYRECEI PTS

L7 CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACTI ON COMMI TT EE) . L I S T THE PAC I DENTI F I CATI ONNUMBER AND THEPAC CHECK NUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se ct i o n 68B . 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 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 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 a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

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

D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e es 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 r i b u t i o n t o t h ec o mmi t t e e R e i 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 gr e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Pa g e 2 o f f o r ms 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 s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa g e 1 9, o f _L0q_-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 Sc h e d u l e . A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P i AMOuI NT ! F FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE! VED FUNDi i M t v i l D D I Y R ) AND PAC CHECK ( i f a p p l i c a b l e i R AI S

NUMBER ! NCOI DD# ( p23- T L &~ o r s - t " I COhDoComm" Ve -4 r D2 ~ l a l ~e l Q r eCK# >>~~ i o e S ~ o ! ~ ~S : 1 7 4 ~D31 i

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14/17

T HI S BOX APPL I ES TOCANDI DATES' COMMI TTEES ONLY :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 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 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 nSc 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 m a d e b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o 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 nd I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

Pa g e - Z _o f

FOR I NSTRUCTI ONS, SEE BACK OFF 4 SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTR I BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VECANDI DATES, L I ST THE CAND I DATE I DENTI F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPEND I 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 s ame a s o n St a t e e n t o f Or g a n i z a t i o n)

rCAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( D ESCR I B E TRANSACT I 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 PACCHECKNUMBER

1 D# ~ Sr e P1 4 0- , 4 Z-L " ' I I I ' 4~, ~C K# J c 9 ^ - ~a ~ l $ W5, ~. . ~1 D# - 5 ' &- 7e

171 2V~CK# 1 1 / ol . ~-ly_

r " c rCK# 113 l Q e s1 D#

1 D# ( a~\ ; , a . Vj TZQ. ;L) 3 606

1D# t i i _~' 9 3 6- 2 wv q 5

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r s . ,SUB- TOTAL $ I

TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) $


15/17

F0 I I Y S I RL " L I 1 0 1 J S , SCEBACK 0F . i l ' V 1EXPENDI TURES - - MONEYSPENT FROMCOMMI TTEE ACCOUNT

S I A I t PAG t - uMM11 1 EES : NU I t : r UKUUN I K I t % U 1 1 U N J MAUt I UJ I A I t V V I U t UK L t U1 J LA1 1 Y tCANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI CS CAMPAI GN DI SCLOSURE BOARD.I cowMI l l EE I YAWI E I I V l w i be s d l l l e a s O f f J l t R w l l l e r l i Of o f g a l l i z d 6 u l l )

yal _t ~

SCHEDULE_ R u r . r Tn ov

( Re v . 0 9 / 9 7 ) EXPENDI TURESr -

CHECK T HI S BOX I FAMENDI NGFORM

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

T HI S BOX APPL I ES TOCANDI DATES' COMMI TTEES ONLY :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 0 0 o r mo r e must 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 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 mus t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e amou 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 on 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 tSc 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 Code 5 6 . 6 ( 3 ) ( i ) . )

Page

CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTv i , i 1 i v i v L , i v i o c n r = c i w i i t v n C ( DESORi u i . i, AN3ACi ; 0 - ) 1 L . n r=~ i wL . i ~I ( MW- DD-NR)EXPENDED ( i f a p p l i c a b l e ) ( Di s b ur s e me nt ) WAS MADEAND PACCHECKNUMBER

I D#CK# 1 $ X 1 1I D# 1 r r C,v

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16/17

FOR I NSTRUCT I ONS, SEE BACKOF FORMI COMMI TTEE NAME ( Mu s t b e s ame as o n S t : e n o f O r g a n i z a t i o n )

NOTE : De b t s p r e v i o u s l y r e p o r t e d t h a t r e ma i n u n p Wi d must b e i n c l u d e d o n t h i sS c h e d u l e , a s w e l l a s a n y n e w o b l i g a t i o n s i n c u r r e d i n t h i s p e r i o d .

DEBTS I OBL I GAT I ONS REMA I N I NG T HI S REPORTI NG PER I OD( DO NOT I NCLUDE LOANS - - SHOWLOANS ON SCHEDULE F )

" I f a c t u a l f i g u r e i s un k n own , s h o w " e s t i m a t e d " b e s i d e t h e f i g u r e .

c ) C I -

SCHEDULED I NCURRED( Re v . 0 8 / 9 8 ) 1 I NDEBTEDNESSCHECK T HI S BOXI F AMENDI NGFORM

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

Page~-o fj( f o r Sc h e du l e D )

CANDI DATE COMMI TTEES NOTE :' I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h whom t h e c a n d i d a t e ' s c o mm i t t e e h a s e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r m a n c e . E n t e r t h e name o f t h e c o n s u l t a n t wh o p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e m s s u c h a s a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o ro r g a n i z i n g s e r v i c e s . R e p o r t o n S c h e d u l e G t h e n a t u r e o f p e r f o r m a n c e an d t h e e s t i m a t e d p e r f o r m a n c e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

DATE DESCR I PT I ON OF GOODSOR BALANCE OWED ATI NCURRED NAME AND ADDRESS OF PERSON SERVI CES PROVI DED OR CLOSE OF( MM/ DD/ YR) TOWHOMDEBT OR OBL I GAT I ON I S OWED PURCHASED REPORTI NGPERI OD'1 j cc-~ S . ` s $

s l . "3111Q- 7 a3 ( o b & i ~

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TOTAL DEBTS OWED BY COMMI TTEE AT THE END OF T HI S REPORTI NG PERI OD $ ` 7 ~ l ; l cj


17/17

FOR I NSTRUCTI ONS, SEEBACK OF FORMCOMMI 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 )

5~ j I 0 , 7L

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

s c h e du l e )

SCHEDULEE I N K I ND

( Re v . 0 6 / 9 7 ) 1 CONTRI BUTI ONS

CHECKTHI S BOXI FAMENDI NGFORM

' Di s c l o s u r 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 an y r e l a t i v e mak 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 Page I-o f tlc o mmi t t e e Re l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e gr e e o f c o ns an gu 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 ( f o r Sc h e du l e E )b y ma r r i a ge ) ( Se e Page 2 o f f o r ms pa c ke 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 d i d at 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 nt e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn .

DATERECEI VED( MM/ DDI Y R) NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI PTO CANDI DATE

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