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J ? 06 3

T HI S BOX APPL I ES TO CANDI 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 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 ma d e b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r tS c he 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 ) ( 1 ) . )

P a g e _ _ _ 1 . - . - o f _ _ _ L _i r - e~k.. . r . a. a%

FOR I NSTRUCT I ONS, SEEBACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TUR

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DEOR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 0- d-Hi LCKTHI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A UST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a m e 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 )

CANDI DATE VAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I BE TRANSACTI ON) EXPENDED

EXPENDED ( 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 PACCHECKNUMBERl l D# l ( l P S 7 ~ Bv r / r HJc T d " y r ~z n C. 4 d r y e r~pl CK# / O/ gr Ue~WuJ ~ . r Z G _ ~, f ' ae Cl X, 0 . 1 7 Cl $ X02, ~Or

1 0 # 6 /CK#I D # aCK# `1 0 #CK#I D # VCK#D#CK#I D#CK#1 D #CK# r J

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 ) $

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FOR I NSTRUCTI ONS, SEE BACK OF FORM ZOAMDI SCLOSURE SUMMARY PAGE J AN 3 0 2 0 0 2

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 i n i z a t l n )C o i r r i - ` 'GBtT LZ r EI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e l 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 ( 4 ) C o u n t y / L o c a l C a n d i d a t e( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l Co mmi t t e e( 8 ) S u p p o S l a t e o f Can i d a t e sSI 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 ) TELEPHONE

Ro u t i n e Pen al t i e s Due F o r L a t e F i l e d Re p o r t s Rang e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONSONBACKANDCOMPLETETHE FOLLOWI NG SENTENCE :I AM F I L I NG A TI. , " / f a o a C- - - - - REPORT FORAN/ A ) ELECTI ON / ( 2 ) NON- E L E CT I ON YEAR .

( r e p o r t ' d a t e ) I . ) ) , / ~ I n d i c a t e o n eCHECK I F AMENDMENT TO REPORT DATED

Ch 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 DR- 3 .( Yo u mu s t c o nt i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )

STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b eg i n ni n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a lo f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s am o 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 d o f t h e l a s t r e p o r t i n g p e r i o d ,o r 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 f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Ca sh 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 ed u l 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 Ca mp a i g n Pr o p er t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e du l e H a pp l i e s t o Ca n d i d a t e s ' Commi t t e es On l y )SUB- TOTAL . . . . . . $

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 nc e Mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0. . a . . . . 63x . 4 . 0 . . . . $

FORMDR- 2 DI SCL OSURE( Re v . 0 1 / 9 8 ) REPORT

F o r O f f i c e Us e On l yComm . # ) _ 3 5I n d e x e d f L. ~

A u d i t e dCompu t e r

l -DATE SI GNED

L o c a l Co mmi t t e e s , e n t e r Da t e o f E l e c t i o nC o 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 nw h i c h E l e c t i o n i s h e l d

SUBTRACT TOTAL MONEYSPENT THI S PERI OD s j aa, ~ c rSc h e d u l e B : Ex p en di 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 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 ) . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ z t e p aI N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - At t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Z e r U OOUTSTANDI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -z e . - - aCANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h e du l e G At t a c h ed ? ) YES -VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - At t a c h Sc h e d u l e H) $ zC' YY> ~ ~ o i s

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( 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 e me n t o f Or g a ni z a t i o n)

1f , -5 -?G- . ! " c i r T~77 ' I r e 6w

D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p 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 t f i n i t y ( r e l a t i v e s b ymana 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 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 .

SCHEDULEA I MONETARY( Re v 0 6 / 9 7 ) RECEI PTSQCHECK THI S BOXAMENDI NGFORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEWED F ROM A STATE PAC ( P OL I T I C A L ACTI ON C OMMI T T E E ) , L I S T THE PAC I D E N T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A USTOF 1 0 NUMBERS I S AVAI LABLE F ROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 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 m a t 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 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 sf o r a ny 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 .

P a g e_/- o f( f o r S c h e d u l e A

DATE PAC 1 0 NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT JRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED( MMI DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RNUMBER II D#

1 i _P 1 CK# r / l ~ v ? i t 1 ~ ~ ~ ~ r 005 0. . l f . -c K# i ~ t ' S g l t r ) . A . ZA

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dIi t ' S rI D#CK#1 0 #CK#I D#CK#I D#CK# CA4~ SOB- TOTAL $

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FORI NSTRUCTI ONS, SEEBACKOFFORMCOMMI TTEE NAME ( 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 )

C ' S 1 P~ yrNOTE : 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 a i 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/ OBL I GATI ONS REMAI NI NG THI S REPORTI NG PERI OD

SCHEOULEID I NCURRE( Re v 0 8 / 9 8 ) 1 I NDEBTEDNEOCHECK THI S BOI F AMENDI NGFORM

An " i n c u r r e d d e b t ' i s a d e b t fg o o d s o r s e r v i c e s o r d e r e d o r( DONOT I NCLUDE LOANS - SHOWLOANS ON SCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y te n d o f t h e r e p o r t i n g p e r i o d . ,r e g a r d l e s s o f wh e t h e r a n i n v oh a s b e e n r e c e i v e d .

' I f a c t u a l f i g u r e i s u n k n o w n , 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 . Pa g e l o f-~( 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 wh om 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 ms 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 a n 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 .

DATEI NCURRED( MWDDI YR) NAME AND ADDRESS OF PERSONTO WHOMDEBT OR OBLI GATI ON I S OWEDDESCRI PTI ON OF GOODS ORSERVI CES PROVI DED ORPURCHASED

BALANCEOWEDCLOSE OFREPORTI NGPERI OD`

/ No - 0 1 P " q p i t -i t ) &W- AAr d ~ s

/ I qq- o l f l u j x ~ Qo

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SUB- TOTAL $

TOTAL DEBTS OWED BY COMMI TTEE AT THE END OF THI S REPORTI NG PERI OD $z