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FORI NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( M u 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 )

I MPORTANT I n d i c a t e b ~ t t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l C o mm i t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PAC ( 9 ) C i t y PAC ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u eANDI DATE COMMI TT EES ONLY :

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l a n d c r i m i n a l p e n a l t i e s P u r s u a n t t o I o w a Co d e s e c t i o n 6 8 B . 3 2 A ( 7 )t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mmi t t e e , a n d t h e c h a i r p e r s o n , f o r a n y o t h e r t y p e o f c o mmi t t e e , i s t h ei n d i y * a l r e s p o n s i b l e f o r f i l i n g t i m e l y a n d a c c u r a t e r e p o r t s .

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

[ : ] CHECK I F AMENDMENTTO REPORT DATEDC h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a

( Y o 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 D

STATEMENT OF CAS H ON HAND

TELEPHONE DATE SI GNED

( 1 ) ELECT I ON / ( 2 ) N ON - E L E C T I O N YEAR .I n d i c a t e b y #0

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 o t a l o f a l l f u n d s h e l d b y t h ec o mm i t t e e . T h i s a m o u n t MUST b e t h e s am e a s t h e c a s h o n h a n d a t t h e e n do f t h e l a s t r e p o r t i n g p e r i o d o r mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T H I S PERI OD .S c h e d u l e A: C a s h C o n t r i b u t i o n s t o t a l ( A t t a c h S c h e d u l e A ) ( * a l s o s e e i n - k i n d b e l o w ) . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e F : L o a n s R e c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h e d u l e H : T o t a l S a l e s o f Ca mp a i g n P r o p e r t y ( A t t a c h S c h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e d u l e H a p p l i e s t o C a n d i d a t e s ' Co mmi t t e e s O n l y )SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 I DI SCLOSURE( R e v . 1 2 / 2 0 0 5 ) REPORTF o r O f f i c e Us e O n l yComm . #L o g g e d I r l lS c a n n e dC o mp u t e rA u d i t e d

/ a -% o

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 C o mmi t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

' l 7 F 7 . 1 3

J , - z , ( ' pSUBTRACT TOTAL MONEY SPENT T H I S PERI ODS c h e d u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h S c h e d u l e B ) ( * * a l s o s e e d e b t s a n d l o a n s b e l o w ) . . . . . . . . . . . . . .S c h e d u l e F : L o a n R e 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 tb e z e r o ) ( A t t a c h DR - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" * UNP AI D B I L L S ( F r o m S c h e d u l e D - A t t a c h S c h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ t ` i* I N K I ND CONTRI BUT I ONS ( F r o m S c h e d u l e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ G* * OUTSTANDI NG LOANS ( F r o m S c h e d u l e F - A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULTANT BREAKDOWN ( S c h e d u l e GA t t a c h e d ? ) _ YES NOCANDI DATE COMMI TT EES ONLY :VALUE OF CAMPAI GN PROPERTY( F r om S c h e d u l e H - A t t a c h S c h e d u l e H ) $STATE COMMI TT EES : S u b mi t a r e c o n c i l e d c a mp a i g n a c c o u n t b a n k s t a t e m e n t i n J a n u a r y o f e a c h y e a r

t o Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e ) F i l e w i t h :C " r L I t I o w a E t h i c s a n d C a mp a i g nD i s c l o s u r e B o a r dO f f i c e S o u g h t D i s t r i c t ( i f S e n a t e o r H o u s e ) 5 1 0 E 1 2 ' " , S t e . 1At ' 1 / P ~ a l i S Des Mo i n e s , I o w a 5 0 31 9Fa x : 5 1 5 - 2 8 1 - 3 7 0 1

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Fo r I n s t r u c t i o n s , Se e Back 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 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 )

STATE CANY) I DATES hOTE: I F A CONTR I BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) . L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK 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 CAMPA I GND I SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 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 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 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 .

SUB- TOTAL

TOTAL ( i f l a s t page o f t h i ss c h e du 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 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 e .c o mm i 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 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 n d i d a t e , b u t t h e r e i s n o P a g e-~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 e du l e A )

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

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I O NS HI P AMOUNT J I F FRECE I VED ( i f a p p l i c a b l e ) TO CAND I DATE' RECEI VED FUND( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI D ICK# ~ ~ 3 . . . a s d ` ~

t r I D#CKa l Se ~ ` 1 3 r G ` ` ; S i ~ Si . I Te

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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 )f COMMI TT 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)/ V A

f o r a n y c o mme r c i a l p u r p o s e b y a ny p 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 e s .

SUB- TOTAL

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

lSTATE CANDI DATES NOTt . 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 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 L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C od 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 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

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 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 ma k i n g a c o n t r i b u t i o n t o t h e .c o mm i t t e e . R e l a t i o n s h i p mu s t b e s how 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 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 t h e r e I s n o P a g e 3_ 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 e du l e A )

SCHEDULEA MONETARY

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

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FRECEI 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 SNUMBER I NCO

I D# I ' e S S 7 1 e - j . / $

~ 1 ! d D( CK# ~ 9oS Ur c' ~ T I ' q l ~ ~ c i dL~C_ s 7 - 5 ~ , s o aI D # r 1 r G ~ ~ Y i L J ZCK# y o b a o v " s_ U GuI D # 6 6 j 4 SS o c : . ~ i e d 6 e n e e o 4 Co o TR, 4GJ D1 j - S ~ ~T j ~ / > / Q L +7 0 1 t r Gd : z r t T d u e , .CK # e s J ' 7 0 1_. ~ q r 3I D #CK# 2 ~ I N. ( , I 1 r C r ' t ~ J L , Scu1~ j ~J I Li tC a o Z

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f ? 3S_ / V L - ~ D tI D # 7 / ~ c LCK# t ~ f 9 ~ ` ~ ' ' l yo I D #CK#

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FOR I NSTRUCT I ONS, SEE BACK OF FORMEXPENDI TURES - - MONEYSPENT FROMCOMMI TTEE ACCOUNT

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L E GI S L A T I V ECANDI DATES, L I S T THE CANDI DATE I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COL UMN ANDTHEPA C CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWAE T HI CS & CAMPAI GN DI SCLOSURE BOARD .

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

CHECK T HI S BOX I FAMENDI NG FORM

T HI S BOX APPL I E S TO CANDI DATES' COMMI TTEES ONLY:P u r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S c h e d u l e H ( R e f e r t o S c h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s m u s t a l s o b e d e t a i l i t e m i z e d o nS c h e d u l e G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e 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 oS c h e d u l e G i n s t r u c t i o n s a n d I o w a Code 5 6 . 6 ( 3 ) ( i ) . )

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COMMI TTEE NAME ( Mu 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 )

CANDI TE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MM/ D D/ Y R) ANDPACCHECKNUMBERI D# 5 T o r z . , ~ Co . ~ c r d ~ Ta ~ . C ~ L ~ s i o - F y G o ,CK# ~ l . V ~ , . S %. l l o h s o v e r - / 1 j e , v - F I y $ 1 , 5 ; 7

I D# l r f - Z ~ ' s 7 r a i ' 1 r ~ n ~ i %Gl 7~ ( i ,Dnu1 _ CK 1 0 6 1 Q , , DwKGGl = i 4 I l G G~9~~K t 3 ' t )r i 1 2 , 4 2 1 ~ . 4 . PCs l r D i / 1 C ' S T

I D# TAZU+n wA f - 1 , , , aCK# 1 6 &, 2 ZA o e ^ C , t ~ i l U ~ ~ T Y ' ~ 7 d ~ " CF ( u Ps l ~ j Or r ~ t =I D# CAr 2 T e : 2 P _ l < r 7 1 r r f c ~ PR/ n %~n l ~f +r t ~ S; ~ ; a

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