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FOR I NSTRUCTI ONS, SEE BACKOF FORMDI SCLOSURE SUMMARY PAGECOMMI 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 )

l d t e , QJ J Q44 11 rC. P

r 9 e e_ , l Z GJ - r r 1 ) / 1 J f 4 . , bI MPORTANT : I n d i c a t e b y # t y p e o f c o m m 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 r P o l i t i c a lS 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 l S 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 e

CANDI DATE COMMI TTEES ONLY :Ca n d i d a t e Name

P o l i t i c a l P r t y ( i f a p p l i c a b l e )

' N

P _ 1 0 u h

a U

I T' r i S 1 1 4 4

O f f i c e S o u g h t

D i s t r i c t ( i f Se n a t e o r H o u s e )

t i . . , CoOwi tL 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 Cod 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 mm i 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 gA r t y p e o f c o mm i t t e e , i s t h e i n d i v i d u 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

ASI GNATURE OF PERSON

I NG REPORT

D E C 2 9 2 04OCHECK I F AMENDMENT TO REPORT DATED0C 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 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 must 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 DR - 3 i s f i l e d . )

_

FORMDR- 2DI SCLOSURE( Re v 1 2 / 2 0 0 5 )

REPORT

F o r O f f i c e U s e O n l yCo mm . #L o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

3 51 - ~9 ' Y / aTELEPHONE

DATE S I GNED

I AM FI L I N G A

REPORT FOR ( 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 b y # E 1

STATEMENT OF CASH ON HANDCASH 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 mmi t t e e . T h i s amoun t MUST b e t h e same a s t h e c a s h o n h a n d a t t h e e n d

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y & L o c a l C omm i 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

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t - OK I NS FRUCT I ONS , SEE BACK OF FORM I x e s e t r o a n SCHEDUL EEXPENDI TURES B- - MONEY SPENT FROMCOMMI TTEE ACCOUNT MONETARY( R e v . 0 7 / 0 3 ) EXPENDI TURES

STATE PAC COMMI TTE ES : NOTE : FOR C ON T RI B U T I ON S MADE T O S T A T EWI D E OR L E G I S L A T I V EC A ND I D A T E S , L I S T T H E C AN DI D AT E I D E NT I F I CA T I O N NUMBER I N THE D E SI GN A T E D COL UMN AND THE CHECK THI S BOX I FPA C CHECK NUMBER FOR EACH E X P E ND I T U RE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMEND I NG FORME T H I C S & CAMPAI GN D I S C L O S UR E BOARD .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 O r g a n i z a t i o n )

V. .CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( D ES CR I B E 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 / D D/ Y R ) AND PACCHECKNUMBER

I D#CK#

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FORI N ST RU CT I ON S, SEEBACKOF FORMCO

I T TE ENAME ( Mu s t e s a me 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 )

SCHEDULEE I N- K I ND

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

OCHECK T HI S BOX I FAMENDI NG FORM

DATE

RECEI VED( MM/ D D/ Y R) NAME ANDADDRESSOF CONTRI BUTORRELATI ONSHI PTO CANDI DATE

* ( i f a p p l i c a b l e )DESCRI PTI ONOF I N K I ND

CONTRI BUTI ON

ESTI MATEDF AI R MARKET

VALUEJ I F FOR

FUND- RAI SERCONTRI BUTI ON

RI PI _ L , . - I I I I F - 1

F - 1F771

F - 1F7

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FOR I N ST R UC T I O NS , SEE BACK OF FORMCOMMI TTEE NA ME ( Mus t b e s a m 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 )

TOTAL ( PART I )

$

TOTAL U NP AI D LOANSFROM LAST REPORTI NGPERI OD $

- _I x

PART I - MONETARY LOANS RECEI VED T HI S REPORTI NGPERI OD( O r i g i n a l s o ur c e o f l o a n , s u c h a s a b a n k , mu s t b e s h o w n i f a t h i r d p a r t y i si n v o l v e d I n c l u d e l o a ns f r o m c a n d i d a t e ' s p e r s o n a l f u n ds . )

' 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 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 ema k i n g a c o n t r i b u t i 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 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 fc 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 ) . I f s u r n a me o f c o n t r i b u t o r i st h e s a m e a s c a n d i d a t e , b u t t h e r 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 a p p l i c a b l e " i n t h er e l a t i o n s h i p c o l u mn w h e n i t a p p l i e s .

NOTE : T h i s s c h e d u l e r e p o r t s money l o a ne d t o t h e c o mmi t t e e w h i c h i s d e p os i t e d i n t h e f c o mmi t t e e a c c o u n t .

PART I I - MONETARY LOAN REPAYMENTS MADE T HI S REPORTI NG PERI OD( L o a n s f o r g i v e n must b e r e p o r t e d o n Sc h e d ul e E - I n - k i n d C on t r i b u t i o n s . )

TOTAL CASH REPAYMENTS ( P ART / / )

$

F r o m Sc h e d ul e E - - TOTAL LOANS FORGI VEN

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TOTAL OUTSTANDI NGLOANS END OFREPORT P E RI O D

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P a g e o f( f o r Sc h e d u l e F )

SCHEDULEF LOANS

( Re v . 0 7 / 0 3 ) RECEI VED& R EP AI DCHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VEDMM/ D D/ Y R

NAME AND ADDRESS OF LENDER( I n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e ) R EL A T I O NS HI PTO CANDI DATE

I f A p p l i c a b l e * )AMOUNTOF LOAN

DATE P AI D( MM/ D D/ Y R)

NAME ANDADDRESS OF LENDER( I n c l u d e E nd o r s e r ' s Name, I f A p p l i c a b l e ) R EL A T I O NS HI PTO CANDI DATE'I f A l i c a b l e

AMOUNTR EP AI D