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FOR I NSTRUCTI ONS . SEE BACK OF FORM : _ '! ADI SCLOSURE SUMMARY PACCOMMI TT EE 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

CANDI DATE COMMI TT EES ONLY :C a n d ~ i d a t NamecJ ! ~v a~ . cT. .TY' ~ f- I c 5 1 - -

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

I AM F I L I N G A . . , ( / ~ . ~ sn ~ CTYVN1,Mf (Di t

g r 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 .( 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 DR- 3 i s f i l e d . )

I 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 a r : 9 9( 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 m m 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 Ot 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 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

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 )

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

STATEMENT OF CASH ON HAND

r m

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 wa 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 m m 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 e r t y p e o f c o m m i t t e e , i s t h ei 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 me l y _ ~ a V c u r a t e r e p o r t s .

6 3 1 9 ) S 7 2 1 0 2 ! : ~ 0

REPORT F OR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR .( r e p o r t d a t e ) I n d i c a t e b y #

MCHECK I FANENTTO REPORT DATED

CASH ONHAND 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 m m i t t e e . T h i s a m o u n 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 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 must 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

b e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2 DI SCLOSURE( R e v . 1 2 1 2 0 0 5 ) REPORT

F o r O f f i c e Us e On l yComm #Logge d I nScannedCompu t e rA u d i t e d

F i l e w i t h :I o wa E t h i c s a n d Campa i gnD i s c l o s u r e B o a r d5 1 0 E . 1 2 ' h , S t e . 1 ADe s Mo i n e s , I o w a 5 0 3 1 9F a x : 5 1 5 - 2 8 1 - 3 7 0 1

* L EPI i ONE DA SI GNED

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 nL eeC o u n t y & L o c a l C o m m 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

I _ i y 1 1 6 . 90ADD TOTAL MONEY TAKEN I N THI S PERI ODS c h e d u l e A : Cash 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 Campa i gn P r o p e r t y ( A t t a c h S c h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc he d ul e H a p p l i e s t o Ca nd i d a t e s ' Cg mr n i t t e e s On l v 1SUB- TOTAL . . . . . . . . . . . . . . . . . . . . . . .

SUBTRACT 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 Repa y men t s t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ONHAND a t t h e e nd 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 QR OO* " UNPAI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $' I N I OND CONTRI BUTI 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ l ' i ~636" " ` 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 G A t t a c h e d ? ) !YES_NOCANDI DATE COMMI i mONLY.VALUE OF CAMPAI GN PROPERTY#Fr o t n 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 m i 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 v o f e a c h v e a r .

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F o r k i l s t r r r c d o t l s , Se e B a c k o f F o r mCONTRI BUT I ONS - MONEY TAKEN I N

( I n c l u d i n g c a nd i d a t e s p e r s o n a l f u n d s )CONOWTEENAME( Mu s t b e s ame a s o n S t a t e me n t o f Or g a r a l z aa t t )Tr e - ~~ v l o v DYSTATECANDI DATES NOTE . I F ACONTRI BUTI ON I S RECBVED FROAI I ASU7 CMf r -AL ACTI ON C OMMI T T E E ) , UST THEPAC I DENT I F I CATI ONNUMBERAND THE PAC CHECKNUMBER I N THE DESI GNATEDCOLUMN. A LMOFI D NUMBERS I S AVAI I ASLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.QAN, i i OI I G Se c t i o r 1 68 B- VA r e po d s a n d a t a bs n e r l t s f o r s o l i a t r c l g c o n t i bu 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 ecommt o d i s c l o s e t or eWUo r v ; h i p o f sn 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 be 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 ( M o o t ! r d a t l v e s ) ' a n d a f i t y ( r e l a t i v e s byma r r i a g e ) . I f s u r n a me o f c o n b' b ut o r i s t h e s a me a s c a n d i d a t , bu t t h emi s n o paw o ff - Wa l - r e l a bo n s hi p , e n t e r ` n o t a pp i k a bl e " I n t h e r e l a do f s f r i p ' o o l t s r n - ( f o r Sc h e d ul e A

SCHEDULEA MONETARY

( Re v . 0 7 / 0 3 ) RECEI PTS0 CHECK T HI S BOX I FAMENDI NG FORM

. _ . r . , _ . ~ . . . u f . - ~ A~1g1 4AFFOR .~VED ( i f a p Ql l c a b i e ) TO CANDI DATE" RECENED FUND-( Wi V I l D D1 YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUN~ER R1 _i Ks ~ .2ZV- Z1f 2 hd C3CK# ~~ d ~ a x Ke l ~ Sa v r ~ . Z~S~l ' Z5

1 D # _r , 00- l D - Ol ~ / 220 / d ue 8 - Mv , . SZ G2 7I D #CK#I D #CK#I D #CK#

CK#

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I D #CK#I D #CK#I D #CK#

SUB- TOTAL $ ~0TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )

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T HI S BOX A PP L 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 m p a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r m o r e m u 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 t 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 Gb 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 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 Gi n s t r u c t i o n s a n d I o w a Co d e 6 8 A . 4 0 2 ( 3 ) ( i ) . )

P a g e o f

( f o r S c h e d u l e B )

FOR I NSTRUCTI ONS , SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTE E ACCOUNT ( R e v . 0 7 / 0 3 ) EXPENDI TURES

C A ND I D A T E S , L I S T DATE I D E N T I F I C A T I O N NUMB THE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FPA 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 FROMTHE I OWA AMENDI NGFORME T H I C S & CAMPAI GN DI SCLOSURE BOARD .CONMTTEE 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 )

Y' e l ~d / a~1 - 10 orCANDI DATE NAME ANDADDFESSTO PURPCSE AMOk WTDATE I D NUMBER EXPE ( DESCRI BE 4 C T K X 4 ) 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( MWDDf YR) AND PACCHECKNUMBER

I D# , s f - v p - r r ~. ~Ye~ Td ~ / ~ e- i l w d !J C Cr s e . ~ . c " - y r ~ r, ~ ' 2 , ~ r' K# i L ~ ac ( 7 ~ s l g ' Y t C~X~e~t SG. SA5 50~ j ' n r l / r ! F- dl SO L ! ~ a ~ S ~ 2 1 2 ~ , ,CN'h I P. dOhJ~K. ede

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FOR I N S TR UC T I ON S , SE E BACK OF FORMCOMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e m e n t o f Or g a n i z a t i o n )

SUB- TOTAL

TOTAL ( I f l a s tp 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 n d i d a t 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 n i n k i n d 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- - - - - - ~ 10see-9 o f f o r ms n 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 o

SCHEDULEE I N- K I ND( R e v . 0 6 / 9 7 1 CONTRI BUTI ONS

QCHECK T HI S BOX I FAMENDI NG FORM

DATERECEI VED( MMI DDI YR) NAME AND ADDRESSOF CONTRI BUTORRELATI ONSHI PTO CANDI DATE

` ( i f a p p l i c a b l eDESCRI PTI ONOF I N K I NDCONTRI BUTI ON

ESTI MATEDFAI R MARKETVALUE~ I F FORFUND- RAI SERCONTRI BUTI ON

St e " - . ; r e r ~ t d~ 9 0 ` l t ~ 2 ) . S ' z G z 7 Fe r10 _ nr u c r r e SS oT

F - 1F - 1F - 10F - 1F - 1F - 1