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FOR I A I S FRUCT I ONS . SEEBACK OFF ' I

CANDI DATE COMMI TTEES ONLY :

SUBTRACT TOTAL MONEY SPENT T HI S PERI OD

Ca n d i d a t e Na me P o l i t i c a l P a r t y1 i ek ~ - . I E f l - R- 1 ~ - GN l i -E - MO 1647- 1 ( ? -

O f f i c e So 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 )S I - h I E 5E~A I T -: 5 Si c N! ? TI Ep l c - 1OZ - Z . N/ 7 - aQo2,S I GN .A' NREOF TREASURER ( o r p e r a n f i l i n g t h i s r e p o r t ) TELEPHONE DATE SI GNED

R o u t i n e P e n a l t i e s Du e F o r L a t e F i l e s ! R e p o r t s Ra n g e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI NS ON SACK AND COMPLETE THE FOLLOWI NG SENTENCE :I AM FI L I NG A E LC / l - 19- o REPORT FOR ANI A ( ' l ) E L ECT I ON / ( 2 ) NON- E L E CT I ON YEAR .

( r e p o r t d a t e ) I n d i c a t e o n eE] CHECK I F AMENDMENT TOREPORT DATED

E l C 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 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 N o 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 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 l o f a l l mo n i e s h e l db y t h e c o mmi t t e e . T h i s amou n t MUST b e t h e s a me 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 HI S PERI ODSc 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 Sc 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 ) . . . . . . . . .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 Camp a 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .( Sc h e du l eHa Do l l e s t oCa n d i d a t e s ' Co mmi t t e e s On l v 1

SUB- TOTAL . . . . . $

Sc 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 ) ( * * 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 ) . . .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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

FORM

Compu t e r G L _ _ JT - - -

J AN 1 7 2 0 0 2

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

r 3 S_ / . 9 7v5 7 , 5 - 9 S , Oa

0 8 7i 0 G L , 1 a

NO

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 mu s tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 9 8y 9 7

* * UNP AI D BI L L S ( F r o mSc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N K I ND CONTRI BUTI ONS ( F r o mSc h e d u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ a , a* * OUTSTAND I NG LOANS ( F r o mSc h e d u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YESVALUE OF CAMPAI GN PROPERTY ( Fr o m Sc h e d u l e H - A t t a c h Sc h e d u l e H)

DI SCLOSURE SUMMARY PAGEC~7 110772= NAME f i V u s t b e s a me a s o n S t a t e m e n t o f O r g a n i z a t i o n )TE f t i n - ) F _ d -F :612 STy f T6 7 S~ ( 1 CAMMI %Z-EE

DI SCL OSURE( Re v . 0 1 / 2 0 0 1 ) 1 REPORTF o r O f f i c - - Us e O n i v

I MPORTANT : I n d i c a t e 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 : Co mm . # LVTI n d e x e d Si d( 1 ) S t a t e w i d e / 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 A u d i t e d 9 ^ 1 0 - - "{ 5 l C o u n t y PAC ( o ) B a l l o t I s s u e i F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y i C t t y C e n t r a l C o mm i t t e e( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s

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Fo r I n s t r u c t i o n s , Se a 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 )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)_DE6"t 4 - ' C- 6 Q ENI YT E e _ a mA& , 7T t = E

SCHEDULEA MONETARY( Re v . 0 & 9 7 ) I RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L AC T I 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 TH E DESI GNATED COLUMN A L I S T OF 1 0 NUMBERS I S A V AI L A B L E FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 88 . 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 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 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 omme 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- 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 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 mm i 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 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 same a s c a n d i d a t e , b u t t h e r e i s n of a mi 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 .

Page o f( f o r Sc h e d u l e A )

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( 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 ds )COMMI TTEENAME ( Mu s t b e s ame a s on St a t e me n t o f Or g a n i z a t i o n )f ) c f } 1 2~) E1 1/ t ' 0 I 2 ST4Te SEA) j C ~Ol GCN1 i T jc~STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM ASTATEPAC ( P OL I T I CA L ACTI ONCOMMI TTEE) . L I S T THEPAC I DENT I F I CAT I ONNUMBER AND THE PACCHECKNUMBER I N THE DESI GNATED COLUMN. A L I ST OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 688 . 3 2A ( 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 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 o nt r i bu 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 b y any 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 p ag e o f t h i ss c h e du l e )

Di 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 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 mu s t be s h o w n t o t h e t h u 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) ( Se e P a g e 2 o f f o r ms p a c ke t . ) . I f s u mame o f c o n t r i b u t o r i s t h e s ame a s c an di d a t e , b ut 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 bl e " m 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)

SCHEDUL EA MONETARY

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

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i f a p pl i c a bl e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a bl e ) RAINUMBER I NCI D# GRcG: 3 ' v i - ~ELC- 0 1 S

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e r ' i > e a ' F e " - ' S T O Y 7 ' c- EA 4 T , E ( 20 o e r a . G 1 i TT G L =STATE CANDI DATES NOTE . I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L A C T I ON COMMI TTEE) . 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 UST OF 1 0 NUMBERS I S A V A I L A B L E FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI 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 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 .

' 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 i r b u t i o n t o t h ec 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 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 ym a r r i a g e ) ( S e e Pa 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 same 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 .

SUB- TOTALTOTAL ( i f l a s t page o f t h i ss c h e du l e )

P a g e " 5 of / 3( f o r S c he d u l e A )

SCHEDULEA MONETARY( Re v . 0 & 9 7 ) RECEI PTS0 CHECK THI S BOX I FAMENDI NG FORM

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F o r ' I n s t r u c t i o n s , Se a B a c k o f F o r t yCONTRI 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 h i n d a )COMMI 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 O r g a n i z a t i o n )

r r k I ~ c i L ' F o l e - . 5 T t } TE ~ ' S c ! l % / f TE ( ~ o h i A A , -TT C ~ 'S T A T E C A ND I D A T E S N O T E : I F A C ON T R I B U T I ON I S R E C E I V E D F R O M A S T A T E P A C ( P O L I T I C A L A C T I O N C O M M I T T E E ) L I S T T H E P A C I D E N T I F I C A T I O NN U M B E R A N D T HE P A C C H EC K N U MB E R I N T H E D E S I G N A TE D C O L U M N A L I S T OF I D N U M B E R S I S A V A I L A B L E F R O M T H E I OWA E T H I C S A N D C A MP A I G ND I S C L OS U R E B O A R DCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a 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 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 m e 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 m m i t t e e s

TOTAL ( i f l a s t p a g e o f t h i ss 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 c o m m 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 m a k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e R e l a t i o n s h i p m u 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a r n 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 m e o f c o n t r i b u t o r i s t 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 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 m n

SUB- TOTA L

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F o r I n s t r u c t i o n s , Se a B a c k o f F o u rCONTRI 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 h i n d s )COMMI TT EE NAME ( M u s t b e same a s o n S t a t e m e n t o f O r g a n i z a t i o n )U , 5 ' + 4 1 2 b E - A / POP- 9176 7 c ` SeA) 4 T r - - 0 cAt i t r TTt b

S T A T E CA ND I D AT E S N OT E I F A C ON T RI B U T I O N I S R E CE I V E D F R O M A S T A T E P A C ( P OU T I C A L A C T I O N C O MM I T T E E ) L I S T T HE P AC I D E N T I F I C A T I O NNUMBER A N D T H E P A C C H E C K NUMBER I N T H E D E S I G NA T E D C O L U M N A US T O F I D N U M B E R S I S A V A I L A B L E FROM T H E I O WA E T H I C S A N D C A MP A I G ND I S C L O S UR E B O A R DCAUTI ON : S e c t i o n 6 8 8 . 3 2 A ( 6 ) , I o w a 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 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 m e 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 mm i 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 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 e b t d i o n t o t h ec o m m i 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a 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 t s u r n a m e o f c o n t r i b u t o r i s t 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 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 a~$ DTOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e ) 1 $

P a g e o f( f o r S c h e d u l e A )

SCHEDUL EA MONETARY( R e v . 0 & 9 7 ) RECEI PTSQ CHECK THI S BOX I FAMENDI NG FORM

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F o t + I n s t r u c t i o n s , Se e B a c k o f Fo 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 h x W e )COMMI 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 O r g a n i z a t i o n )

STATE C A N DI D A T E S NOTE I F A C ON T RI B U T I O N I S R E CE I V E D F R O M A S T A T E P A C ( P O L I T I C A L A CT I O N C OMMI T T E E ) , L I S T T HE P AC I D E N T I F I C A T I O NNUMBER A N D T H E P A C C H E C K NUMBER I N T H E D ES I G N AT E D C O L U M N A L I S T O F 1 0 N U M B E R S I S A V A I L A B L E FROM T H E I O WA E T H I C S A N D C AMP A I G ND I S C L O S U RE BOARDCAUTI ON : S e c t i o n 6 8 8 . 3 2 A ( 6 ) , I o w a 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 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 m e 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 m m i t t e e s .

' D i s c l o s u r e ! a w r e q u i r e s c a n d i d a t e c o m m 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 m a k i n g a c o n t r i b u t i o n t o t h ec o m m i 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a r n 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 m e o f c o n t r i b u t o r i s t 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 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- TOTALTOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e )

P a g e 6 0 o f( f o r S c h e d u l e A )

SCHEDUL EA MONETARY( Re v . 0 & 9 7 ) RECEI PTS

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NC

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s 7 - E 2 D2 o st o D3 - v 1 bM . ~ A- 5 ' 0 3l zI D# $' ?EVAN Pe r 2 S e ) t iCK# . 30o W4 . Nu r 5 7 " UN 7 ~~ ' GOZ ~M I A- 5030 9 / DOI D# R>4N D y 13 & u e 2CK# l o o ~ l v D D~Ml ` sqNb

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y e s - ~ u s r ~ 4 s ~ o OD. ,f =~~ - v l DK# ~ l S7G D I I yQ - s o 3o y 'I D # 3o r + t i - t -- 2/ +de , ~A L l r 2 0CK# _ 3o ~ f s T f t ~ uT a w V 4 0 0 ' f f 0 v_b I & ~ A- So321I D # , K, e p 4A- _ i _ 9 ~ - - Deao - r f r y l ` t , 4 v l e 6

I - CK# r { - 3 LS- -S W3 1 St s / O .0d ` 1 - U ( 5 ~ f S ` DA t . S - a 3 z f

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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 rCONTRI 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 t u r 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 a n i z a t i o n )Dt ~ t - 1 2 ~~N 1 =o f ' 2 S Tf ` r E SCA t AT6- L ' o . a - ^ I TTe6 '

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACT I O N COMMI TTEE) . L I S T T HE 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 L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 8 . 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 m a 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 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 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 es .

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 ! 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 t w t i o n t o t h ec 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 h ow 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 a me o f c o n t r i b u t o r i s t h e same 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 -f a mi 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 )

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSO CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D # &4- 0 ~- 1~v a * LWr 4TE 5 7i f T=CK# / / 7 3 p i t ( I e oM Ay2 zi s . a 2 DN T , ~ v . $ o a V" ; E- t Q - r 0 , VI D # ~ f FM ~ - ~ , 4 - C oNw~l 2a wl s -

! 7M ~~ ~ o 3 r 7 , og39 OI D # f } U L cE I - - r I S A 1 I 4 A )a - 7 - 4 1 6 68 8 d p n N D f t - U . CK# j y - 9 DM _- T- - A - .g - 3/ Z c I D # - 3 - o > ` I e A LL t = y5 - v 0I D # _ 3 _ r f Mt sCK# (ZS S 8 5 - N~ s . ~ 6 _ a7 9 8 1 RU A , ) S w~ 3 7I D # 3o 5EAf + " F RUTH L / F ~ { = f 2 SCK# 3 / f ~ 5, 0A&M I T' D' / STA- De

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9 1a - a f c K# 6 , g ~ i X 1 3 wc :7 ~s 7 - 5 , 0* N l ~ _ - ' r ' A -I D # 76 H A J U Z I E F c . ~ t NNc i c y

CK# / o A - a s -t S' ` o /x - 7 9 9 w2 t ~ t ~0I D * V ( TRus7e ) 0 0CK# ~ ! 3 ~ ~ / ~ - ~ 2 ' W S e o , c l S r l t l ~p~Mt S ~~ F Soo i ' - f

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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 )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 )E! ~ K t 7 c 7 To P- S-r A TE- SZi t / * T E- o I f s . d 1 i 7 - T 6

S TATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TT EE) . 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 T HE DESI GNATED COLUMN . A L I S T OF I O NUMBERS I S A V A I L A B L E FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON: S e c t i o n 6 88 . 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 m a t i o n c o p i 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 omme 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 es .

TOTAL ( i f l a s t page o f t h i sD 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 b u u t o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t be 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 ) 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 Page 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 same 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 .

SUB- TOTAL

s c h ed u l e )

Pa g e go f 1?( f o r S c h e d u l e A )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECE I P T SCHECK T HI S BOX I FAMENDI NG FORM

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I D #CK# g~~ ~ SJ o ' A- - 3 k OI D # ~ I / K ~ J o SA LEE 0 ' REEAJ -- - 0 0

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0 ~ q ~ a M y o3 r 7I D # ; ~ y v i _ fCK# l a a t , t a_E, y s ~ . vA i s d 3/ d_ . 2 9 / oI D # ( 2 RA / d wAyt - EYeeCK# / 2L OL t o Z . LA- / ~ U I cwA 1 6I D# Mf t k f Ly t i r i A

GI - ~3- o ICK# ~87~ E. O0

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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 l d e l e ' s p e r s o n a l t u n d e )COMMI TTEE NAME ( M u s t b e same a s o n S t a t e m e n t o f O r g a n i z a t i o n )Dc } ( 1 Dc N To / 2 . S~TI ` F T > = ~ 5 ENh?~ 0. , 1 1 , 0 , a l I T 7 - EESTATE CANDI DATES NOTE : I F A C ON T R I B UT I O N I S R EC E I V E D FROM A S T A T E P A C ( P O L I T I C A L A CT I O N CO MM I T T E E ) . L I S T T HE P A C I D E NT I F I CA T I O NNUMBER AND T HE PACCHECK NUMBER I N THE D E S I GN A T E D COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM T HE I O WA E T H I C S AND CAMPAI GND I S C L O S UR E BOARD .CAUTI 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 a n d s t a t e m e 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 m m e 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 mm i 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 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 b u t i o n t o t h ec 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 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 ym a 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 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 m n .

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

P a g e q o f( f o r S c h e d u l e A )

SCHEDUL EA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG F ORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED F UN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D # ~ . e + ~ ~ t r ' r r4UDN~- L ~CK# c H 0 L - 4 - $ d oD I r k _TA - X03 17I D # c l p A - 1 - D ~ / ^ ( , F r f f I - E EuOv c i 2 A l F ' d

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