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    FORI NSTRUCT I ONS, SEEBACK OF FORMDISCLOSURESUMMARYPAGE

    COMMI TT EE NAME ( M u s t b e same a s o n St a t e me nt o f O r g a n i z a t i o n )~ r i c l t 'I MPORTANT : I n d i c a t e 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 : a( 1 ) S t a t e w i d e / t _ 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 PA C ( o " ) 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 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

    SI 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 )

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    REPORT FOR ANNA ( ' 1 ) ELECT I ON / ( 2 ) NON- ELECT I ON YEAR

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    Chec 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 an 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 rm DR- 3 .

    C 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 n( Y o u m u 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 . )

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    F o r I ~ s t r u c t i o n s , - S e e Back o f F o 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 TT EE NAME ( Mu s t be s ame a s o n St a t e me n t o f Or g ani z a t i o n)

    De nn i S - Or /Owcu STaJc

    uS' f .STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACT1ON COMMr r r E 9 , L I ST THE PAC I D EN TI F I C A 7 1 0 1 1NUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPA I GN!DI SCL OSURE 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 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 n t r i b u t i o n s o rf o r any c o mm e 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 mm i t t e e s .

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    Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN 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 as o n S t a t e me n t o f O r g a n i z a t i o n )D"Y) i S ~- o r , 1 . - o wa- t j f a~e _/-l o u s e - S T A T E CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECE I VED FROM A S T AT E P AC ( P O L I T I C A L ACT I ON C OMMI T T E E ) , L I S T T HE PA C I D EN T I F I C A T I O NNUMBER AND T HE P AC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .C AUT I ON : S e c t i o n 6 8 B . 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 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 an 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 mmi t t e e s .

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    F o r I n s t r u c t i o n s , Se e Back 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 f u n d s )COMMI TTEENAME ( Mu s t b e s ame as o n St a t e me n t o f O r g a n i z a t i o n )

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    Fo r J ~ s t r u c t i o n s , - S e e Back o f f d 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 ( M u 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 d o n ). U- e z o n i , s ~'o r . _ 1 ~ c 7 c L l t x J v ~~ ' ~ ~ e , l o o L , s C . -

    STATE CANDI DATES NOTE I F A C ON T A I B U T i O N I S R E CE I V E D F R OM A S T A T E P A C ( P OL 1 T I C AL A CT I O N C OMMI T T E E ) , USTTHE PAC I D E N T I F I C A m 1 0 NNUMBER AND T H E PAC CHECK NUMBER I N THE D E S I GN A T E D COL UMN A L I S T OF I D NUMBERS I S A VA I L A B L E FROMT HE I O WA E T HI C S AND C A MP A I G ND I S C L O S UR E B O A R D .CAUTI 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 t o n s o rf o r a n y c o mn i 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 mmi t t e e s

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    Fo r I n s t r u c t i o ns , - Se e Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N( I n c l u d i n g c a n d i d a t e ' a p e r s o n a l f u n d s )COMMI TTEENAME ( Mu s t be s ame 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 )b e- n v l , s

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    CAUTI ON: S e c t i o n - 6 8 1 3 . 3 2 A 4 0 ) , I o wa Co de , 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 mn i e r c i a l p u r p o s e by 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 .PAC I D NUMBER( i f a p p l i c a b l e )ANDPAC. CHECKNUMBER

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    FOR I NSTRUCTI ONS, SEEBACKOFFORMEXPENDI TURES - MONEYSPENT FROMCOMMI TTEEACCOUNT

    STATEPACCOMMI TTEES : NOTE: FORCONTRI BUTI ONSMADE TOSTATEWI DEORLEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THEDESI GNATED COLUMN ANDTHEPACCHECKNUMBER FOR EACH EXPENDI TURE. AL I ST OF I D NUMBERS I S AVAI LABLEFROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .

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    FORI NSTRUCTI ONS, SEEBACKOF FORMEXPENDI TURES - MONEY SPENT FROMCOMMI TTEEACCOUNT

    STATE PAC COMMI TTEES: NOTE: FOR CONTRI BUTI ONS MADETOSTATEWI DE OR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBERFOREACH EXPENDI TURE. A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWAETHI CS & CAMPAI GNDI SCLOSURE BOARD .

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    FORI NSTRUCT I ONS, SEEBACKOF FORMCOMMI TS 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 d o n )r . ,

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