Foege Romaine887scanned

8/7/2019 Foege Romaine__887__scanned

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FOR I NSTRUCTI ONS, SEE BACK Or - ' ) RM

DI SCLOSURE SUMMARY PAGCOMMI TTEE NA f I I ~ E ( Mu s t r e s ame a s o n St a t emen t Or g a n

, f r z . e i sI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r :

J A N 9 2 0 0 2

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( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e( 8 ) S Wp o r t S~po o f C a n d i d a t e sY h` S~ Ma v u , J < ~ )SI GNATUREO THE S R R ( o r p e r s o n f l l f n g t h i s r e p o r t ) TELEPHONE DATE SI GNED

I AM F I L I NG A

Ro u t i n e Pen a l t i es Du e Fo r La t e F i l e d Re p o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ONBACKAND_ COMPLETE THE FOLLOWI NGSENTENCE :y1_~` o ~0 f - - - - REPORT FOR` ANNA ( 1 ) ELECTI ON / ( 2 ) NON- E L ECT I ON YEAR.

( r e p o r t d a t e ) I n d i c a t e o n e 1 qCI CHECK I F AMENDMENT TO REPORT DATED

El 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 .( Yo u mu s t c o nt i n ue t o f i l e r e p o r t s u n t i l a No 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 eg i n ni 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 d b y t h e c o mmi t t e e . Th i s amo u n t MUST b e t hes ame a s t h e c a s h o n h a n d a t t h e en d o 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 THI S PERI ODSc h e du l e A : Ca s h Co nt r i b ut i o ns t o t a l ( A t t a c h Sc h e du l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du 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 du l e H : T o t a l Sa 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 Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a o Pl i e s t o Can d i d a t e s ' Commi t t e e s On l y )

SUBTRACT TOTAL MONEY SPENT THI S PERI ODSUB- TOTAL . . . . . . $

Sc h e du l e B : Ex p e nd i t u r e s t o t a l ( A t t a c h Sc h e d ul e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 _ 81 1 6 - OdSc h e du 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0

CASH ON HAND a t t he en 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ l

UNPAI D BI L L S ( F r o m Sc h ed u l e D - At t a c h Sc h e d ul e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N KI ND CONTRI BUTI ONS ( F r o m Sc h e du l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r o m Sc h e d ul e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S

FORMDR- 2 I D I S C L O S U R E( Re v . 0 1 / 9 8 ) REPORT

F o r O f f i c e Us e OnIComm # __I n d e x e d .A u d i t e dCompu t e r

L o c a l C o mmi t t e e s , e n t e r Da t e o f E l e c t i o n

Co u n t y & L o c a l C o mmi t t e e s , e n t e r Co 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 , &0 ' l 5 00( )2a 4 5 - 7 . s 7

bCANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h ed u l e G At t a c h ed ? ) YES NOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e du l e H) $


2/17

CONTRI BUTI ONS - - MONEY T AK Ef V I NF 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 mr r ~

( I n c l u d i n g c an d i d at e ' s p e r s o n a l f u n ds )COMMI TTEENAME ( Mus t be s ame as on St at ement o f Or g an i z a t i o n )

t -Ce" e ~cr C[ . f 1 Zt ' r [ SSTATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CA L ACT I ON COMMI TT EE) . L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I ST OF I D NUMBERS I S AVA I L A BL E FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t s t h e us 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 on t r i b u t i of o r any c o mme r c i a l pu r po se b y any p e r s o n o t h e r t h an 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 .

Di s c l o s u r e l aw r e q u i r e s c an d i d at 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 L i b u t i o n t o t h ec o mmi t t e e . Re l a t i o n s h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c on s an gu 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 ee P a g e 2 o f f o r ms p ac ke t . ) . I f s ur name o f c on t r i b u t o r i s t h e s ame a s c an d i d at e , b u t t h e r e i s n o Page 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 pp l i c ab 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 MONETAR

( Re v . 0 6 1 9 7 ) RECEI PCHECKTHI S BOAMENDI NG FOR

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNTRECEI VED ( i f a pp l i c ab l e ) TOCANDI DATE' RECEI VED( MM/ DD/ YR) ANDPAC CHECK ( i f ap p l i c ab l e )NUMBER1 6 ~ I D# t c . . ~ 7 r ~e U. ~ s t - o ,1l eC, Sae, tCK# r c : (I D # , znhCK# - - ? L , t 3 . ~ ~ St Sf rer n c . I I ~I D # 1

a L F ` a . ( m e - i tCK# ~ [ 3 SCU f L - y n n ~r Jn en ( S ' o 0 3 - 1/ 3 I D # Ar - A &e : ~ ~ ~ . 4' U( : KG e (CK# / . ) - e - 7 WS - t a J - Q ~ S f - , 0 7J. . ,t i t La -r n j i .1 D # 46 , 7 7 6 c c e - L h i , r x t - c' y

I c - l ~na5(CLsCK#l ) VL I - j ~~ - 3 - 3 -I N

CK# r y ( 9 r t k Sfes d r n 4 Ps I I I 7- o 3 , 0-3603I D # ~1~ i ~ ~ vm~ bc . ( d e f s ' .SsdcCK# ( ~ , ~ s x o ~r t ~ s ; , 4 l e o

I N 6 6 - 13 l oc va I q e d i c a - ICK# Sa o ( s r G . ~ d Ae"~~ ~~ , ~ l e s ~ s ( S " ~~I D # 1 6 e e

/ / CK# 130e I f 1 1 l [ . ' ~I D #CK# -3 - L 4 , 0K t e -awa _ 4/ 4 . Z2I ~ - SUB- TOTAL

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


3/17

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONt RI 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 a s o n S t a t eme n t o f O r g a n i z a t i o n )

- r ) n. sSTATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S R E CE I V E D FROM A S TA TE PAC ( P O L I T I C A L A C T I O N C OMMI T T E E ) , L I S T T HE P AC I D E NT I F I C A T I ONNUMBER AND T HE PAC 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 T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI 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 of o r a ny c omme r c i a l p u r p o s e b y a ny 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 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 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 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 P a g e ' Af 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 ( f o r S c h e d u l e A

SCHEDULEA MONETAR

( R e v0 6 1 9 7 1 RECEI P TCHECK T HI S BOAMENDI NG FOR

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTR I BUTOR RELA T I ONSHI P AMOUNTRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECE I VED( MM/ DDI Y R) AND PAC CHECK ( i f a p p l i c a b l e )NUMBERI D# E l l ( - ~ C r c t r 1CK# S C

2 - 1 d a m - d s 5 Z 4 o 3I D# / ` C C 7 1 i Z u c e A ~l S YCK# S - w/t~- ~ t < "I D#one D i 'ZL l n t _ h I t r r a t~ , 11 _ ~d af r _ d S

a CK# ) ej q U l ~q z1 G ~ o f CK# 1 , 1 4 - 1 154WQ ~ - d ( s - J A ~ ' v Us ~ ,I D # , , J " L La n r C / h o i ' Y . Sl Q l ~ CK# %{ ~~ . Ve . r . - I o n ~o~ 2 c ~ . Sc0 )

I D # l 1 x r Y 1QS~l ~ t r t ~ ' ~/ D ' l 3 f 1 l CK# Z2 L ar ) r2 3 l e ' ( s' f l e i J X2 - 3 ~ D 7 1 ,I D # - , - ~ 1 4 J s ? ) , )

l b l - D t CK# l oS 6604,Ammvset ( _ J A S22c~5I D # &/ t e W, / / / ~ '. 1 U' l a CK# q 6 1 ' C a S t r- 1 ,Ana n- l os ~A ~z2~s 'D# i t - 5 1m,/ p . 1 . CK# ~ l ~ 9 i C ~ ~ ~ wman L . t i - n c A I _ C

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


4/17

Fo r I n s t r u c t i o n s , Se e Ba c k o f F o 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 TTEENAME ( Mu s t be same a s o n S t a t eme n t o f Or g a ni z a t i o n)I

STATECANDI DATES NOTE : I F A CONTRI BUT I ON I S RECE I VED FROM ASTATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THE PAC CHECKNUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CSAND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se ct i o n 68B . 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 ma t i o n c o pi 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 ont r i bu t i o ns o rf o r a n y c omme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an 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 st page o f t h i s s 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 ommi 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 mak i ng a c o n t r i b u t i o n t o t h ec ommi 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 ) and a f f i n i t y ( r e l a t i v e s b y

m a 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 no P a g e 3o ff a mi l i a l r e l a t i o n s h i p , e nt 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 umn . ( f o r Sc h e d u l e A)

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

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D#

~D, 0f CK# x v e -l 5 0 ~I D#

w"s A5U ! ~ . I II D # &. r t ?Q~~ = 3 . rCK# , 3 1 4 l V o r mon i c eh ( I T QLZS2 )I D# V J d t u Y i c l f ~~

/ t ? CK# , ~ 1 q i e r r a c c f c e tv c - ) a ( : - %J A ~Z2~Sy ,I D# mar e gt "t a5e - v )

l D ` G ' 1 CK# ne~ o v SEt ; ( Sl F i > ` r ~. 5

CK# e ~ r ' ~i ( S ~ d r 1 1i ~ ~I D# ~ , " / a Ck sMI ` k F Q,~X04 SE

I D# .uPe r y u '5 2g1 23 2I D# d Qr K" S v e l a ( 1 A CZ _

/ 0 01&0/ CK# _ 1 a - r I Z Z Ie


5/17

F o r I n s t r u c t i o n s , S e e B a c k o f F o r mC O N T R I B U T I O N S - - M O N E Y T A K E N 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 )C O M M I T T E E N A M E ( M u s t b e s a m e 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 - o e 4 ( C c - r i e . 1 l S - - 4 1 9 9 1 7

SCHEDULEA I MONETARY( R e v 0 6 / 9 7 ) RECE I PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S REC E I V E D FROM A STATE PAC ( P O L I T I C AL ACT I O N C OM MI T T E E ) , 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 L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAUT I 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 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 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 p a g e o f t h i s s c h e d ul 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 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 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 mm 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 y ' 1m 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 same a s c a n d i d a t e , b u t t h e r e i s n o Page 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 S c h e d u l e A)

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI 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 SENUMBER I NCOMI D# 74~QSGh / e en I C~G~~

l U l " 3 ~U I C ' I 7 , 3 N, L r t 1 r ) S"k ZAIo , l c v i a C4 , 41 4 44~ 6- Z 7 - 4 0 $ / 00, 6THI D# COMMA- e 4Au k r n v/ I ? ! 1 l CK# I / 1 &*, l e .W o i r 1 CS ~- 4 A l O l , tI D# 9 ' 3 Mer c k PAC- "1 C ) ~ 0 / CK# . ` ; q7 WQ l P e n n ~ " ~2 r 1 x n . ~ l ~ - V e i u c ~ , I v ' ~S ~n C~l X ~I D#

Nr v 'CK# r n f V Q , r n t m4P ~z 1 c l 2 d ? 1 . b hI D# pk uj - . e br r s r r ar l. U~ C K# ZWU Av e , Aj c C I ( ~A C S ( Y1 sU 2 - ~ d 7 1 . Dc I t - L Q SI D# r 4 ( mbvu '

2 A C 1 / CK# * F 0 1 0hst r va4 c t~d _ 6 - 0- 31 1I D# l D~ ~G Y SY t1 0 , 3 0- 0 1 CK# - - f , l 9f n ~~s~ ~ ~' ' C) , 3e.0 1 CK# ~~33 Co" 75C V t i i ? Sf f ~ c . c y ' l a1 41~ ~ I e St ~C5 Moi r~s c 5 ' ~ G.~~I D# Theodore ~ l ' .- dl e se r , , JY

or CK# 301l L i o n Lee C- ~ .e Mo' a- 5 6 31 , 7 2 t ' T D . ~


6/17

F o r I n s t r u c t i o n s , Se e Ba 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 n d i d a t e ' s p e r s o n a l f u n d s )I COMMI TTEE NAME ( Mu s t be 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 )

s - ~~

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

SCHEDUL EA I MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBERANDTHE PACCHECK NUMBER I N THE DESI GNATED COL UMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON: Se c t i o n 68B. 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 ma 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 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 by an 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 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 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 ms 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 a m e a s c a n d i d a t e , b ut t h e r e i s n o P a g e6o ff 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 S c h ed ul e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT V I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RA I SENUMBER I NCOMI D # EU- 1 2 . l - C e j - -32z-I D # l ark- Smi q-h

.0 1 CK# 8 t f v ~ o b w ' ~ s ~ c r t l ~ D . d ~S ( wnI D # D e n n l ' s 0 0 r h a k -l CK# 22 / 3 A . Pa am 1 4 4 3Z2~0I D # ~ t s ~ ( i c mn0 / CK# 22~ 3 ~ a / n 2~I D #

1 1 / CK# 1 4 0 Co 1 2 0 ~~ A v ? ' Sam, ~ lp r < i i d . S 5~- ~0I D # e h i r l - s J -. 1CK# q o s Ne

k r o ' me l e rAn k e hI D # ~ I CI ' ~ ~ s ` j Wa l i q

I l ~ O . p~ CK# c r ZL k # " ~ . 2 4 - 0CK# N LUGt . L S f ~QI D # An y F l e1 ~ ~ l CK# a s l ~ Cl t ' ~ . Q ~ S 5 o / UI D # Jea . r ~ a r n ~

1 l v CK# c + . ~wr d sp o , % l o / 0 0 . 0


7/17

Fo r I n s t r u c t i on 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 TTEE NAME ( Mu s t b e s ame as on S t a t e me n t o f O r g a n i z a t i o n )[ -,Deaf f or d' - 4 -

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

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


STATE CANDI DATES NOTE : I F A C ON T RI B UT I ON I S RECE I V E D FROMA S TA TE PAC ( P OL I T I C A L ACT I O N C OMMI T T E E ) , L I S T THE PAC I D EN T 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 D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD.CAUT I 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 ma 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 an y c omme r c i a l p u r p o s e b y a ny 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 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 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 r i a g e ) ( S e c Pa g e 2 o f f o r m s p a z x e t . , I f s u r n ame o f c c . i 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 a i t t h e r e i s n o Page L,: 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 S c h e d u l e A )

DATE PACI D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONS H I 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 S ENUMBER I NCOMI D# Af a n

I ~ ' O CK# ZSbO4 t 1 =o ' v e s t ~OTI " 6vhe S l l o i f ' U Q S Q45' 0x12I D# &L 3_ Q~I DU~~2 . ~~/ ~ I 2 , o l CK# 728 Sb~,Q~, Qe s l o ~ s r ~- o o .

I D# ~ ' . , 1o u x ~ I V r t , ! ' S C S ~ F s s o c , . / + on PA- L1 1 I ~ D I CK# l l o ' ~ g / c o l ~ f z S- 4 1 lWes t 4 ' Y l o ; n a s ~o a( c l 1 6 d . 6 D

I D# 4 e Q Sn q"6 ! ~ e re r i/ - 7 0 1 3 AaQt . s a d e s l e a d1 1 l 2 Dl CK# mou . n ~ I l u - r i o n , JA 5Z31~ - 50 . 1 , E

I D#P3~

o t d ~ - ~ n c c J n Av y .1 1 l ' DI CK# M4 - e r o r n o~ SZ~~ lo9 ~D.I D# Si c Vo l t y l a ndQ. ma - e , h' 'l ~ 12~1 CK# 3~f ' 32 . Fo 1' G l ~ e ' - . l J ~ l /sI D# ~ `I l h- a r CK# ~ ~ ~ l ` 5v ( ~ ~. v

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l l l 2 0 ~ CK# , ~ } 1 t h v X ~ l c - h ' / Va ~ ~ l I ~ - o aML ) , P\0sojI D# EcP Co n l o wi f . ! 2. 0 ( CK# 10/ Obsc r v a . -s ; r L LS 50x. f 0~. QD


8/17

F o r I n s t r u c t i o n s , S e 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 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 a s o n S t a t e me n t o f Or g an i z a t i o n)

SCHEDULEA I MONETARY( R ev . 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOX I FAMENDI NG FORM~eG/Q-4r OA_. 4i %,, ,

STATE CANDI DATES NOTE : I F ACONTRI BU T I ON I S RECEI VED FROMA STATE PAC( P OL I T I CA L ACT I ON COMMI TTEE) , L I S T T HE PAC I DENT I F I CAT I ONNUMBER AND T HE PAC CHECK NUMBER I N THEDESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Sec t i o n 68B. 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 mat 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 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 omme r c i a l p u r p o s e b y any p e r s o n o t h er 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- TOTAL

TOTAL ( 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 ommi t t e es 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 an 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 ommi t t e e. R e l a t i o n s h i p must 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 ) an d a f f i n i t y ( r e l a t i v e s b yr r 3 r r i a g e ) ( S ee Page 2 c f " a r ms p a c k e , ' ) 1 1 s u r n a r , , e c f c o n t r i b u t o r i s t h e s a r : a s c a n c : : a " c , 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 . Page .

_o f - / - 2 : :-( f o r S c h ed u l e A)

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI S ENUMBER I NCOMI D# ~. OLUS, Q I S8CK# 3 BY~a . r I 2 1d ~ AT

EL2* - Z -I D# b h g r l e S SCK# / mb8 Ok l a h o n ~ c t .1 ~ v 2 - a tD#

~ ' 2 . ' 0 CK#I D# ~y~ew~GYf "

1 1 " ? CK# SOQ Q t h l l I ~i V~ ' l o ah I e t i r > ~ . s s o a pI D#

D~ CK # ~~ t j ~~ ~ 20Z I ~I D# o l l ~ A r r r n s aCK# 63o El l l o 4 S e _ - ~ l VEaI D# S - f e Ve n ~ OVe~l l ' a l ' d l CK# Z , 2 s 9 w h ' J s~~e" s 4 /bI D# YahC l ee. f 2 JC s e ,CK# ~ j ~ w o a d P /I l , a 1 a l d s ~g - 3 / o 0I D# , ~ M~r o c r / ,c K# 2 c ~ 0 ~r n bt ' u - ~- l d ~ . 1 f ~I D# 6&v i d L o eb s a- c k& / a 34, vi mA/C K # VLMO o L l - } - /


9/17

F o r I n s t r u c t i o n s , Se e Ba 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 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 )

l De e-rC~STATECANDI DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D FROM 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 OM MI 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 AND T HE P A C CHECK NUMBER I N T HE D E S I G NA T E D COLUMN A L I S T O F I D NUMBERS I S A VA I L A B L E FROMTHE I O WA E T H I C S AND C A MP A I G ND I S C L O S UR E BOARD.

I' 6~r

SCHEDULEA I MONETARY( R e v - 0 6 / 9 7 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

CAUT I 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 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 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 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 mmi 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 ymar ' a g e ) ( S e , P a g e 2 o f f x ms p a c k a . . I f c u mame o f c o n t r i t a 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 r o cf 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 . P a g e . - o f~~( f o r S c h e d u l e A )

DATERECEI VED PAC I D NUMBER( i f a p p l i c a b l e ) NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI PTO CANDI DATE' AMOUNTRECEI VED J I F FOFUND-( MM/ D D / Y R ) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERN I ) MBER I NCOME

W77 57 7. 2TY77D/ CK# l 3 S ~ S S ~ ' i ~ q v i / l e $ ~' 6. 1 ! ~ z ~

. V u - r t ~ n d z 31 D # Q. I e P _ J ' 1 R" - AWAe! l a ( D I CK# 0 0 Wo c d 6 ~ - i d o ( S - Z a Ar AI D# / ge, ~ F ` r e en 2Q . , r 1

0 / CK# 2* i C u . t . NE~.A v e " r f- I J - 4 6 2WD 5b . 6 ZI D# , a me - s L I ' 1CK# 4 1 5 1 3 $ A l c t v " b 0 * . NTl l a 1 ~ / r ' a ~ i ~ l b Z- 3 6 4 SOI D# RQr u . E L & ~ ~w tCK#

~ s~~ ~ 'D , l l 6 ~ . l P ~I D # 9 " I t ef ) h e r n " ' ' e rCK# 3 1 I ! 3 - 33~~r . S - h !0 1 1 1 D # ; ChQ. r Q _ 4 * - l e a ' .

I I ~ 1 " D~ CK# f ' . D. h ' ox CvSo -n o . J - > 4 - ~~zs3 ~D. 6~I D#CK# a . Y ~ o o . L ~ ? - a~2 2- L10~ 5 ~ 0 4)

1 l ~ I l b A-rv~S.1 1 ~l 0~ M~. v t r n o n J4~Z3~ AdI D#a7(3 ~J Qs h~CK# M4, V&71


10/17

Fo r I n st 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 )

SCHEDULEA MONETARY( Re v - 0 6 / 9 7 ) I RECEI PTS0CHECK T HI S BOX I FAMENDI NG FORMCOMMI TTEENAME( 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)

loe a - f o rSTATE 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 TTEE) , L I S T THEPACI DENTI F I CATI ONNUMBERAND THE PACCHECK 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 ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B. 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 ma t i o n c op i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c omme r c i a l p u r p o s e by an y p e r s o n o t h e r t h an 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 as t page o f t h i s sc hed 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 any r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p must 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 ) and a f f i n i t y ( r e l a t i v e s b y

r z T r i z g a ) ( S e e Page 2 o f f o r ms p a c k a t , 1 . - 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 nd i d at e b ut t h e r e i L r w Pag e - _of~~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 e r e l a t i o n s h i p c o l umn ( f o r Sc h e d u l e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' I RECEI VED FUND-( MM/ DD/ YR ) ANDPACCHECK ( i f a p p l i c a b l e ) RAI SENUMRFR I NCOMI D# l i t , J d f a - - t ' Y l 7 0Yr Y' I*~ $CK# / &~o Pol k A - v t ~ ~3~3 D.

I D# Ma r e L i t umt c - ~ c ~ /CK# AZ - 0 ~ a . r d i r t a . 0 Y - d t i e NE 6 6 , QDA r o w h L i b9 r ~5L3I D# -KI GL, U. . C L . V

l ! a ! . a ! CK# ~~s i g r r ~ - t - Nom'I D# ~dCK# 9 E~ l o o r n i n 5 ~v i a _ 1Z ~~ ,I # y ~ i m _ C o l

/ 1 ,~, 0 / cK# M C~ oA . k i eZ-3 , . L ~D.I D# ' C" . ~d 0 - Sc K# S~ o , ~~S l 4 - v e >~' a f f l o , t 44 /I D# ~ . l n 1 1 - Q ,CK# D~WI D# ~~I ,7rDCK# ~r u. r oI D# P~cha . i - d ? ; a e v n 0 xo CK# Po8" 2 1ZArn. es 0010I D# l n l t A~nbvvl eB

1 Des o c : r us o. / A ad31 ! ~D. 6~


11/17

Fo r I n st r u c t i o n s, 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 O r g a n i z a t i o n )

~oe e - f i r / I : / 'S T A T E C A N D I D A T E S N O T E I F A C O N T R I B U T I O N 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 H E P A C C H E C K N U M B E R I N T H E D E S I G N A T E D C O L U M N A L I S T O F 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 O W A E T H I C S A N D C A M P A I G ND I S C L O S U R E B O A R D

s -4 - ~ rCAUTI ON: S ec t i o n 68B. 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 ma 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 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- TOTAL

TOTAL ( i f l a st page o f t h i s sc hed u l e)

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

IRECEI PTS


' 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 mmi t t e e R e l a t i o n s h i p must b e shown 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 nd 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 c 2 o f f o r m s p a c k e t . ! . s u r n 2 MP o r c o n t r i b u t o r i s t h e s a r r - a s - a n d i d a t e , b u t t h e r e i s no P a g c ~~ o f _ ,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 . y ( f o r S c he d ul e A)

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SE

NUMBER I WOMI D# Ra s h , ~n s h d rCK# e s ~ s ! r t e 5bZ~I D# ~ MW-I D#CK# 2 3 3 - 0 ~. 3 - - 9 ~ .l 5 b 3 1I D# D- v r d w ~ r ~ I c . r ~ b r

! l ~ - l d CK# 2 oy ~ ' ' ~ S . ~X~. 3. s u e - 7 - - 5b 2 4- r ,I D# KD 6Vaf ~r '

! l ~ o ~ CK # 3 q B, 7 t ~, s sI D # Ma100 v l a . s vI D # ~ ~

/ CK# ' 1 J. st i ~i nn j P Z3 l o 2 - s : 0

I D# - r )CK# 3 5 ~ ~ e' ~a3 ! dI D# ) ( ~Aso1k hCK#I D # ~~Po r ker '

1 1 - ~ l o T C"# V a


12/17

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 a s on S t a t e me n t o f O r g a n i z a t i o n )oege - f a r C, C- i , Ls 9$9I V- - 1

STATE CANDI DATES NOTE : I F A CONT RI B UT I ON I S RECE I V E D FROM A S T AT E PAC ( P OL I T I C A L AC T I O N C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND T HE P AC CHECK NUMBER I N THE DESI 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.CAUT I 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 ny c omme r c i a l p u r p o s e b y a ny 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 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 mm 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 r i a g e ) ( S e e Pa g- 2 o f f o r m s p a c k e t . ) I f c a r n a me o f c o n t r i b u t o r ~ s t h e s am e a s c a n d i r : ~ e , b u t t h e r e i s n o P a c e &- _- : , f 1 1 3 1 -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 e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

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


DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VEDI

FUND-( MM/ DD/ Y R) ANDPACCHECK ( i f a p p l i c a b l e ) R AI S ENUMBER I NCOM

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13/17

F o r I n s t r u c t i o n s , Se e Ba 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 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 )

I s , , " ~r

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

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


~oe Q TOT' ~~'STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBER AND THEPACCHECKNUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se ct 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 ma 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 n t s f o r s o l i c i t i n g c on t r i b u t i o ns 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 er s o n o t h er t h an 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 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 an 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 b e 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 ) an d a f f i n i t y ( r e l a t i v e s b y / /m a r r i a g e ) ( S e e Page 2 o f f o r ms I f s u r n a me o ` c o n t r i b u t o r i s t h e s l me a s c a n d i d a t e , b ut t h e r e i s n o Page o ff 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 S ch e d u l e A)

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DDNR) AND PACCHECK ( i f a p p l i c a b l e ) RAI S E

NUMBER I Nr n n -I D# 4 l !&V J . Ar r v t s 4 " h ~ $A CK# C - I l r a ~ S o f t - t o m - , AI F DI n k s ' i o n OCr o o a -I D# R o n ~ c L ~ F I

l ~ ' w b l CK# a g l 9 Skew" La k Al e a00 , p 7 ~44 6 7 , 3 - 3 9 -I D# ~ ( . o j j f r l s

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l am . 6 ~k i ) l s f - - b e - S o kU 44 4 0I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#


14/17

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Pu 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 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 Sc h e d u l e H . ( R e f e r t o Sc 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 mus t a l s o b e d e t a i l i t e mi z e dSc 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 ma d e b y t h e p e r s o n / e n * 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 mmi t t e e . ( R e f eSc h e d u l e G i n s t r u c t i o n s a n d I o wa C o d e 5 6 . 6 ( 3 ) ( i ) . )

( f o r Sc h e d u l e B

FOR I NSTRUCTI ONS, s t t f j A C f c OF FORM SCHEDULEEXPENDI TURES - - MONEY SPENT FROMCOMMI TT EE ACCOUNT B MONETARY( Re v . 0 9 / 9 7 ) EXPENDI TU

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T HI S BOXPAC CHECK NUMBER FOR EACH EXPENDI TURE A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e sa me a s o n St a t e me n t o f Or g an i z a t i o n )

J c - FQ~ ' ' ~~r ~- enSCANDI DATE 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 m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER/ d f I D# Sk;t% ~ - e c el 0 - " i S f - . . ~ r ' ~~ ' F~0 f C/ + h r J ' a r i 5 t n

I D# I /A i 7 ~ . n a E t " a r c C ~ w~7CK# PC) r o c A-4S- v = ~ 3

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15/17

T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :Pu 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 mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )Ex 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 mus t a l s o b e d e t a i l i t e m i zSc h e d u l e G b y t h e am 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 m a d e b y t h e p e r s o n / e n i 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 mmi t t e e . ( RSc h e d u l e G I n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

P a g e -

( f o r Sc h e d u l e

FOR I NSTRUCTI ONS . SEE BACKOr FORM SCHEDUL EEXPENDI TURES B MONETAR- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TU

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE OCHECKCANDI DATES . L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE T HI S BOXPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPA I GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a e a s o n St a t e me n t o f Or g an i z a t i o n)

C ' ( a ~ ~ r r ( Z ' C' ~ SCANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

y 1 I D# I ~ ~ I - E ~ c ~ n z . x t 5 1 " SCK# $3I D# T h e S

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l I D# ~G~~~ - J~ ~ 4 P S Ii Wl ~ ,b o i 9 ~ ' . dc r rCsl YLrCK# ~t z , f f h e . S'.M+ j a r ,We r Ae r t ( , 2 _ >4 t 7 ( ; c - e n a r AI St ~ '

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16/17

T HI S BOX APPL I ES TO CANDI DATES' COMMI TTEES ONLY :Pu 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 5 0 0 o r r n o r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H ( R e f e r t o Sc 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 mus t a l s o b e d e t a i l i t e m i zSc 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 m a d e b y t h e p e r s o n / e n i 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 mmi t t e e . ( RSc h e d u l e G i n s t r u c t i o n s a nd I o wa Co d e 5 6 . 6 ( 3 ) ( 1 ) . )

( f o r Sc h e d u l

FOR I NSTRUCTI ONS, SEE BACK C , . FORM SCHEDULEEXPENDI TURES B MONETAR- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TU

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE OCHECK T HI S BOXCANDI DATES . L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DES I GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA AMENDI NG FORMETHI CS & CAMPA I GN DI SCL OSURE BOARD .COMMI TTEE NAME ( Mu s t b e s a m e 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 )( 4~o ~: e ' J a r ~f r L , e n S

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEEXPENDED ( 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/ DD/ YR) AND PACCHECKNUMBERD# &J I . b c ~ 1 c : ( , C s14311 ( PD 66X I l l SV u r e Se r J t c e -CK# e ~Q_ r " r r . ~ S

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17/17

T HI S BOX APPLI ES TO CANDI DATES' COMMI TTEES ONLY :P ur 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 mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H ( R e f e r t o Sc 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 mus t a l s o b e d e t a i l i t e m i z eSc 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 m a d e 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 mmi t t e e . ( RSc h e d u l e G I n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )

FOP I NSTRUCTI ONS, SEE BACK Ca r FORM SCHEDUL EEXPENDI TURES B MONETAR- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TU

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI SLAT I VE DCHECK THI S BOXCANDI DATES, L I ST THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI 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 ni z a t i o n )

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