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. FOR1NSTRUCI 70 NS,SEE BACK Oi ) RM

DI SCLOSURE SUMMARY PAGE J AN 1 7 2 0 0 2

r

COMMI TTEENAME( M u s tb e same a s o nS t a t e m e n to f Or g a n i z a t i o n)

I MPORTANT : I n d i c a t et y p e o f c o mmi t t e ey o u a r e r e p or t i n gf o r:

( 1 ) S t a t e w i d e / L e g i s l a t i v eCa n d i d a t e ( 2 ) S t a t e wi d ePAC ( 3 ) S t a t eP a r t y ( 4 ) Co u n t y / L o ca lCa n d i d a t e( 5 ) Co u nt yPAC ( 6 ) B a l l o tI s s u e / F r a n c hi s eCommi t t e e ( 7 ) C o u n t y / C i t yC e n t r a lCommi t t e e( 8 ) Su p p o r t 5 1 a Vo f Cand i

( r e p o r t d a t e )

FI CHECK I F AMENDMENT TO REPORT DATED

1- 1

0 Che c k i ft h i si s f i n a l( t e r mi n a t i o n ) r e p o r ta n d a t t a c h No t i c e o f D i s s o l u t i o nFo r m DR- 3.( Yo umust c o n t i n u et o f i l er e p o r t su n t i la No t i c eo f Di s s o l u t i o ni sf i l e d. )

STATEMENT OF CASH ON HAND

I n d i c a t eon e

CASH ON HAND a t t h eb e g i n n i n go f t h e r e p o r t i n gp e r i o d. ( T h i si s t h et o t a lo f a l lmon i e s h e l db y t h ec ommi t t e e. T h i samoun t MUST b e t h es ame a s t h ec a s h o n h a n d a t t h ee n d o f t h e l a s tr e p o r t i n g p e r i o d ,o r must b e z e r oi ft h i si s f i r s tr e p o r tf i l e d. ) . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . . . . . . . .. .. .. .. .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .$

ADD TOTAL MONEY TAKEN I NTHI SPERI ODSc h e du l eA : Cash C o n t r i b u t i o n st o t a l( A t t a c hSc h e du l eA) . . . . .. . . . .. .. .. .. .. . .. .. .. . . . . . . . . . . . . . . . . . . .. .. .

Sc h e du l e F: L o a n sRe c e i v e d t o t a l( A t t a c hSc h e du l e F ) . . . . . .. . . . . . . . .. .. .. .. . . . . . .. .. . . .. . . . . . . . . . . . . . . .. .. .

Sc h e du l eH: T o t a lSa l e so f Camp a i g nP r o p e r t y( A t t a c hSc h e du l e H). . . . . . .. . . .. .. .. .. . . . . . . . . . . . . .. .

( Sc h ed u l eH a pp l i e st o Ca n di d a t e s 'Commi t t e e sOn l y )

SUB- TOTAL . . .. . $

SUBTRACT TOTAL MONEY SPENT THI SPERI OD

Sc h e du l e B: Ex p e n d i t u r e st o t a l( A t t a c hSc h e du l eB ). .. . . . . . . . . . . . . . .. . . . . . . . . . . . .. . . . . . .. . . . . . . . . . .. . . . . . . . . . .

Sc h e du l e F: L o a n Re p a y me n t st o t a l( A t t a c hSc h e du l eF ) . . . . . . . . .. .. .. . . . . . . . . . . . . . . . . . . . . . . .. . .. .. .. .. . . . .

CASH ON HAND a t t h ee n d o f t h i sr e p o r t i n gp e r i o d( i ff i n a lr e p o r t ,b a l a nc emust

b e z e r o ) ( A t t a c hDR- 3) . . .. .. .. .. .. . . ... . . . .

. . ........ . . .

. . . . . . . . ....... . .. . . . . . .. .

.. . . . . . . . . . . . . . . . . . . . . . .. .

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FORMDR- 2 DI SCLOSURE( R e v. 0 1 / 9 8 ) REPORT

Fo r O f f i c eUs e On l y

Comm . # r

I n d ex e d

A u d i t e d

Comp u t e r

( l S 6 y ! - l - / G - 6e . -SI GNATURE OF TR SURER ( o r p e r s o n f i l i n gt h i s r e p o r t ) TELEPHONE DATE SI GNED

Rou t i n e Pe na l t i e sDu e Fo r L a t e F i l e dRe p or t s Range f r om $2 0 t o $ 8 0 0

SEE I NSTRUCTI ONS ON BACK AND COMPL ETE THE FOLLOWI NG SENTENCE :

I AM FI L I NGA O2 ` . , 3 / - - U 1 1 /C9 ~ REPORT FOR AN/ A( 1 )ELECT I ON/ ( 2 ) NON- ELECT I ONYEAR .

L o c a l Commi t t e e s ,e n t e r Da t e o f El e c t i o n

Co u n t y& L o c a l Co mmi t t e e s , e n t e r Co u n t y iwh i c hEl e ct i on i s h el d

Y4 6 z . 9 1

j / /L " ` i l

> ' t' 8. 2 - e

UNPAI DBI L L S( Fr o m Sc h e d ul e D - At t a ch Sc h e d ul e D) . .. .. .. .. .. . . . . . . . . . .. .. .. . . .. . . . . . . . .. . . . .. . . .. . . .. . . . . . . . . . .. . .. . $ ,

I NK I NDCONTRI BUTI ONS( Fr omSc h e du l eE - A t t a c hSc h e du l e E) $

OUTSTANDI NG LOANS ( Fr om S ch e d u l eF - A t t a c hSc h e du l eF ) . . . . .. . . . . . . . .. .. .. .. .. . . . .. .. . . . . . . . . . . . . . . . . . . . . .. . $

CANDI DATE COMMI TTEES ONLY :

CONSULTANT BREAKDOWN ( Sc h e du l eG A t t a c h e d ? ) YES

VALUE OF CAMPAI GN PROPERTY ( F r o mSc h e du l eH - A t t a c hSc h e du l eH) $

NO

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Fo r I n s t r u c t i o n s , Se e Back o f Fo r m

CONTRI BUTI ONS - MONEY TA . _N I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf 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 Or g a n i z a t i o n)

~ Vr l L UVL C

CHECK THI SBOXAMENDI NG FORM

A I MONETARY( R e v. 7 ) RECEI P

STATECANDI DATES NOTE: I FA CONTRI BUTI ONI SRECEI VEDFROMASTATEPAC ( POL I T I CA LACTI ONCOMMI TT EE). L I S TTHE PACI DE NT I F I CANUMBERANDTHE PACCHECKNUMBER I NTHEDESI GNATEDCOLUMN. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHE I OWAETHI CSAND CAMPAI GDI SCLOSUREBOARD.

CAUTI ON:Se c t i o n6 8B . 3 2 A ( 6 ) ,I o wa Code , p r o h i b i t s t h eu s e o f i n f o r ma t i o nc o pi e d f r o mr e p o r t sa n d s t a t e me nt s f o r s o l i c i t i n gc o n t r i b u tf o r a n y c omme r c i a l p u r p o s e b y a n yp er s o n o t h e rt h a ns t a t u t o r yp o l i t i c a lc o mmi t t e es.

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t ec ommi t t e e st o d i s c l o s et h er e l a t i o n s h i po f a n yr e l a t i v ema k i n ga C o n t r i b u t i o nt ot h ec o mmi t t e e. Re l a t i o n sh i pmu st b es h ow n t o t h e t h i r dd e g r e eo f c o n s an g u i n i t y ( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e sb y lma r r i a g e )( S e ePage 2 o f f o r m sp a c k e t. ). I fs u r n ame o fc o n t r i b u t o ri s t h es ame a s c a n d i d a t e , b u tt h e r ei s n o P a g e o f -

f a m i l i a lr e l a t i o n s h i p ,e n t e r' n o ta p p l i c a b l e 'i n t h er e l a t i o n s h i pc o l umn. ( f o rSc h e d ul eA)

DATE PAC I DNUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNTRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE' RECEI VED( MMDO/ YR) AND PAC CHECK ( i fa p p l i c a b l e )

NUMBER

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I D#1~ .

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FOR I NSTRUCTI ONS, SEE BACK OF RM

EXPENDI TURES- -MONEYSPENTFROMCOMMI TTEEACCOUNT

STATE PAC COMMI TT EES : NOTE: FOR CONTRI BUTI ONSMADE TOSTATEWI DEOR LEGI SLAT I VECANDI DATES ,L I S TTHECANDI DATEI DENT I F I CAT I ONNUMBER I NTHEDES I GNATEDCOLUMN ANDTHEPACCHECK NUMBER FOR EACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROM THE I OWAETHI CS&CAMPAI GNDI SCLOSUREBOARD .

SCHEDUL E

B MONETARY( R e v. 0 9 / 9 7 )I EXPENDI TURES

[ D CHECK T HI S BOX I FAMENDI NG FORM

COMMI TT EE NAME ( Mu s t b es 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 )

z - I 3 - - u1 CK#1 1 I , C

_w UPI Ot - c f - a v ` ' ~S) L/ YS y , 3 1 7

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PURPOSE( D ESCR I BETRANSACTI ON)

AMOUNTEXPENDED

TOTAL ( i fl a s tp a g e o f t h i ss c h e du l e ) $

SUB- TOTAL' $ I 27~Z b

T HI SBOX AP PL I E STO CANDI DATES' COMMI TTEES ONL Y :

P ur c h a s e s o f c e r t a i nc amp a i g np r o p e r t yc o s t i n g$ 5 0 0 o r mo r e mu s ta l s ob e i n v e n t o r i e do n Sc h e d ul eH. ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )

Ex p e n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc 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 gs e r v i c e smust a l s ob e d e t a i li t e mi z e do nSc h e d u l eG b y t h eamou n t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e f etSc h e d u l eG I n s t r u c t i o n sa n d I o waCod e 5 6 . 6 ( 3 ) ( 1 ). )

( f o rS c h ed u l eB )

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CANDI DATE NAME AND ADDRESS TO WHOMDATE I DNUMBER EXPENDI TURE

EXPENDED ( i fa 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 PAC

CHECKNUMBER

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THI S BOX APPLI ESTO CANDI DATES' COMMI TTEES ONLY :

Pu r c h a s e s o f c e r t a i nc a mp a i g np r o p e r t yc o s t i n g$ 5 0 0 o rmo r e mus t a l s ob e i n v e n t o r i e do n Sc h e d u l eH . ( R e f e rt o Sc h e d u l eH i n s t r u c t i o n s. )

Ex p e n d i t u r e st o p e r s o n s / e n t i t i e sp r o v i d i n gc 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 smus t a l s ob e d e t a i li t e m i z e do nSc h e d u l eG b y t h eamou n t ,p u r p o s e ,a n d d a t eo f e a c h t y p eo f e x p e n d i t u r emade b y t h ep e r s o n / e n t i t yo n b e h a l fo f t h ec a n d i d a t e ' sc o mmi t t e e. ( R e f e rtSc h e d u l eG I n s t r u c t i o n sa n d I o waCode 5 6. 6 ( 3 ) ( 1 ). )

Pag e

( f o rSc h e d u l eB)

FOR I NSTRUCTI ONS,SEE BACK OF r _. 4M SCHEDUL E

. EXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v. 0 9 / 9 7 ) EXPENDI TURESSTATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONSMADE TO STATEWI DEOR LEGI SLATI VECANDI DATES,L I S TTHE CANDI DATEI DENTI FI CATI ONNUMBER I NTHE DESI GNATEDCOLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACHEXPENDI TURE. A L I S TOF I DNUMBERSI SAVAI LABLEFROM THE I OWA AMENDI NG FORMETHI CS& CAMPAI GNDI SCLOSUREBOARD .

COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me n to f Or g a ni z a t i o n)

CANDI DATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i fa 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 PAC

CHECKNUMBER

-

I D# ) f - "

z - 1 3 - - u i CK#

ID#Si a_ , 7 t L s r e v c v

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TOTAL ( i fl a s tp a g e o f t h i s s c h e d u l e ) $ 1 5

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FOR I N9TRUCTi ONS. SEE BACK OFF

COMMI TT EENAME ( M u s tb e s ame a s o nS t a t e m e n to fOr g a n i z a t i o n )

SCHEDULEE I NKI ND

( R e v. O t 3 1 97 ) CONTRI BUT

Q CHECK THI S BOX IAMENDI NGFORM

' D i s c l o s u r el a wr e q u i r e sc a n d i d a t e st od i s c l o s et h er e l a t i o n s h i po fa n yr e l a t i v ema k i n ga n i nk i n dc o n t r i b u t i o nt ot h e _c o mmi t t e e. R e l a t i o n s h i pmu s t b es h ow n t ot h et h i r dd e g r e eo fc o ns an g u i n i t y ( b l o o dr e l a t i v e s )a n da f f i n i t y( r e l a t i v e s ( f o rS c h e dub yma r r i a g e ). ( S e ePage2 o f f o r m sp a c k e t. ) I fsumame o fc o n t r i b u t o ri s t h esame a s c a n d i d a t e. b u tt h e r ei sn of a m i l i a lr e l a t i o n s h i p. e n t e r' n o ta p p l i c a b l e 'i nt h er e l a t i o n s h i pc o l u mn.

DATERECEI VED( MMI DD/ YR)

NAME AND ADDRESSOF CONTRI BUTOR

RELATI ONSHI PTO CANDI DATE' ( i fa p p l i c a b l e )

DESCRI PT I ONOF I NKI ND

CONTRI BUTI ON

ESTI MATEDFAI RMARKET

VALUE

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