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FOR I NSTRUCTI ONS, SEE BACKOF FORM

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STATEMENT OF CASH ON HANDCASHON HAND a t t h e b eg 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 lo 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 . T hi s amo u n t MUST b e t h e

s ame a s t h e c a s h o n han d a t t h e e n 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 : Cas 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 du l e A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

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

SCHEDULEA

MONETARY( R e v 0 6 / 9 7 )

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CHECK T H I S B OX I FAMENDI NG FORMCOMMI TTEE NAME ( 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 )Y

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S T A T E CANDI ES N O T E I F A C ON T R I B U T I O N I S R E CE I V E D F R O M A S T AT E P A C ( P O L I T I C A L A CT I ON C OM MI T T E E ) , L I S T T H E P AC I D E N T I F I C A T I O NN U MB E R A N D T H E P AC 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 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 CL O S U RE B O A R DC AU T 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 mm i t t e e s

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI VED( MM/ D D/ Y R) ( i f a p p l i c a b l e )AND PAC CHECK TO CANDI DATE'( i f a p p l i c a b l e ) RECEI VED FUND-RAI SERNUMBER I NCOME

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

CHECK THI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI 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 SERNUMBER I NCOME~i r h I D # Dew I L I M4 ; V"

CK# 9I 3 L A ) F ~ - ~ y ) n b o o $ o - 6 tS I D# ~ , I q( H o v o e l k , t 1 j e y ' s f f ~ s r , P-CK# y 0 0 1 Ni c k VV4" A) -D 13 ~~ b c f n e . l o w, 3, gj 1j I D# ( ~ o A - SSr r _ 1 c L f e d - G" e v - d t mt "~ c K# 3?6 , " l P , n r 3 o l . t i 5 - 7D es r r ) o I ne s l oWw ~ _ o 3 0 3 n ~ t J YL tc 1 J v l I D# 6 , 0 6 9 / l p n e

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STATE CANDI DATES NOTE I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PA C ( P O L I T I C A L AC T I ON C OMMI T T E E ) , L I S T T HE P AC I D EN T I F I C A T I ONNUMBER AND T HE P AC CHECK NUMBER I N THE DESI GNATED COL UMN . 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 HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUT 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 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 e s .

SCHEDULE

A' MONETARY( Re v 0 6 / 9 7 ) R ECE I P T S

I ~ CHECK T HI S BOX I FAMENDI NG FORM

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Fo r i n s t r u c t i o n s , See 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 )

ME ( 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 )

STATE CAND I DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PA C ( P OL I T I C A L AC T I O N C OMMI T T E E ) , L I S T THE P AC I D EN T I F I C A T I ONNUMBER AND THE PA C CHECK NUMBER I N THE DESI GNATED COL UMN . 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 .CAU T 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 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 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 .

SCHEDULEA ' MONETARY( R ev . 0 6 / 9 7 ) RECEI PTSQ CHECK T HI S BOX I F

AMENDI NG FORM

DATERECEI VED

PAC I D NUMBER( i f a p p l i c a b l e )

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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 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 s a m 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 )

l &~4v~2IS T A T E C A N D I D A T E S N O T E I F A C ON T R I B U T I O N I S R E CE I V E D F R O M A S T AT E P A C ( P O L I T I C A L A CT I ON C OM MI T T E E ) , L I S T T H E P AC I D E N T I F I C A T I O NN U MB E R A N D T H E P AC 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 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 O WA E T H I C S A N D C AM P 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 mm i t t e e s

SCHEDULEA MONETARY

( Re v 0 6 / 9 7 ) RECEI PTSCHECKTHI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME5 b c ~ I D# Sv. s t z n t KCA441 ev " 1N $ a o ~ a ~0 1 CK# Al K1 / 4 n "1 1 S } . C , I v V v / 4 Sh32SI 5 v c r ~ - I D#~ o o Vg746?

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( 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 bame 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 )

S

AI ~oase 66 -2- -rSTATE CANDI DATES NOTE : I F A C ON T R I B UT 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 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 EN T I F I C AT I O NNUMBER AND T H E P AC C HE CK NUMBER I N T HE D E S I G N A T ED COLUMN . 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 H I C S AND C A MP A I G ND I S C L O S U RE BOARD .

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 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 .

SCHEDULEA- MONETARY( R e v 0 6 / 9 7 ) RECEI PTSL I CHECK T H I S BOX I F

AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D / Y R ) A ND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMEI g A l o t l I D# - 7 2 ) / 0V I me di C- &, ( p~Cm CK# f " t ) o ) 6 t ~ e L v l - ~2 3sd - -o2S mo t e -1 I D# t ~ o - 7 3 w " t t - ~ e wr wf l 0 4C

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

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DEOR LEGI SLAT I VE CHECKTHI S BOX I FCANDI DATES, L I ST THECANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHEPACCHECK NUMBER FOR EACHEXPENDI TURE. A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e same a s o n St a t eme n t o f O r g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE

( MM/ OD/ YR ) AND PACCHECKNUMBERI D# l t 7 f I J Bn a UV' m~F i - C PA-11); ' 6 6 1 Ft v ov - bYl v eCK# ` I ~ ~ 1 j j q5 ~ n t nPs l SUFI &4 1 $ a000

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COMMI TTEE NAME( Mus t b e s ame 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 )o S , W- 6~Z

TOTAL UNPA I D LOANS FROM LAST REPORTI NG PERI OD $PART I - MONETARY LOANS RECEI VED T HI S REPORTI NG PERI OD( O r i g i n a l s o u r c e o f l o a n . s u c h a s ab a n k mu s t b e s h o w n i f a t h i r d p a r t y I s

i n v o l v e d . I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

TOTAL ( P ART I )

' D i mc 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 z c o n t r i b u t i o n t o t h e c 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 hown t o t h e t h i r d d e g r e e o f' o n s a n g u i n d 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 m a r r i a g e ) . ( S e e P a ge 2 o f f o r m sp a c l w i 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 am e a s c a n d i d a t e , b u t t h e r e i s n o f a m i l i a lmi a t i u n f , 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 when i t a p p l i e s .

NOTE : T h i s s c h e d u l e r e p o r t s money l o a n e d t o t h e c o m m i t t e e w h i c h i s d e p o s i t e d i n t h e c o m m i t t e e a c c o u n t .

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