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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGE J AN 1 7 2 0 0 27. 0 6 1 N r ' . ~ / / - ) ~ e l t l W ~m - / ~C O M M I T T E E NAME ( M t h e 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 )I 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 :( 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( 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 ) TELEPHONE

Ro ut i n e Pe n a l t i e s Due Fo r La t e Fi l e d Rep or t s Range f r o m $20 t o $800

SEE I NSTRUCTI ONS ON BACKANDCOMPLETETHE FOLLOWI NG SENTENCE :I AM F I L I NG A . v ^ I - R . ~ ? FORAN/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

( r e p o r t d a t I n d i c a t e o n e[ : ] CHECK I F AMENDMENT TO REPORT DATED

E] Ch e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t a 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 n F or m DR- 3 .( Y ou must c o nt i n u e 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 . )

STATEMENTOFCASHONHANDCASH ON HAND a t t h e b e g 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 . T h i s amou n t MUST b e t h es ame a s t h e c a s h o n h a n 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 mus 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Ca 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e F : Lo a ns 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 Pr 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 e H a pp l i e s t o Ca n di d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . $

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

F o r O f f i c e Us e On l y .Comm . #I n d e x e d 'A u d i t e dCompu t e r

1 - / e t / - 0 2 - -DATE SI GNED

L o c a l Co mmi t t e e s , e n t e r D a t e o f E l 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 i nwh i c h E l e c t i o n i s h e l d

70 6 9 1 - 4 7

7 0 b S ' r L I ' 7SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u 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 u l e B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ( 9 7 , 75 ,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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 0

CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h e du l e G At t a c h e d? ) YES _ZNOVALUE 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) $

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 ce must( a . , I q 9 , 7 2b e z e r o ) ( A t t a c h DR- 3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

UNPAI D BI L L S ( F r o m Sc h e d u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ( ]I N KI ND CONTRI BUTI ONS ( F r o m Sc h e d u l e E - At t a c h Sc h e d u l e E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4 0 0OUTSTANDI NG LOANS ( F r o m Sc h e d u l e F- A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $


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Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r m` . n V .CONTRI BUTI ONS - - MONEYTAKENhe: t

( 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 St a t e me nt o f Or g a n i z a t i on )

SCHEDULEA MONETARY

( R e v . 0 6 / 9 7 ) I RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

STATE CANDI DATES NOTE : I M 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 THE PAC I D E NT 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 AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se 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 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 ur 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 mmi t t e es .

* 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 Pa ge 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 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 mn .

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

P a g e I o f( f o r S c he d ul e A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I I FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUN( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI D#

1 0 CK#Z: 14 5CY- 10

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Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEYTAKENi . .

( 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 St a t emen t o f Or g a n i z a t i o n)

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

CHECK T HI S BOX I FAMENDI NG FORM

STATE CAND I DATES NOTE : I F A CONTR I 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 THE PAC I D EN T I F I C AT 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 AVAI LABLE 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 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 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 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 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 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 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 Pa ge 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 i f 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 Pa 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 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 ul e

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI O NS HI P AMOUNT 4 I FRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE" RECEI VED FUN( MM/ DD/ YR ) AND PACCHECK ( i f a p p l i c a b l e ) R AINUMBER I NCI D# Py 1 :A Sc w' Cl t Q z , .CK# C ~~ 3 % ` / / s ' ~ . t c t i l q , . r ~ I ~ ~U ccE~0se~ = > ~ T

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Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN . . J

( 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 St a t e me nt o f Or g a ni z a t i o n)

SUB- TOTAL

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

STATECANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACT I O N COMMI TTEE ) , L I S T THE PAC I D EN T I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AN D CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68 B . 3 2 A ( 6 ) , 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 and 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 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 ommi 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 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 Pa ge 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 o Pa g e S'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 umn . ( f o r Sc h ed u l e

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) R EC EI P T S


DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR R ELA T I O NS HI P AMOUNT I FR EC EI V E D ( i f a p p l i c a b l e ) TO CAND I DATE ' R EC EI V E D FUN( MM/ D D/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NC

I D# 0 1 - q PO"t ) J $ 1~. c x SZ V f - S o q ` o (I D#7 / q

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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 mCONTRI BUTI ONS - - MONEYTAKEN .

( 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 Or g a ni z a t i o n)

Ot ~S _ Q_STATE 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 THE PAC I D E NT 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 AVAI LABLE FROM THE I OWA E T HI 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 op 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 any comme 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 a n s t a t u t o r y p o l i t i c a l c ommi t t e e s .

SUB- TOTALTOTAL ( i f l a s t page o f t h i s s c he 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 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 hown 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 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 Pa 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 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 S ch e d u l e A

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECE I PTSCHECK 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* RECE I VED FUN( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCOI D# R eI D# f a - # - S F - r z . ~ n

1 3 ` i RGI ~ ' St fM, 65c ,

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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 ON T R I B U T I O N S - - M O N E Y T A K E 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 ni z a t i on)

SCHEDULEA MONETARY

( Re v 0 6 / 9 7 ) I RECEI PTSCHECK T HI 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 ACTI 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 THE DESI GNATEDCOLUMN A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se 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 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 a ny c omme r c i a l p u r p os e b y a ny 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 - TOTALTOTAL ( i f l a s t p a g e 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 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 ma 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 hown 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 Page 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 nof 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 Pa g e-/ o f( f o r Sc h e d u l e

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUN( MM/ DD/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# ~_

I ` 1 1 3 UP~ SL 4 , j $CK# a s t ac ,I D# R . P s t -e v ~ p _ F~, ( C. Z .

I 11 a 3 ` a ~ c K# I -73 ( a / o fz~2


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Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN A

( 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 St a t e me n t o f Or g a n i z a t i o n )

~ e~ t i ~ S~ DJS~.

SCHEDULEA MONETARY( R e v . 0 6 1 9 7 ) I RECEI PTS


STATE 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 THE PAC I D E NT 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 AVAI LABLE 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 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 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 o mme 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 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 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 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 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 y 1ma 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 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 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 Sc h e d u l e A

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUN( MMI DDI YR) ANDPAC CHECK ( i a p p l i c a b l e ) RA INUMBER I NCI D#

I . i CKX s ~ ~3 l l l c ~ J . ~ vW _ _ V 7

CK# v?5 t r u . 5 T4 yb 1 a c 7 . C: ,I D#

1 ( 1 - 7 - 31 0 1 CK4 U ? t S1 - f , ~ ; c ~ o1 7 1 t 5cG66 t o

I D# m, o i _ t 4 - g, ~ e JW- C . ~ L . Ci J C -t L I A3 l o I CK# l i d I ? / V 1 0 I M- 5 r a 1 . f >~I D# r c j f - F s r - , e j l - e. &

I ' l a 3 / ~ . 1 CK# a 3 , 9 . s u e AXZaLVA I ' v e .I D# I ' v t o , , t , ( y v t 5 Sc . ( 1 ~ c , ~r c r _ .) 1 6 3 ) , q cK#

r n 5 . ~ . c ~~ ~ ~ c vL D#1 4 2 3 / 0 CK# g y n ~ , l l s t -PC, Ae I g 1 X5v , 1 6 L 1 C : ; 1 . 5. UI D# Boo S r f 2 . AI -ec, ~

t 1 1 , 7 3 / a l CK# 1 Ni . Z A) , j 4W( [ ,e, zs/ ' Y 4 ~ - ~ ~y4 - vYo doI / . 2 3

I D# 3 + ~Ys - ~ - 1 SP. O . y/ ~ CK# ~. , q3 +2,t37 ( noI D# P~-~ p hy 1 1 5 w; 1 1 . 5

l j I a 3 / 6 l CK# a- /~ 07-k


8/14

F o r 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 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 St a t e me n t o f Or g a n i z a t i on )

l a m- M1~ ) S- Q- .STATE 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 THE PAC I D EN 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 AVAI LABLE 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 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 op 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 ny c omme r c i a l p u r p os 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 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 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 how 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 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 umn P a g e~-o f - 1( f o r S c h e d u l

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

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 4 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 PACCHECK ( i f a p p l i c a b l e ) RA INUMBER I NC

1 1 1 - 2 3 1o l f 3 1 ; Z f r ` L ' Sw p v - e o ( $CK#i l I ~ ~r ` ~ r- W- ~yoI D # T o C, t a , k _CK# 1 . 4 a4 5 wM ~I 4 3 ' 0 qo 6

D# C~ S~ ~ ~ ~ L ~ t . r 2 v L' 731 CK# r l i 21 1 1 ,93 1. 1 CK# S- ~ S< < c ~ - '-t t au. , oD#

CK# r x ' 1 ac w- S f - PI D #

I 1 1 4 - 3 1 , t o ? 1 S ; S haz ~ l r 5 c ~ . c Vv a " L r a VI D # J-6I t / a 3 1 ~ I CK# Ot / r 4s I n , , , , , , 1 + : . /D# e - ~ " m y G - e . , pe r r , C - L -' 4 - e , ' e y6

UD# n q e r e , y Sw

wt , ~ z . c . ~ ` f Y tW : Sv lr a h ~ ~ o ~

D#Ct~~ ' ~~y ~ , ~ ooCK# s ~ ~ ~ . . e 1 c ( ~~Y75


9/14

Fo rFo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN . . .

( 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 St a t emen t o f Or g a n i z a t i o n )

! " ) - - L 1 , 4 - -A~JSTATE 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 D E NT 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 AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI 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 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 o mme r c i a l p u r p o s e b y an y 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 .


* 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 Page 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 Page / ~ o f 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 . ( f o r Sc h e d u l e A )

SCHEDULEA MONETARY( R ev . 0 6 / 9 7 ) RECE I PTSQCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I FRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECE I VED FUN( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SNUMBER I NCO1 , R4 3 1 D #

CK# 1r 031 a 7 ~3 ~o . . S ' v w" " t 66P c l ~( c K ' 6 4 - Sc j I I ~C - - n e p t ~ . u . r 1 C~ VYY c y i . 50 oI D# `

c K#G 33AI D#CK#I D#CK# W4E1 D# a GyI d/ l l ~ ~ CK# 6~ ~ L y r i c - kL A . )

Q~ r i u - CL Z ~ I q 5a ( D OI D#CK# ~bq 3 f ~ ` ~ S+ ~r ' ~ s ~ Q 6a o ~v, oc 9

I a ~ l l ~ a )I D# 5 , t i t , ~ . , l , e yCK# I i = 0, v i 5 r o et, , / 1 r l 41 D#CK# Po . , g a m Y S 4 - So yl l I o o . o of l ov , 4-I D# ~ 4 W10. CkaA. 0 _kl a t I ~ o ( CK# 5t -


10/14

Fo r I n s t r u c t i o ns , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEYTAKEk - . J

( 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 St a t e me n t o f Or g an i z at i o n)

~ f - r J l ~Yg- #0~SCHEDULEA MONETARY

( Re v . 0 6 / 9 7 ) I RECEI PTSCHECK 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 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 I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GNDI SCLOSURE BOARDCAUTI 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 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 o n t r i b u t i o n s o rf o r an y c o mme 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 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 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 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 ma k i n g a c o n t r i b u t i o n t o t h ec o m mi 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 Page 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 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 Sc h e d u l e i ~

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I FRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUN( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAINUMBER I NCa ~ l I ~G / CK# a 1 , Vr s f : ; , V , I (

e - i C/ C OI

l c 9I D# SLk~e t , t ` W? c t . ~ - \ RS/ i ~ CK# l l a 3 Wo l ~f , 5I D#CK# ~ l y ~ h ' u t / l j f 'I D#

. ~ ! u

I D#l e Y/ . ~ CK# 5 / Oo - o 0sv. - _- ;0yo' s - - ,D# ms s pr . a~ o c ~M. - ~C~` q . S oI D#

1d/ o y ~o ( CK# - k >DI D# t rCK# l d I r ; - r . 4 - . t . ~ .a. i

t a~ ' ~l lI D# s t n * - 5 4 c " . 0 " ' ,CK# A-). e s ~ . . ~ p r o


11/14

Fo r I n s t r u c t i o ns , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN

. ( 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 St a t e me n t o f Or g a n i z a t i o n)

W6 , 35 - C

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

STATE 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 THE PAC I D EN 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 AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8B . 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 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 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 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 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 ) 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 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 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 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 Sc h e d u l eA0

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

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~1 I FRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI V ED FUN( MM/ DD/ YR ) ANDPACCHECK ( i f a p p l i c a b l e ) RAINUMBER I NC

l o S ~ l l ~t N~CK#I D#

s f - y f i t ,CK# C - > / V 1 a dF ` Z ' ~ G C3 v z G, ~6 ~ Jd OI D#

CK# 3 6 3 , R i c Z - i d l d;I D# ,d C > i q v w " . "l , ; w ( CK# ~ c j . 2 c c - 16r " Ad St l ~~r , ~ , a 00I D# Qv b > rYv t l ~f ~~. ~rJ 0 7 / 1 r CK# a s o ol - ; s QCI ` s , E- e Z 4 r v , j cI D#J ~

/ ! r l , , / CK# ~ A- 5VO$ ' O ~ I . { ~ I T t J t p 1 l ~ . _46 ) CC)Yl ~ - 4 r ' p l 0

Ot . Roy,a Z J r 3 / 0 CK# I a r L o r ~ . ~ ; w r k , j t -Z~~ 4I D# MAO- - &-A J ~ } wv ( e t f - t f I c i SS P y - ' ~ s . uf d ~ t y f o ~ CK# 635 5 , ~. O4, 4 ~ ? 5 , avF a r t . . Gs ` ~ ~~ , ~4 > ydI l l ~ ~ o / CK# t - 4- N 5 r o0

I D# ~~, C~G . . I 2 t f Y


12/14

Fo r I n s t r u c t i o ns , Se e Back o f Fo 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 f u n d s )COMMI TTEENAME ( 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 )

Y4AND I DATE S NOTE : I F A I . O N T R I B UT I ON I S R E CE I V E D FROM A S TA TE PA C P OL I T I C A L ASTATE C ( A C T I O N C OM MI T T E E ) , L I S T T HE PA C I D E NT I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N T HE D ES I GN A T E D 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 GND I S C L O S U RE BOARD .

CAU 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 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 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 m m i t t e e s .

SUB- TOTA LTOTAL ( i f l a s t p a g e 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 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 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 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 1~ 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 m n . ( f o r S c h e d u l e A )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI P TSCHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT IRECEI VED ( i f a p p l i c a b l e ) T O CAND I DATE" RECE I VED FU( MM/ D D/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RANUMBER I N

CK # ' 7 ' 1 1 N. Ye _ , - t c _ I eI D#

1 f ~ 9 ~o CK# ~ yGn~ ~l "I -. New I - / . a - nl p s k : ! r c ~O"OU_L o s e _ ~z vI D# m; c L . o ~1 Dc . ) . U A)CK# S. f 7 H, r " K~5k 1 r ~- -M/ 4 S o r t Lt a v , ~~ ,wI D#CK# 6 0 ~ - , l e t v ~ , " r ~ Pc k - ~ N . Jr4d0/ n XZ t " OL Z , ~ r i t a V0I D# 2 . E , m* - y t - AP. C . Q~ , f 6 n S lCK#

v ~ I l - e _ r ) 1 4 - , ? 6 7 ' V I OG, a pI D# a . . . . ~ z ' , v , wL 4 . , S . ~CK# ~ ~ v ~ s u e ' S C- )

i ' 4 77/ J- , S ' 6 YD ID + u j c ( 4 _ ~ Po ~fi ~ ? l 3 1

I D# 4 ' y o ~ ty r t " Vv \ d v - a \ y t v ^ t 1 ( p 1 0 1I l ~dl ~wi CK# CO CU1 D#

CK#I D#CK#


13/14

THI S BOXAPPLI 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 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 . ( Re 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 pe nd 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 er v i c es mus t a l s o b e d e t a i l i t e mi z e d o nSc h e d u l e Gb y t h e amoun t , p u r p o s e , a n d d at e o f e a c h t y p e o f e x pe nd i t u r e made b y t h e p e r s o n / e n t i t y o n b e ha l f o f t h e c a nd i d a t e ' s c o mmi t t e e . ( Re f e r t oSc 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 Code 5 6 . 6 ( 3 ) ( 1 ) . )

P a g e_-o f( f o r Sc h e d u l e B )

FOR I NSTRUCTI ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEYSPENTFROMCOMMI TTEEACCOUNT ( R e v . 0 9 / 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEE S : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EG I SLATI VECANDI DATES, L I S T THE CANDI DATE I DENTI FI CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK THI S BOX I FPAC CHECK NUMBER FOR EACH EXPE NDI TURE A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCL OSURE BOARD.COMMI TTEE NAME ( Mus t b e same 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 )

r_ Rr ~ ~ F D~CANDI 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 me n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

r I D# P sCK# $ In0? . ( DoI D#/

/ 0 1 CK# v o l ~ . x . 1 - ~ . s . ~^ c . a . c A< , 0 7d13%I CK# de. J ! L ~ e _ , 4 , 4 v 4J OPVs 300-06

I D# i A3 o, k h t o s s + ' 1 - L~ ; . x . u ~ + . n e " ~y ~. ,P o B o t o I L h . , - u ~ a . sCK# , ~ 3C " - kI D#CK#I D#CK#I D#CK#I D#CK#



14/14

F OR I NS T RUCT I ONS , S EE BACK OF FORMCOMMI T T EE 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 )

Ih

SCHEDULEE I N KI N D( Re v . 0 6 / 9 7 ) C ON T RI B U T I ON S

[ ] CHECK THI S BOX I FAMENDI NG FORM

S U B - T OT A L

T OT A L ( i f l a s tp a g e o f t h i s

s 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 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 n i n k i n d c o n t r i b u t i o n t o t h e P a g eIo f _ L_c 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 ( f o r S c h e d u l e E )b y m 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 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 .

D A T ERE C EI V ED( MM/ DD / YR) NAME AND ADDRESSOF CONTRI BUTORREL A T I ON S HI PT O C A ND I D AT E' ( i f a p p l i c a b l e )

D ES C RI P T I ONOF I N KI N DC ON T RI B U T I ONE S T I MA T E DF AI R MARKETVA LUE

4 I F FORF U N D- RA I S E RC ON T RI B U T I ON. , . . , , , ~

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