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Fo r I n s t r u c t i o n s, See Back o f FoCONTRI BUTI ONS - - MONEYTAK

( 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 ds

COMMI TTEE NAME(lqRtWAr t St

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A MONETARY( Re v . 0 7 / 0 3 ) I RECEI PTS

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CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) . I o wa Co d f , 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 St a t e m e nt 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 o mme r c i a l p u r p o s e b y an y p e r s o n Ot 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 .DATE PAC I D NUMBER NAME AND ADDRESSof CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR

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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- - MONEYTAKE

( 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( MUC

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ON I S RECEI VED FROMA STATE 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 OND E 3 I GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GN

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Fo r I n s t r u c t i on s , See Back o f Fo rCONTRI BUTI ONS - - MONEYTAK

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f o r any c o mme r c i a l p u r p os e b y an y p e r s o n

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 .

ON I S RECE I VED FROM ASTATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) . L I S T THE PAC I DENT I F I CAT I ONDESI GNATED COLUMN, A L I S T OF 1 0 NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GN

PAGE 0 9 / 1 9

CAUTI ON : Se c t i on 6BB . 3 2 A ( 6 ) , I o wa Co d j , p r o h l b l 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 and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o r

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11/16

1 0/ 1 8/ 2 00 4 1 7 : 4 8 3193645110 PAGE 12 / 19

FOR I NSTRUCTI ONS, SEE BACK OF ORM ~ ` R e s c t : o t o SCHED UL EEXPEND I TURES - - MONEY PENT FROMCOMMI TT E E ACCOUNT B MONETARY( R e v , 0 7 / 0 3 ) EXPENDI TURESSTATE PACCOMMI TTEES : NOTE : FORCO RI BUTI ONS MADE TO STATEWI DEOR L E GI SL A T I V ECANDI DATES . L I ST THE CANDI DATE I D ENTI F I C T I ON NUMBER I N THE DESI GNATED COLUMN ANDTHE CHECK T HI S BOX I FPAC CHECKNUMBER FOR EACH EXPENDI TU . A L I ST OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA AMENDI NG F ORME T H I CS $ CAMPAI GN DI SCL OSURE BOARD.

COMMI TTEE NAME ( Mmt ~ ~ i &e se o OS t a t 4 r n e n Of O r g a n i z a t i o n )CANDI DATE NAM AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( D b u r s e me n t ) WAS MADE( MM/ D D/ y R) AND PACCHECKNUMBERI D # R, e . f bu. - TSe - - ~ ; c , rf r * } o . e - d - US pe SV

o 9 - Al - 0 q, CK# C1530 Ce~.Ao5 ~ I t ~ " ~ . > ` ~ r ~ ~ oc K# S s~I ~ c ~ ~ k

e . , . ~ . r 3 o a l e . t } s b ` ~ , 9 bo 9 - a l , ' y 2 5 ' 3 1 Goal d z f t s a o yX950 I l e +~ ha . n~ Pr . N~ p a r c e l r n t ~ tv 9 - a 1 - o ~ / C K # a 5 3 o C e d , Q , , ~ , . ; ~ ~~ s a 9 o a ~ P S+ ` q e ` - 7 - o y ~ ~ 9 3I D # R E . ~ m u ~ r S e - ~ A r ` E S ~ 0. e , ~ 1C K # A9 0 9 Or N. _ I I e _ % h a , n . r G e . " ` ' M0. tD 9 , 2 1 - o i l a 5 C ~ q . t d a r i a ~ o s ~ o . ~ c - a 4 - e y 1 4 g ' 7

I D#c K# ag3o o t e . 9 t i 0. r , N r. 7- 2 - o y ad 1 ' 539 - a 1- 0 d 5 aI D#


12/16

10/ 18/ 2004 17 : 48 3193645110 PAGE 13/ 1 9FOR I NSTRUCTI ONS, SEEBACK ( 7 F ORM SCHEDULE

EXPENDI TURES - - MONEY . , PENT FROMCOMMI TTEEACCOUNT B MONETARY( R e v , 0 7 / 0 3 ) EXPENDI TURESSTATE PACCOMMI TTEES : NOTE : FORCO TRI BUTI ONS MADE TO STATEWI DEOR LEGI S LAT I VECANDI DATES, L I S T THE CANDI DATE I DENT I F I 4 ATI ON NUMBER I N THE DESI GNATED COLUMN ANDTHE CHECK T HI S BOX I FPAC CHECKNUMBER FOR EACH EXPENDI TU' E , A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS $ CAMPAI GN DI SCLOSURE BOARD

COMMI TTEE NAME ( Mu s t b e saCOa s l u S j i e e t t t tl a g r g a l z a t i o n )CANDI DATE NAM AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

EXPENDED ( i f a p p l i c a b l e ) t ' s b u r s e me n f l WAS MADE( MM / OD/ YR) AND PACCHECKNUMBERI D # 5 ~ , 9 ~ , r ~ ~0 4 - A i l ' d q CK# 1 - V l

t n ~ ( I o w1 v $ 11o-~a .I D# Posh - al e

I V- a - p ~ C K #a 5 a ~

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16- 13- 01 C K # 1 5 A I u 1 5 1 . ~ 3I D#CK# I t $ en d a k - a > ` . 9 9 , 0 0~CLsI D# e M_ u r$ Nc l } ! 9~. e A' Y t t e [ 1 ~ ' l G . h ~ ~f NGCK# Ga- s ~ . ao y s- d. 5 _ t o qI D# of ~


13/16

10/ 18/ 2004 17 : 48 3193645110 PAGE 14/ 19FOR I NS r N UC T I ON S , SEEBACKOF FOR ' - SCHEDULE

D I NCURREDCOMMI TTEE NAW~~~~tVf S t o f p r g a n i z e t i o n ) ( Re v . 0 8 / 8 8 ) I NDEBTEDNESSAd St a e d E l CHECK T HI S BOX

NOTE: De b t s p r e v i o u s l y r e p o r t e d t h a t r a mSc h e d u l e , a s w e l l a s a n y new o b l i g i n u np a i d mu s t b e i n c l u d e dI F AMENDI NGo n t h i st i o n s i n c u r r e d I n ( h i s p e r i o d , FORM

DEBTS/ OBLI GATI ONS REMAI NI(DONOTI NCLUDELOANS- - SH

AnGTHI S i sREPORTI NG " i n c u r r e d d e bt " f o rPERI OD a d eb tg o o d s o r s e r v i c e s o r d e r e d o rt ~ I W LOANSONSCHEDULE F ) r e c e i v e d , b u t n o t p a i d f o r b y t h ee n d o f t h e r e p o r t i n g p e r i o d . .r e g a r d l e s s o f wh e t h e r a n i n v o i c eh a s b e e n r e c e i v e d .DATE

I NCURRED NAME AND DRESSOF PERSONDESCRI PTI ON OF GOODS ORSERVI CES PROVI DED OR

BALANCEOWED ATCLOSEOF( MM/ DD/ Y R ) TOWHOMDEBT ROBLI GATI ON I S OWED PURCHASED REPORTI NGPERI OD"SNe . d

`~or ( o o . c l l l r c c~ l l e g h a n . l

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14/16

1 0 / 1 8 / 2 0 0 4 1 7 : 4 8 3 1 9 3 6 4 5 1 1 0

FOR I N S T R UC T I O N S , SEE B AC K OF FORMCOMMI TT EE NAME ( M u s t b e s a m e a s

SCHEDULEE( R e v . 0 8 / 9 0CHECK T HI S BOX I F

AMENDI NG FORM

PAGE 1 6 / 1 9

I N K I N DCONTRI BUT I ONS

DATERECE I V ED( MM/ O DI Y R )

NAME A ND ADDRESSOF CONTR I BU R

RELAT I ONSHI PT O CANDI DATE' ( i f a p p l i c a b l e )

DESCR I PT I ONOF I N K I NDCONTRI BUT I ON

EST I MATEDF A I R MARKETVALUE

J I F F ORFUND- RAI S ERCONT RI B UT I ON

0 7 - I 4 - OyC - A AC

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To l nn W1 n , ~ i e r3 1 A ( , > R d ; r o dCC- da . r t ' c ' - a ~ k Dr N ~ - V t , e. 1 1R e n ~ a . t 9 S _ g6 ~ - v ~

- 3 - 0 v \ r x n e a r c3 i a ~ R d r ~ r o r . dC; e Q. r i 2 ~ t d s

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3 ~ ~ ( o ! ~ d i r o r t i c l ~ i ` p c ~ 1 = ( 0 4 3 71


15/16

FORI NSTRUCTI CNS, SEE BACK OF FORMCOMMI TTEE NAME( Mus f b e .

me t t P i E 4 f t r 6 a n )Ar t St a e d

NOTE : T hi s s c h e du l e r e p o r t s money l o a n ed t o t h e c o mmi t t e e w hi c h i s d e po s i t e d i n t h e c o mmi t t e e a c c o u n t .TOTAL UNPAI D LOANS FROM LASTREPORTI NG PERI OD $

3, OOO"OO

PART I - MONETARY LOANS RECEI VED_THf s REPORTI NGPERI OD( O r i g h r a f s o u r c e o f l o a n , s u c h a s a b a n i t must b e shown i f a t h i r d p a r t y i si n v o l v e d I n c l u d e l o a ns 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 ( PART f )

$

O

` D i s c l o s u r e l a w r e q u i r e s c a nd 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 o n s hi p o f a n y r e l a t i v ema t i n g a c o n t r i b u t i o n t o t h e c o mmi t t e e . R e l a t i o n s h i p mu st b e s h o w n t o t h e t h i r d d e g r e e o fc o n sa n gu i n i t y ( b l c 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 ma r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i st 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 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 er e l a t i o n s h i p c o l u mn w h e n I t a pp l i e s .

PART 1 1 - MONETARYLOAN REPAYMENTS MADE

T H I S REPORTI NG PERI OD( L o a n s f o r g i v e n musl b e r e p o r t e d o n S c h e d u l e E- I n - k i n d C o n t r i b u t i o n s )

TOTAL CASH REPAYMENTS ( PART 1 0 ) $ yFr c m Sc h e d u l e E - - T OT AL LOANS FORGI VEN

$

TOTAL OUTSTANDI NGLOANSEND OF RE PORT PERI OD

$

3 OOQ. OO

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NAME AND ADDRESS OF LENDER( I n c l u d e En d o r s e r s Name, I f A p p l i c a b l e )

RELATI ONSHI PTO CANDI DATE

( i f A l i c a b l e 'AMOUNTOF LOAN

5

DATE PAI D( MNUDI DYR)

NAME AND ADDRESS OF LENDER( I n c l u d e E nd o r s e r ' s Name, J f A p p l i c a b l e ) RELATI ONSHI PTO CANDI DATE'i f A l i c a b l e

AMOUNTREPAI D


16/16

FORI NSTRVCT; ONS , SEE BACK OF FORM

T HI S FORM I S USEDBYCANDI DATES' COMMI TTEES ONLYCOh i h 1 1 T T EE NAME f f s l h f l i f t f f t " I ~ a f i o n )

An St a e dR e s e t Fo r m

PART I I - I TEMI ZED BREAKDOWN OF UNREI MBURS ED EXPENSES PA I D BY CONSULTANTTO OTHERS I N PERFORMI NG SERVI CES OF CONTRACT ( T h e s e e x p e n s e s s h ou l d NOT h ePART I - NAME ANDADDRESS OF CONSULTANT

r e p o r t e d o n S c he d u l e B , a s t h e y a r e d l r a c l p a y me n t f r o m t h e c a n s u l t a n t . )

TOTAL ANTI C I PATEDCOMPENSATI ON FORCONTRACT PERI OD I j MM I D DI Y R )

PERFORMANCE

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ESTI MATES OF PERFORMANCE

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NAME ANDADDRESSTOWHOM EXPENDI TUREOi s b u r s e me n n WAS MADE

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