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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 r - i r m

CONTRI 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 St a t e me n tOrganzat on)

t ~ - k ,~

STATE CANDI DATES NOTE . I F A CONn I BUT I DN I S RECEI VED FROM A S T A T E PAC ( P O L I T I C AL ACTI ON C O MMI T T E E ) , L I S T THEPAC I D EN T I F I C AT I O NNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWA E T H I C S AND C A MP A I GNDI SCLOSURE BOARD.

CAUTI ON: S e c t i o n 6 8 8 . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e us 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 any Co 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 mm i t t e e s .

SCHEDULE

I MONE- ARY

( R e v . 0 6 / 9 7 )

R EC Ej ' P 7 S

QCHECK T HI S BOK I FAMENDI NG FORK

I N C ~

I D# o i l

; i v , Y1 Q_ _I

~D l v l

u

CK # r 4 1

6D

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I b CK #' N61

WYY/WKt , ( , r e V I

CK #

Li d

CK#

DATE PAC I D NUMBER NAME AND ADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT 7 4 1 FRECEI VED ( i f a p p l i c a b l e )

ITO CANDI DATE' RECEI VED F UI

( MWDD/ YR ) AND PAC CHECK ( I f a p p l i c a b l e ) R A I !NUMBER

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FOR I NSTRUCTI ONS, SEESAc , K OF FORM

EXPENDI TURES - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC C OMMI T T E E S : NOTE : F OR C ON T R I B U T I ON S MADE TO S T A T E WI D E OR L E GI S L A T I V EC A ND I D A T E S , L I S T T HE C A ND I D A T E I D EN TI F I CA T I O N NUMBER I N T H E D E S I G N A T E D COL UMN A N D T HE

PAC CHECK NUMBER FOR E A CH E X PE N DI T U RE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T H E I OWAE T H I CS & C AMP A I G N D I S CL O SU RE BOARD .

COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e m e n t o f Or g a n i z a t i o n. )

C A ND I D A T EI D NUMBER

( i f a p p l i c a b l e )AND PAC

NAME AND ADDRESS TOWHOMEXPENDI TURE

( D i s b u r s e m e n t ) WAS MADE

PURPOSE( D ESCRI B E TRANSACTI ON)

SCHEDULE

VCNETARY( R e v . 0 9 / 9 7 ) 1

EXPENDI TURI

QCHECKTHI SBOXI F

AMENDI NG FORM

CHECK

NUMBER

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L ACV

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4 - d x ~

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FOP 1 1 ,11STRUCTI ONS. SEE BACK C - =ORM

DI SCLOSURE S~MMARY PACE

COMMI TTEE NAME ( Mu s t became a s o n S t a t e m e n t o f O r g n i z a i i o nvI MPORTANT : I n d i c a t e t y p e o f com

e e y ou a r e r e po r t i n g f o r :

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

) C o u n t y PAC ( o ) B a l l o t I s s u e / F r a n c h i s e C o mm i t t e e ( 7 ) C o u n t y i C i t y C e n t r a l C o mmi t t e e( 8 ) S u pp o r t S l a t e o f Ca n d i d a t e s

CANDI DATE COMMI TTEES ONLY :

Ca nd i d a t e e

O f f i c e S o u g h t

411 d i

P o l i t i c a l P a r t y

D i s t r i c t ( i f S en a t e o r H o u s e )

- 3 1

SI GNATUREOF TREASURER ( o r p er s o n l i f t i n g t h i s r e p o r t )

I AMF I L I NG A

~ 7D3

TELEPHONE

Ro u t i n e P e na l t i e s Due F o r L a t e F i l e d Rep o r t s R a n g e f r o m $ 2 0 t o $ 8 0 0

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

1 bZ

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

( ] CHECK I F AMENDMENT TOREPORT DATED

0 Che 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 N o t i c e o f D i s s o l u t i o n F o r m DR -

( Y o u mus t c o n t i n u e t o f i l e r e p o r t s u n t i l a N o 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 HAND

CASH ON HAND a t t h e b e g 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 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 e s 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORM

DR- 2( R e v . 0 1 1 2 0 0 1 )

For Of f i c e Us e O n l y

Comm. #

. 1

I n d e x e dA u d i t e d 6- 02 - -

C o mp u t e r

J AN 2 2 2 0 0 2

DATE i G ED

L ECT I ON / ( 2 ) NON - E L ECT I ON YEAR .

id i c a t e o n e

L o c a l C o mm i t t e e s , e n t e r D a t e o f E l e c t i o n

C o u n t y & L o c a l C o mmi t t e e s , e n t e r C o u n t y i n

w h i c h E l e c t i o n i s h e l d

DI SCLOSURE

REPORT

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Fo r I r s t h ; r e i c n s , Se e Back o f Fo r

CONTRI El 9T I CNS - - 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 T ' I I EE NAME ( Mu s t b e s ame a s o n St a t e me n t f Or g a ni z a t i on )

STATE CANDI DA TES NNUMBER AND THE PAC CDI SCLOSURE BOARD .

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 DE NT I F I C AT I ONI ( NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I CWA ETHI CS AND CAMPAI GN

CAUTI ON : Se 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 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 r

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

MONETARY

( Re v . OE l 9 7 ) RECE i P1S

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-

( MMI DDl YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME

b CK#3

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~M r v

I D#

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FOR I NSTRUCTI ONS, SEE BACKOF FORM SCHEDULE

EXPENDI TURES a MONETARYs- MONEY SPENT FROM COMMI TTEE ACCOUNT

( Re v . 0 9 1 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE 7 CHECK THI S BOX I F

PAC CHECK NUMBER FOR E4CH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.

COMMI TTEE NAME ( Mu s t be s ame a s t e me n t o f Or g a n i z a t i o n )

~l

o TS

- - S ; X Pr

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNT

DATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDED

EXPENDED ( 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 PAC

CHECK

NUMBER

I D # n 9

CK#

1 D#

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CK#

I D# I J

I D#

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1 0 c 1 e Z ' 6 Z t A- t j C -6

o a " 4 i res 5 h Ii ~ b ^ - o v u 1 ~Q .

~DL' C - S 2

S `

- ~ ` Q - a ~ ^ -

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_--v i , wv r r _ n v o , JGG i mi l d \ Ur r uKm

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

r U

NOTE : T h i s s c h e d ul e r e p o r t s mono

n

t o t h e c o mmi t t e e wh i c h i s d e p o 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 LAST REPORTI NGPERI OD $

TOTAL ( PART 1 ) 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 e c o mmi 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 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 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 e r e l a t i o n s h i p c o l umn w h e n I t a p p l i e 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 . )

PART I - MONETARY LOANS RECEI VED I R I S _ REPORTI NGPERI OD

PART 1 1 - MONETARY LOAN REPAYMENTS MADE THI S_ REPORTI NGPERI 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 a b a n k , must b e s h o w n I f a t h i r d p a r t y I s

( L o a n s f o r g i v e n must b e r e p o r t e d o n S c he 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 I Q

$

F r o m S c he d u l e E - - TOTAL LOANS FORGI VEN

$ , _ -

TOTAL OUTSTANDI NG LOANS END OF REPORT PERI OD

( f o r Sc h e d u l e F )

SCHEDULE

LOANS

( R e v 0 8 / 9 6 ) RECEI VED& REPAI D

[ ] CHECK T H I S BOX I FAMENDI NG FORM

DATE

RECEI VEDMM/ DDI YR

NAME ANDADDRESS OF LENDER

( I n c l u d e E n 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 I l c a b l e * )

AMOUNT

OF LOAN

DATE PAI D( MM/ DDI YR)

NAME ANDADDRESS OF LENDER( I n c l u d e E n 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 )

AMOUNT

REPAI D