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F O R - I N 8 ; " RUCT I ONS, SEE BACK OF f MDI SCLOSURE SUMMARY PAGE

COMMI TTEE NAME ( Mu s t b e s ame a s on S t a t e me n t o f Or g a ni z a t i o n)

I MPORTANT : I n d i c a t e t y p e o f c o mm i 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( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s

SEE I NSTRUCTI ONS ON BACK ANDCOMPLET E THE FOLLOWI NG SENTENCE :

[ : ] CHECK I F AMENDMENT TO REPORT DATED

(~4)(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 nd 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 or m DR - 3 .( Y o u must 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 HANDCASH 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 mon i e s h e l d b y t h e c o mmi t t e e . T h i s amoun t MUST b e t h esame a s t h e c as h on h a n d a t t h e end 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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADDTOTAL MONEY TAKEN I N T HI S P ER I ODSc h e du l e A : C a 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 S c he du l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he du l e C : F u n d - r a i s i n g Ev e n t s t o t a l ( A t t a c h Sc h ed u l e C ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he du l e F : Loan s Re c ei v e d t o t a l ( A t t a c h S c he du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c he du l e H: T o t a l Sa l e s o f Ca mp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h ed u l e H a p p l i e s t o Ca nd i d a t e s ' Commi t t e e s Onl y )SUB- TOTAL . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S P ER I ODS c h ed u l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h ed u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S c h ed u l e F : Loan R ep a y me n t s t o t a l ( A t t a c h S c he du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t t h e end 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 c e mus tb e z e r o ) ( A t t a c h DR - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

UNPAI D BI L L S ( F r o m S c he du l e D - A t t a c h S c he du l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2( R e v . 0 2 / 9 6 )

F o r O f f i c e U s e _ On l yComm . #I n d e x e d -A u d i t e dC o mp u t e r

P e n a l t i e s Du e Fo r L a t e F i l e d Rep or t s R a n g e f r o m $1 0 i ~ $ 4 0 0

DI SCLOSUREREPORT

~~-a~. ~ _ r r 7 3 l l 7 OSI GNATURE OF TREASURER ( o r p e on f i l i n g t h i s r e p o r t ) TELEPHONE ~ DATE I GN D

J AN a 7 2 0 0 2

I AM F I L I N G A ` I hU GY~. . REPORT FOR AN/ A ( 1 ) ELE CT I ON / ( 2 ) NON- EL CT I ON YEAR .( r e r t d a t e ) I n d i c a t e one

L o c a l C o 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

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

_ mI - ! c -

I N KI N D C ON T RI BU T I ON S ( Fr om S c h ed u l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NG LOANS ( F r om S c h ed u l e F - A t t a c h S c he du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY : ~CONSULTANT BREAKDOWN ( Sc h ed u l e G A t t a c h e d ? ) YES ' ENOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h ed u l e H) $

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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 TAKL . , d 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 ame 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 )

f 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

S T A T E C A ND I D A T E S NOTE : 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 A T E P A C ( P O L I T I C A L A CT I O N C O MM I T T E E ) L I S T T H E P A C I DE NT I F I CA T I O NNUMBER AND T HE P AC CHECK NUMBER I N T H E D E S I G NA T E D C O L U M N A L I S T O F I D N U M B E R S I S A V AI L A B L E FROM T H E I O WA E T H I C S A N D C A MP A I G ND I S CL O S U R E B O A R DCAUTI 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 n 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

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 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 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 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( Re v . 0 6 / 9 7 ) RECEI PTSQCHECK THI S BOXAMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT JRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED F( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RNUMBER II D# C . ~ 33CK# T I - 0

7~l 7 ~/ ~, ST , - -1I D# 4 4 " t ; i l i e

J a r CK# r t i , r i ., f e . ; 1-I o # ~f ' 4 a X h r ~ /l CKO 1 - 1 5 v ~ ~I D # k h , / / , - s s 6 ~ r ~/ CK# X 3 0 , 3 d 2 a t e , S~/ - z >b 7 - - -

I D S 4 1 - F & ~ ~ r G - r t e ~ ~1 r S S 2 . ' = ~ ~v o ,~CK#I D S MCz 1- ~ ) ,~, ACK# 1 7 2 7 S 7 L 7 ` ' SCr ~ ~ e .". r ~L~UI D # 1 , ' ~

l D~ o ~ v CK#I D S 2 ) i ~l / 0CK# Gas% ~~ 5~o~h l c ~. ~r 9 S~dGG/~ I D # Ne t . . ) l V ' r i ' G~. ~ i PTl = F G a C _ o o ~ ~ f ./ ~ , ~ , , . ~ , ~ , ~~ 7 R ~ r yCK# 79 7 &! 1 * C9~ l S 7 " , l b ! ~ S7F ' SGGI D # C , ! : t 3 g ' ( Ri 2 A~ b r a 5 7 ~ y c C a d 6 o p % 64 . 6

. r A e~SUB- TOTAL

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F o r I n s t r i j i t t i o n s , Se e B a c k o f Fo 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 ( 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 o n)GAV

SCHEDULEA MONETARY

( R e v . 0 2 / 9 6 ) RECEI PTSCHECK THI 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 N 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 : Se c t i o n 68 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 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 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 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 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 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 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 Page ; L 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 A )

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNTRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e )NUMBER

I D# C y f f / ( / e e ~Swr a1 - 5~o

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CK#I D#CK#

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F O I L I NSTRUCT I ONS . SEE BACK OF F o r . .COMMI TT EE NAME ( M u s t b e same 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 )

1 / 9 / Cl " ( ~ 9 AV A, - Z - GPI /I N K I ND

CONTRI BUTI O

C3 CHECK T HI S BOX I FAMENDI NG FORM

P a g e ~ o f ~ u l e E-( f a S c h e d )' 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 ec o r v n i t t e s . R e l a t i o n s h i p mu s t b e s h o w n t o f t t h i r d d e gr 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 sb y m a r r i a g e ) . ( S e e P a g e 2 o f f o r ms p a c k et ) M s umame 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 l i o t a p p l i c a b l e ' i n 1 M r e l a t i o n s h i p c o l u mn .

DATERECE I VED( MM/ ) D/ Y R) NAME AND ADDRESSOF CONTRI BUTORRELA71 ONSH I PTOCANDI DATE

* ( i f a p p l i c a b l e )DESCR I PT I ONOF I N KI NDCON TRI BUT I ON

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T HI S BOX APPL I ESTO CANDI DATES' COMMI TTEES ONLY :Pu r 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 . ( R e 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 p e n d 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 e r v i c e s 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 G b y t h e a mo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e ma d e b y t h e p e r s o w e n t i t t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e rSc 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 C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

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

FOR, I N$ TRUCTI ONS . SEE BACKOF ' CT M SCHEDUL EBEXPENDI TURES MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 9 / 9 7 ) EXPENDI TURE

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VE CHECK T HI S BOX I FCANDI DATES. L I S T THE CANDI DATE I DENTI F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF 1 0 NUMBERS I S AVAI LAB LE FROM THE I OWA AMENDI NG FORMETHI CS S CAMPAI GN DI SCL OSURE BOARD .

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 a n i z a t i o n )

CAND I DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCR I 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 PACCHECKNUMBER

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c r v ~r P Z~9I N

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