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T H I S B O X A P P L I E S T O C A N D I D A T E S ' C O M M I T T E E S O N L YP u 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 h e i n v e n t o r i e d o n S c h e d u l e H ( R e f e r t o S c 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 i 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 m u s t a l s o b e d e t a i l i t e m i z e d o nS c 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 made b y t h e p e r s o n l e n t i 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 r t oS c h e d u l e G i n s t r u c t i o n s a n d l o w s C o d e 6 8 A . 4 0 2 ( 3 ) ( i )

( _ f o r S c h e d u l e H )

FOR f I V ST R f . 1 C Tt ONS . SEE AAC ' K OF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI T TEE ACCOUNT ( R e v . 0 7 / 0 3 ) EXPEND I TURES

S TATE PA C COMMI TT EES : NOTE : FOR CONTRI BUT I ONS MADE T O STATEWI DE OR L EGI S LAT I VECANDI DATES, L I S T T HE CANDI DATE I D E N T I F I C AT I O N NUMBER I N THE DESI GNATED COL UMN AND THE CHECK i HI S BOX I FPAC CHECK NUMBER FOREACH E X PE I ' A Di T UR F A US T OF ! D NUNr BERS I S AVAI LABLE FROM THE ! O WE , AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NA ME ( Mu s t b e s a m e a s o n S t a t e me n t o f Or g a n i z a t i o n )COIM .OA ' ! t p - ~ ' k - 0 E C O Q S y ~ e ~ ~

CAND I DATE NAME AND ADDRESS T O WHOM PURPOSE I AMOUNTDATE I D NUMBER EXPEND I TURE ( DESCRI BE TRANSACT I ON) EXPENDEDEXPENDED ( i f a pp l i c a b l e ) ( D i s b u r s e me n t ) . " + A S MADE( MM, ' D D ! V R ) - A R I D PACCHECKNUMBER

I D# CO ~G K~ Ia a ~ q ' w,W04, 0, 5CK# CU Ca a A J{~VOC~UJPi ' st o v _ ZI V + hID# 1 4 _J

S 4 ~ 1 c _ _ uP TI b o g4 ' ~ ) . , C( v o ' i NS X5 , 0 1 1I D # KDEG( ~ O H . S ~ t i f t a t d ~ v ~ ~p CK# f p k c +I, I ~ T - A 5 Z i o ~ ( % VWI D # C ( C L ! k 1I WL ~~ CK # I ) b r ~ - ` ~ ~' Wf l w J l 7 : N N N O I ~ t l 3 y ( ~c o wa s Z 1 0 C a B P S f ~ 1 s P ~ I l p t ~C K #D#0 K #0 1 tC K 4O f fC K #

S U B - T O T A LT O T A L ( i f l a s t p a g e o f t h i s s c h e d u l e ) 7 7 1 T 7

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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 )COMMI TT EE 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 )

1 4 4 , KA ' # ` i . p . E , 4o~( eP I " J L ) 1 4 40 5 41n S - a v ,S TA TE C ANDI D ATE 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 ROM A S T A T E P A C ( P O L I T I C A L A C T I O N C OMMI T T E E ) , L I S T T H E PAC I D E NT I F I C AT I ONNUMBER AND T H E P AC CHECK NUMBER I N T H E D ES I G N 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 T H E I O WA E T HI C S AND C A MP A I G ND I S C L O SU R E BOARD .NOTE : ANY PERSON, OTHER THAN AN I N D I V I D U AL , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GNMAY HAVE F I L I N GR ES PO N S I B I L I T I E S AND SHOULD I MMEDI ATELY CONTACT THE BOARD .

I J B - O ALTOTAL ( I f l a s t p a g e o f WD- a c h e a r t e )

CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , 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 r f o r a n yc 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 a c l o s u r a l a w r e q u i r e s c a n d i d a t e mmmi t t e s s t o di 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 m u s t b e s h a m 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 ) , I f s u r n a m e 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 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 S c h e d u l e A )

SCHEDULEA MONETARY( R e v , 0 7 / 0 3 ) RECEI PTSOCHECK T H I S BOX I FAMENDI NG FORM

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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 F o r mC B U- re ii v 0 i n v . ~! E - I M , vn i w e nY T _ ~ ~EL - "-. l e Y tv.C}IrJTRIuiYi 1

( 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 r . S t a t e me n t o f O r g a n i z a t i o n )

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I SCHEpULEjMONETARY( Re v . 0 7 1 0 3 ) RECEI PTS

0CHECK THI S BOX I FAMENDI NGFORMSTATE CANDI DATES NOTE : ' F"- q- _ , T ` , t l E , ~ _ I E1 F , ` a . A - T A T E ' A ~ ; p ' 0 1 - M = - A L A . " _ e : - , n T . E F T - ! E P AC- CE ' . F . - A N T i ( ) ~ ii n n A n T . G o - - u I . : ~ . T u - ; n n n T n c E F i n n T H E ! u ! , - - : _ o .1 5 1 ' P E B O A R - - )NOTE ANY PERSON, OTHER THAN AN I N Di V I D U A L , THAT CONTRI BUTES MORE THAN $ 7 5 0 TO YOUR CAMPAI GN MAY HAVE F I L I N GRESPONSI BI LI TI ES AND SHOULD I MMEDI ATELY CONTACT THE WARDCAUTI ON : S e c t i o n 6 SB . 3 ' _ A6 ) , 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 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 r f o r a n yc 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 f 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 ed u l e )

D i s c l o s u r e l a v v r e w 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 ec o m; n i t t e e . Re 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 ym a 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 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 Page ; ? ,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 u mn . ( f o r S c h e d u l e A )

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v I F FORRFCEI VFD ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND}( MM/ D D1 YR ) AND PAC CHECK. ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

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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 mC0NT .. Fn 1 6 8 L + T 1 10-NS7 - `A0NEN - , r . . -K. 1 " V

( I n d u dwg u a a d i d a i t t ' s p e r s o n a l f u n d s )COMMI TTEE NA P A E " v i t u s t u S a r n o a s c a n S t a t e me n t o f O r g a n i 7 a t o n )

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STATE CANDI DATES NOTE - ! F - , ` ) I , a l - . ' C , - n - w T i EF ~ L i s T ~ ' ~ . .. : . _ n _ F a ~ o ^ J" a : - P T r ' F PA N" , K P! L , .d e ; r . . 4 c r - Gn r c ; , n c n ~ a ~ F n ao ~ n _ - n i " - u . , - , a ~: ; . r , . aNi ~ ; I ^ " , I P , . 9 P A ' i ST . I . . . h ' - A 7r ~ . _ _ . . r . a . F - R _ , - _ _ - , A - . . , ~ F_ F P ( T N r = . - HA FT . - t i . r t n 4MP49 , ,- uRF e C l 4P1

NOTE - ANY PERSON, OTHERTHAN AN I ND I V I D UA L , THAT CONTRI BUTES- , MORE THAN $ 7 5 0 TOYOUR CAM- P , A I GN MAY HAVE F , L ! N c jRESPONSI B I L I T I E S ANDSHOULD I MMEDI A T EL Y CONTACTTHE BOARD .CAUTI ON : Se c t i o n 6 8 1 3 . 3 - n , ( S , " , 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 o p i e d f r o m r e p o r t s a n d s t a t o r n o n t s f o r s o l i c i t i n g C o n f r i b u t i o n s o r f o r a r mc 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 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 es .r d

" D i s c l o s u r e l a v a 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 e n t o t h ec o r n mi t t e e . R e l a l 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 s t 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 ) , r n d a f f i n i t y , r e a t i v e s b yr n a r n 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 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 P a g e~_o f_3f 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 )

SUB- TOTAL

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