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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARYPAGE MAR 1 1 2 0 0P ,M- 3 rJCOM4 4 I TT E ME ( s t b e s 7 , ,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 ~; ^I MPORTANT : I n d i c a t e t y p e o f c o m m i t t e e y o u a r e r e p o r t i n g f o r : D

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( 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 m m i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o m m i t t e e( 8 ) S u p p o r t S l a t e C 6 t e sSI GNA 1' Ui WOF 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 u t i n e P e n a l t i e s Du e F o r L a t e F i l e d Re p o r t s Rang e f r o m $ 2 0 t o $ 8 0 0SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :I AM F I L I NG A b r L) r 3 - REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- EL ECT I ON YEAR .

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

I ] Che c k i f t h i s i s f i n a l ( t e r m i 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- 3 .( Y ou 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 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 lo 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 amo u n t MUST b e t h es am e a s t h e c a s h o n h a nd 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 ul 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 ul e F : L o a n s 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 ul e H : T o t a l S a l e s o f Camp a i g n P r o p e r t y ( A t t a c h Sc h ed ul e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

( Sc h e du l e H a pp l i e s t o Ca n d i d a t e s ' Co mmi t t e e s On l y )SUB- TOTAL . . . . . . $

SUBTdRABTOp e n d i Nt IuOr e s E o t a l ( A t t a c h Sc h e d u l e B) . . . . . . . . . . . ~. ' . . . . . . ~ . ~ ~ . ~ D~ . . . ~ ( . . . s ` . . . . . . . . . . . . ,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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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 mus t 5 1 6 S4 3 ` 4 , Ib e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

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

4 kDATE SI GNED

L o c a l C o m m 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 m mi 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( r ( do ~ b p 1 .

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5 4. ~N3UNPAI D BI L L S ( F r o m Sc h e d u l e D - At t a ch 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 - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTSTANDI NGLOANS ( F r o m Sc he du l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( Sc h e du l e G At t a c he d ? ) YES XNOVALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d ul e H - A t t a c h Sc h e d u l e H)


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Fo r I n s t r u c t i on s , Se e Back o f Fo r t hCONTRI 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 TTEENAME ( Mus 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 )

,)A, _~ . ~_\_ tl l - e c - - - i ' y

STATECANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATE PAC( P OL I T I CAL ACTI ON COMMI TTEE) , L I ST THEPAC I DENTI F I CATI ONNUMBERAND THEPACCHECKNUMBER I N THEDESI GNATED COL UMN . AL I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD.CAUTI ON: Se c t i o n 68B. 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 mat i on c o p i e d f r o m r e p or 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 on t r i bu t i o n s o rf o r any c omme r c i a l p u r p o s e b y any 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 .

TOTAL ( i f l as t p a ge 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 nd i d a t e c ommi t t e es 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 an 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 ommi t t e e. R e l a t i o n s h i p mus t be s h o w n t o t h e 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 s b yma 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 . ) . 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 as c a nd i d a t e , bu t t h e r e i s n of a mi l i a l r e l a t i o n s h i p , e nt 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 .

Page~r ~Of( f a ' Sc h e du l e A)

SCHEDUL EA MONETARY

( Re v . 0 6 1 9 7 ) RECEI PTSCHECKT HI S BOX I FAMENDI NGFORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VED FUND( MMI DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SE

NUMBER I NCOMa . I D# 0-T_T~S r i v \ 100CK#

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F o r I n s t r u c t i o n s , Se e Back o f F o r mCONTRI 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 TT EE NAME ( Mu s t b e s ame as o n St a t eme n t o f O r g a n i z a t i o n )LkiL1

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I V E D FROMA STATE PAC ( P OL I T I C A L ACTI ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . 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 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 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 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 an y commer 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- TOTAL

TOTAL ( l f l a s t p a ge 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 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 P a g e 2 o f f o r m s p a c k e t . ) . I f s u r name 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 . ( f o r S c h e d u l e A)

Page a- o f

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

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SNUMBER I NCOM-I D# ~ 1 Rvv - - ~ r - ~CK# uI D# t A

" CK# - ( S e b J ~ U3 _I D# ) a l ~Z L O N.CK#I D# T - f ~ L , , ~ e S C ( o L , , 5CK# ~~ S~ ~ LSZ d o 6 ) 3~ UCK# S C s r . I J ^ c ~ S~ ~ ~5 1 ) oI D# 3 I V Lt - ( + U, V - C~ o )- z - ~ r t . a Q) , UJCK# l ~ s ~ L ~ j l i 5v ~i

1CK# C 2 S t , v ' ~ . ~ ~ ~ - SU~t UI D# - A 2 ) ~ ~ , V- L d S~CK# 33 I - 7 c r -. T) St Ju ~ c ~ 6I D#

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Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI 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 t o f O r g a n i z a t i o n )

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( P O L I T I C AL ACTI ON C O MMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA E T HI C SAND CAMPAI GNDI SCLOSURE BOARD .CAUT I 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 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 rf o r a n y c o mme 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- TOTAL

TOTAL f i f l a s t page o f t h i s s c h e d u l e )

P a g 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 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 Pa g e 2 o f f o r m s p a c k e t . ) . I f s umame 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 . ( f o r S c h e d u l e A)

SCHEDULEA MONETARY( Re v . 0 6 1 9 7 ) RECE I PTS

CHECK T HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTR I BUTOR RELAT I ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I V E D FUND( MM1DD/ y R ) ANDPACCHECK ( i t a p p l i c a b l e ) R AI S ENUMBER I NCOMI D# V ;c K# C , I y h - a - y b u s i r v ( ( ~I D# ~ l I t i l ~ \ _ l _ V 1 . . e t t yCK# 5 ' F1CK# C ' , e ' , Z - t - 6 4 ' - . -- I D# S C I ! ~ - ~ ~ ' _ ~ C ~ U_ j

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F o r I n s t r u c t i o n s , Se e Back o f F o r mCONTRI 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 TTEENAME( Mu s t be s ame as o n St a t e me n t o f Or g a ni z a t i o n)

r C. f ~STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMASTATEPAC ( P OL I T I CA L ACTI ON COMMI TTEE) ,

L I S T THEPAC I DENTI F I CATI ONNUMBER ANDTHE PACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se ct i o n 68B . 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 ma 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 ont r i b ut i o ns o rf o r an y c omme r c i a l p u r p o s e b y any 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 .

TOTAL ( i f l as t p ag 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 ommi 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 an y r e l a t i v e maki ng a c o n t r i b u t i o n t o t h ec ommi t t e e. R e l a t i o n s h i p must 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 ) and 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 ms p a c k e t . ) . I f sumame o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b u t t h e r e i s n of a mi l i a l r e l a t i o n s h i p , e nt 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 .

SU&TOTAL

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


DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SEr NUMBER I NCOMUD- CK#

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Fo r I n s t r u c t i o n s , Se e Bac k o f F o 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 O r g a n i z a t i o n )

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STATE CAND I DATES NOTE : i F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E PAC ( 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 THE PAC I D EN T I F I C AT I O NNUMBER AND T HE P AC CHECK NUMBER I N T HE D E S I G NA T E D COL UMN. A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I O WA E T H I C S AND C A MP A I G ND I S C L O S UR E BOARD .CAUTI 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 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 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 .

SUB- TOTALTOTAL ( I f l ast ~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 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 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 b ym 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 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 n : 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 )

SCHEDUL EA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTS


DATERECEI VED( MM/ D D / Y R )PAC I D NUMBER( i f a p p l i c a b l e )AND PAC CHECKNUMBER

NAMEANDADDRESS OF CONTRI BUTOR REL ATI ONSHI PTO CANDI DATE'( i f a p p l i c a b l e )

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Fo r I n s t r u ct i o n s , See Back o f Fo r mCONTRIBUTI ONS- - MONEYTAKENI 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 ( Mu s t b e s ame a s on S t a t emen t o f O r g a n i z a t i o n )

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 C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER ANDTHE PACCHECK NUMBER I N THE DESI GNATED COL UMN . 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 HI C S AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: S ec t i o n 68B. 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 mat 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 on t r i bu 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 by any 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 .

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 aw r e q u i r e s c a nd i d a t e c ommi t t e es 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 an 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 must 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 ) and 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 mr 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 as c a n d i d a t e , b ut t h e r e i s n 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 S c h ed u l e A)

SCHEDULEA MONETARY( R ev . 0 6 / 9 7 ) RECEI PTS

CHECKT HI S BOX I FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SE

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Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI 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 ( 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 )

STATE CAND I DATES NOTE : I F A C ON T R I B U T I O N I S R E CE I V E D FROMA S T A T E PA 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 P A C I D EN T I F I C AT I O NNUMBER AND T HE P AC CHECK NUMBER I N T HE D E S I G NA T E D COL UMN. A L I S T OF I D NUMBERS I S A V A I L A B L E FROM TH E I OWA E T H I C S AND C A MP A I G ND I S C L O S U RE BOARD .CAUTI 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 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 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 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 .

TOTAL ( 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 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 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 b ym 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 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 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 .

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SCHEDULEA MONETARY( R e v . 0 6 1 9 7 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

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T HI S BOX A PP L I E S TO CANDI DATES ' COMMI TTEES ONL Y :P u r c h a s e s o f c e r t a i n c a m p 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 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 / 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 / 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 I o w a C o d e 5 6 . 6 ( 3 ) ( 1 ) . )

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STATE PAC COMMI TTEES : NOTE : FOR CON TRI BU T I ON S MADE T O STATEWI DE OR L E GI S L A T I V EC A N DI D A T E S , L I S T THE C AND I D A T E I D E NT I F I C A T I O N NUMBER I N THE DESI GNATED COLUMN AND THE CHECKTHI S BOX I FPAC CHECK NUMBER FOREACH EXPEND I T U RE . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA AMENDI NG FORME T H I C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b 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 l e f -I ( `

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T HI S BOX APPL I ES TO 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 S c he d u l e H. ( R e f e r t o S c he d u l e H i n s t r u c t i o n s . )Ex p e nd i t u r e s t o p er s o ns / e n t i f 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 , man ag 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 nS c he d u l eGb 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 p en 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 ha 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 he d u l eGi 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 ) . ) - -

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STATEPACCOMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TO STATEWI DEOR L E GI S L A TI V ECAND I DATES, L I S T THECANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DES I GNATED COLUMNANDTHE 0 CHECKTHI S BOX I FPACCHECKNUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A VA I L A BL E FROMTHE I OWA AMENDI NG FORMETHI C S & CAMPAI GNDI SCLOSURE BOARD.COMMI TTEE NAME ( M u s t b e same 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 )

CANDI DATE NAME AND ADDRESSTOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( Di s b u r s e me n t ) WASMADE( MM/ D DI Y R) AND PAC

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DEBTS/ OBLI GATI ONS REMAI NI NG THI S REPORTI NG PERI OD( DONOT I NCLUDE LOANS - - SHOWLOANSON SCHEDULE F )

* I f a c t u a l f i g u r e i s u n k n o w n , s h o w " e s t i m a t e d " b es i d e t h e f i g u r e .

SCHEDUL ED I NCURRED( Re v . 0 8 / 9 8 ) I NDEBTEDNESS

CHECK T HI S BOXI F AMENDI NGFORM

An " i n c u r r e d d e bt " i s a d e b t f o rg o o d s o r s e r v i c e s o r d e r e d o rr 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 an i n v o i c eh a s b e e n r e c e i v e d .

Page I - o f -A( f o r Sc h e d u l e D)CANDI DATECOMMI TTEES NOTE :* I n c u r r e d i n d e b t e d n e s s a l s o i n c l u d e s e a c h p e r s o n / e n t i t y w i t h w h o m t h e c a n d i d a t e ' s c ommi t t e e h as e n t e r e d i n t o a c o n t r a c t d u r i n g t h e r e p o r t i n g p e r i o d f o r f u t u r eo r c o n t i n u i n g p e r f o r ma nc e . E n t e r t h e name o f t h e c o n s u l t a n t who p r o v i d e s o r p r o c u r e s s e r v i c e s f o r i t e ms s u c h a s ad 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 , manag i n g , o ro r g a n i z i n g s e r v i c e s . Re p o r t o n S c he d u l e G t h e n a t u r e o f p e r f o r ma nc e an d t h e e s t i ma t e d p e r f o r ma nc e r e a s o n a b l y e x p e c t e d o f t h e c o n s u l t a n t .

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