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FOR I NSTRUCTI ONS, SEE BACK OF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEE 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 )

CIn 4 _ Ad_L2I MPORTANT : I n d i c a t e b y f l 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 :( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PAC ( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l C o mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 8 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PAC ( 9 ) C i t y PA C ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s s u e 1CANDI DATE COMMI TTEES ONLY :Ca n d i d a t e Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

1 0 , 4 w , - , 3% POI LLA CLC . - yOf F c e S o u g h t D i s t r i c t ( i f Se n a t e o r H o u s e )0L 77 7

-A 4 0 1SI GNATUREOF PERSON F I L I T N G REPORT

I AM F I L I NG A Oc - r - Z9 , ZL7D( r e p o r t d a t e )CHECK I F AMENDMENT TO REPORT DATED 0 L - - 2 - 8 2 0 0 4

0 Ch e 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 an 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 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 DR- 3 i s f i l e d . )

REPORT FOR ( t i ) ELECTI ON l ( 2 ) NON- EL ECT I ON YEAR.I n d i c a t e b y # :

STATEMENT OFCASHON HAND

( Sc h ed u l e H a p p l i e s t o Ca nd i d at e s ' Co mmi t t e e s On l v )

SUBTRACT TOTALMONEY SPENT T HI S PERI OD'SUBTOTAL . . . . . $

Sc h e du 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 e d u l e B ) ( " a l s o s e e d e b t s an d l o a n s b e l o w ) . .Sc h e du l e F : L o a n Re p a yme 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 c e mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $" UNP AI D BI L L S ( F r o m S ch e du l e D- At t a ch Sc h e d u l e D) . . . . . . . . . . . . . . . . . , . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

FORMDR- 2( Re v . 0 7 1 2 0 0 4 )F o r O f f i c e U e I S _I ~3Comm. #L o g g e d I nS c a n n e dC o mp u t e rA u d i t e d

DI SCLOSUREREPORT

L at e r e p o r t s a r e s u b j e ct t op os s i b l e c i v i l an d c r i m i n a lp en a l t i e s .

712 - T 2 - -F 6 ' a_ _2 d - , ? - O` fTELEPHONE DA E SI GNED

LWa 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 nCo un t y & L o c a l C o mm i 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

/Q~ f f l

` I N K I ND CONTRI BUT I ONS ( F r o m Sc h e du l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . , . . . . . . . . . . . . . . , . . . . . . . . . . . . . , . . $" OUTSTANDI NG LOANS ( F r o m S ch e d u l e F - At t ac h Sc h e du l e F ) . . . . . . . . . . , . . . . . . . . . . . . . . . . . . , . , . . . . . . . , . . . . . $ V'CANDI DATE COMMI TTEES ONLY :CONSULTANT BREAKDOWN ( S c h ed u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( F r o m S ch e d u l e H - A t t a c h Sc h e d u l e H )

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 o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amoun t MUST b e t h e s ame as t h e c a s h o n h a n d a t t h e e n d .a' )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 . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc h e d u l 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 ) ( ' a l s o s e e i n - k i n d b e l o w) , . , . . . . . 100Sc h e d u l 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 u l e H T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h S c he d 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 - - 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 Or g an i z a t i o n)

Ci T) - 7 a - - , , ) I L L. r , P >STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED F ROM ASTATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DENTI F I CATI ONNUMBER AND THEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE 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 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 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 any 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 u t 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- TOTAL

$ a49. DTOTAL ( i f l a st page o f t h i s s c h e du l e ) I

' 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 ny 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 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 ) a nd 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 ) , 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 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 Sc h ed u l e A

p .

SCHEDULEA MONETARY

( Re v , 0 7 1 0 3 ) RECEI PTSUCHECK THI S BOX I FAMENDI NG FORM

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

RECEI VED FUND-( MM/ DDNR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

r . CK# 1 o A ,4 - - 9f - 7 l q

I D # 1a y . , V e, 4 f ~ VV - 9 4 j 2 6f A3 4 ,/ 096 q &I D # ~ c . r r Aoy

P/ j j / 0 CK# Zap 29 , , i i ~9 l k - ~a t PL , ~~= _ S-0G +Z ~wI D # k " - ~~c . 6~g00 - 4/ o / ! L 6 c~r a '

CKOD03D6g ` y 3 ZD A A L_ J . ZD

CK# 0P. 0 , / _ ? m/ JI D# L/POD Br , i f 'CK# i 4 - - 41I D #CK#I D #CK#I D #CK#

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

COMMI TTEE NAME ( Mu s t b e same as o n S t a t emen t o f O r g a n i z a t i o n )Ct T ) z ` ~ > 1 0- I r 4 u `

EXPENDI TURES - - MONEY SPENT FROMCOMMI TTEE ACCOUNTSTATE PACCOMMf 1TEES, NOTE : FORCONTRI BUT I ONSMADE TO STATEWI DE OR LEGI S LAT I VECANDI DATES, L I S T THECANDI DATE I DENT I F I CATI ON NUMBER I N THEDESI GNATED COLUMN ANDTHEPACCHECKNUMBER FOREACH EXPENDI TURE, A L I ST OF I D NUMBERS I S AVAI LABLEFROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD.

SCHEDULEB MONETARY( Re v . 0 7 1 0 3 ) I EXPENDI TURES

CHECK THI S BOX I FAMENDI NG FORM

SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )

THI S BOX APPL I ES TO CANDI DATES' COMMI TT EES ONLY :Pu r c h a s e s o f c e r t a i n c ampa 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 must 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 0 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 na g i n g , o r g a n i z i n g s e r v i c e s must a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e amo u n t , p u r p o s e , an d d a t e o f e a c h t y p e o f e x pe n d i t u r e mad e b y t h e p e r s o n i 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 oSc h e d u l e G i n s t r u c t i o n s an d I o wa Co de SaA. 4 0 2 ( 3 ) ( i ) . )

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

P . 3

CANDI DATE NAME AND ADDRESSTOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE( MMJDONR) AND PACCHECKNUMBER

2zS J - K d 3 ~ ~ " , a f I L I s Z. 3t o - t i - o , 4 CK# 1 1 2 1 1 C $J C , 1 ~ L a ZAD# h h ' , _ i ` , O c , ~ , 6 9 Oz ~ . ~ t , r f r c . . r CJ + B v r - r ~ Fr ' 1 ~ ,1D . ~ z

_ o fCK#1D#CK#1D#CK#I D#CK#

I D#CK#I D#CK#I D#CK#

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FOR I NSTRUCTI ONS, SEE BACK CF FORMCOMMI TTEE 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 )

I r T0Z4N3 4 7 - - P / 1u,3e

F17 1 7 775_7 711 11l . - ct YC

SUB- TOTAL 1 $

TOTAL ( i f l a s tpag e o f t h i ss c h e du l e )

SCHEDULEE( R e v . 0 6 1 9 7 ) I N

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r l CHECK T HI S BOX I FAMENDI NG FORM

' 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 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 mak 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 e Page `c ommi t t e e . R e l a t i o n s h i p mus 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 ) an d a f f i n i t y ( r e l a t i v e s ( f o r Sc h e d u l e E )b y ma r r i a g e ) . ( Se e Page 2 o f f o r ms p ac 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 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 .

DATERECEI VEDMMI DDI YR NAME AND ADDRESSOF CONTRI BUTORRELAT I ONSHI PTO CANDI DATE

' ( i f a p p l i c a b l e )DESCRI PTI ONOF I N K I NDCONTRI BUTI ON

ESTI MATEDF AI R MARKETVALUE

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t ' d l lzu~o~1 1 0 1 ) d s r * r os eC>M* 4 , AZ X13

Ao t . t * - n i 4 N , ~ 00aF 7F 7a00F 7