OCT 28 2004 11 :29AM HP LRSERJET 3200

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 0712004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
FormOffice U e I ~3
CIn 4_ Ad_2 , L Co m. # I S_
IMPORTANT: Indicate by fl type of committee you are reporting for: Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
(4 )County Central Committee ( 5 )County Candidate ( 8 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 )Local Ballot Issue 1 Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if applicable)
Late reports are subject to
10,4w,-, 3% POILLA CLC .-y - possible civil and criminal
OfFce Sought District (if Senate or House) penalties .
0L7
77
-A401 712 -T2- F - 6'a__2d - ,? -O`f
SIGNATURE OF PERSON FILITNG REPORT TELEPHONE DA E SIGNED

I AM FILING A Oc-r- Z9, ZL7D REPORT FOR (ti) ELECTION l(2)NON-ELECTION YEAR .
(report date) Indicate by # :

LWal Committees, enter Date of Election

CHECK IF AMENDMENT TO REPORT DATED
0L--2 -82004
County & Local Committees, enter County in
0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
which Election is held
(You must continue to file reports until a DR-3 is filed.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the
committee . This amount MUST be the same as the cash on hand at the end a')
.
of the last reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) , .  , . . . . . 100
Schedule F : Loans Received total (Attach Schedule F) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . .. . . . . . . . . . . . . . . . . .. . . . . .
(Schedule H applies to Candidates' Committees Onlv)

SUBTRACT TOTAL MONEY SPENT THIS PERIOD'

SUBTOTAL . .. . .$
/Q ~ffl
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below)  . .
Schedule F: Loan Repayments total (Attach Schedule F) ., ., ., .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . ., . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . $

"UNPAID BILLS (From Schedule D-Attach Schedule D) . . . . . . . . . . . . . . . . . ., .. . . . . . .., .  . . . . .  . .. . . . . . . . . . . . . . . . . . . . . . . .$

`IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) . .. . . . . . . . . ., . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . ., . .$
"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . .. . . ., . . . . . . . . . . . . . . . . . . . . . . ., ., . . . . . . ., . . . . . .$ V'
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
OCT 28 2004 11 :29AM HP LRSERJET 3200
p .2

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev, 07103) RECEIPTS
(Including candidate's personal funds)
U CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

CiT)-7a--, ,)ILL.r,P>

STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM ASTATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person outer than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP I AMOUNT q IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDNR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

. .. CK# 4--9
f-7lq
r 1oA,
ID# 1ay.,V e,4 f~VV-94 - j26f A34,
/09

6 q&
ID# ~c.r r Aoy
29 , , ii~9lk-~at PL , ~~=
P/jj/0 CK# Zap _S- 0
G +Z ~w
ID# k"- ~~c. 6~g

/o/ 00 -4
!L 6c~ra'

CKO D03D6g `y3 Z D AA L_J. ZD

CK# 0P.0, /_?m/ J

ID# POD Br,if'

L/

CK#
i4-- 1
4
ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (iflast page of this schedule) I

$ a49.D
' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree ofconsanguinity (blood relatives) and affinity (relatives by
Marriage), If surname of contributor Is the same as candidate, but there is no Page of
familial relationship, enter not applicable" in the relationship column . (fo Schedule A
OCT 28 2004 11 :29RM HP LnSERJET 3200 P .3

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

B
(Rev . 07103) I MONETARY
EXPENDITURES

STATE PAC COMMf1TEES, NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

COMMITTEE NAME (Must be same as on Statement of Organization)

CtT) z`~> 10-Ir 4u`

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMJDONR) AND PAC
CHECK
NUMBER

2zS J-K d3~ ~",af

to- ti-o,4 CK# $ ILIsZ.3
11211 C JC,1~ L a ZA
_of ID# hh ' ,_i`,Oc,~,69 Oz~.~t, r fr c..r CJ +Bvr-r~ Fr'1~,
1D .~z CK#

1D#

CK#

1D#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)

Expenditures to persons0entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personientity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code SaA.402(3)(i) .)

(for Schedule B )
OCT 28 2004 11 :29RM HP LRSERJET 3200 p,4

FOR INSTRUCTIONS, SEE BACK CF FORM SCHEDULE

E IN KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 06197) CONTRIBUTIONS

IrT0 Z4N3 47- -P/ 1 u,3

rl CHECK THIS BOX IF
AMENDING FORM
e . -c
F17177 75
_77111
l 1tYC

DATE RELATIONSHIP DESCRIPTION ESTIMATED 4 IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
MMIDDIYR OF CONTRIBUTOR '(if applicable) CONTRIBUTION VALUE CONTRIBUTION

1101) d sr * rose Aot.t*-ni4N, ~

t'dlzu~o~
l
C>M*4, AZ X13

a
0

F7
F7
a
0
0
SUB-TOTAL 1 $
F7
TOTAL (if last
page of this
schedule)

'Disclosure
of law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page `
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
by marriage) . (See Page 2 of forms packet.) If surname of Contributor is the same as candidate, but there is no
familial relationship, enter not applicable' in the relationship column.