FROM ,:CAPITOL --- BINDERY FAX NO . :402 342 5511 Oct .

20 2004 09 :34AN P1

:~E FOR INSTRUCTIONS, SEE BACK OF FORM

DISCLOSURE SUMMARY PAGE
COMMITTEE NAME (Must be same as an Statement of Organization)

-G.ffl rt.iloil ~ f
IMPORTANT: Indicate®r # type of COrtrR1iltee you are teponing for.
C01-
(1 )Statewide&egislative/Judge Standing for Retention Candidate (2)ffa-
ft PAC (3 )State Party
(4 )County Central Committee (5 )County Candidate (6 )City Candidate (7)Schod Board or Other
Political Subdivision Candidate (8 )County PAC (9 )City PAC ( 10 )School Board or Other Polldcal
Subdivision PAC (11 )Local Ballot Issue
CANDIDATE COMMITTEES ONLY:
Ca.~d
.~ate Name Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sough penalties.
05,

%Z ~4 7Z2 3 2-2- /0,,

SIGNATURE OF PERSON FILING REPORT TELEPHONE DA SI NE

I AM FILING A l 1'1D-( REPORT kOR (1) ELECTION /(2)NON-ELECTION YEAR .

(report date) Indicate by #

OCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

QJ t:hec3c if this is final (termination) report County & Local Committees, enter County in
(You must continue to file reports until a OR-3 is filed.) which Election Is held

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 an hand at the end
of the last reporting period or must be zero if INa Is first report filed.) ................ ...:..............$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A Cash Contributions total (Ali Schedule A) ("also see in-Icind below) ..........
Sdtedule F: Loans Received total (Attach Schedule F) ...................... ............. ....................
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ........... ... .. ..................
(Schedule H applies to Candidates' Ca=IttAae Only1
SUB TOTAL ... ..S -z-"?-454k~; 6
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and bans 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) ........................ ................:;!z................... $

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . ...... ~!~ . ....~ .................... $
F) ............. ..................... ... .............. $
"OUTSTANDING LOANS (From Schedule F-Attach Schedule
CANDIDATE COMMITTEES QW :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)
FROM :CAPITOL --- BINDERY FAX NO . :402 342 5511 Oct . 20 2004 09 :35AN P2

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Mus4be some e n Statement nlzp on) AMENDING FORM

STATe CANDIDATES NOT IF A CONTRIBUTION 13 RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC NUMBER IN THE DESKINATED OOLUMN . A LIST OF ID NUMBERS IS AVAII .ABI..E 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 soflcftlng contributions or
for any commercial purpose by any person other than statutory political committees.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (rrappticable) TOCANDIDATE' RECEIVED FUND-
(MMIDDYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#

'00
CKif
l.~ y
IDS

`vI yl
R
Q
01.

IFA
IDiI

cKS `7G I pt
r
(D#

CKO

ID#

CK#

ID

CKO

ID#

CKO

ID#

CK#

I Dll

CK#

ID#

CKO

SUB-TOTAL

TOTAL (N lest page o/ this schedule)

" Disclosure law mrruims candidate committees to dlsOose the relationship of any relative making a contribution to lho
aommiMee . Relationship owst be shown to the third dogma of corwanguirdly (bbod relatives) and affinity (miatives by
Rwnirga) . If sumarne of contributor is the earns as candidate, but them Is no Page I of
familial relationship, enter 'not applcablee' In the relationship column. ule A) /1_
(for, _
 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE . FOR CONTRIBU770M5 MADE TO STATEWIDE OR LEGISLA71VE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHI=CK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE 1OWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

COMMITTEE NAME (Must be some ea on Statement of Organization)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE 10 NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (N applicable) (Diabumentent) WAS MADE
(MMIDDlYR) AND PAC
CHECK
NUMBER
ID#

CK# l `0~ 06
g4A

CK# /~ce. c .mop

- 5. do
-
ID#
--7 ~ 1~:.~ G.~. v s d n ~ cl.
CK# m"t,'k 0`
C9o

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL
TOTAL (#last pWe of gals schedule) $ r

THIS 13OX APPLIES TO CANDIDATES' COMMTTEES ONLY,

Purchases of certain campaign property costing WW or more must also be Inventoried on Schedule H . (Refer to Schedule H Instructions)

Expenditures to parsons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
SChad& G by the amount, purpose, end date of each type of expenditure made by the pereorVentity on behalf of the mndidete's , cornmhtee . (Refer m

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

D INCURRED
COMMITTEE NAME [Must be same as on Statement of OmantrAlonl re- nn00a run9ATrnhrree
FROM -:LAPIT OL --- BINDERY FAX NO . :402 342 5511 Oct . 20 2004 09 :40AM P2

FOR INSTRUCTIONS. SEE BACK OF FORM SCHEDULE

E IN KIND

-R~ 4j . 1
COMMITTEE NAME (Must same as on Statement of
C
fev.0619~ CONTRIBUTIONS

)
ED CHECK THIS BOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED q IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
R OF CONTRIBUTOR ' (If CONTRIBUTION VALUE CONTRIBUTION
$

v J
f1 .5-103 1 17 GmS
t

71
EJ
E:1

F-]

F- 1

'Disclosure lawrequires candidates to disclose the relationship of any relative malft an In kind contribution to the Page ( Of
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (reladves (tar 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 'ot applicable' In the relationship column .