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FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2
(Rev. 07/2004)
I DISCLOSURE
REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
SlS~~~
IMPORTANT: Indicate by a type of committee you are reporting for. / Logged In
(1 )Statewide/LegislativetJudge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candidate ( 6 )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 Issu e Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name - Poftical'F6rt i'Jf applicable)
s. Late reports are subject to
possible civil and criminal
Office Sought fti 2 2 &Act (ifte or House) penalties.

y2G7
SIGNATURE O P0kSON FILING REPORT TE HONE DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .

(report date) Indicate by #

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

_ZF -1-o4
(] Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a DR-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 on hand at the end
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) ., ...... ..
Schedule F: Loans Received total (Attach Schedule F) . ............. ............................. ... ...... ...
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ... ...... ...... .... ...............
(Schedule H applies to Candidates' Committees One
SUB-TOTAL ..... $ )bd ,Db
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) . .. . Stwo , u? D
Schedule F: Loan Repayments total (Attach Schedule F) .... ............ ... ...... . .. ... ... ....... . ...... ... . -0-
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) ... .......... .... . .. ... ..... ...... .. ... . . . . .. . .. . . .$ -Dr

CANDIDATE COMMITTEES ONLY:

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
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For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS - MONEY TAKEN IN

(Including candidate's personal funds)
A
(Rev. 07/03) I MONETARY
RECEIPTS

CHECKTHIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

,y 5Kla~irvFK a C .
STATE CANDIDATES NOTE : IF ACONTRIBUT10N IS RECEIVED FROM A STATE 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 other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDfYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# CIO? Oc,
6-1-©^CC CK# ~/- k-CD-Sfsl Po. ~~Y ?6 7 $ Soot=
~1-?aa . S
r-74- s'8~n
I D#

CK# E:1
ID#

CK#

ID#

CK#

ID#

cK# E:1
tD#

CK#

ID# a

CK# .

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

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 of consanguinity (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 . (for Schedule A)
06/22/05 14 :07 FAX 515 276 8329 TIMMINS KROLL JACOBSEN 0 005/006

FOR INSTRUCTIONS SEE BACK OF FORM - SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev . 07/03)
MONETARY
EXPENDITURES

STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, UST 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)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MWDDfYR) AND PAC
CHECK
NUMBER
ID# f
ZT 5 r-oR T#'4a-

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $ a+

TOTAL (if last page of this schedule)

Fs,<; W

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 personslentiges 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 person/entity on behalf of the candidate's committee. (Refer to
Schedule G Instructions and Iowa Code eaA.402(3)(I) .)

(for Schedule B)