DISCLOSURE SUMMARY PAGE

IMPORTANT: Indicate type or committee you an reporting toe.

t i )Staiewboe&egatatnre Candidate ( 2 )Staiewooe PAC % 3 )State Party (4 )Counry/Locat Candcate

( S )County PAC ( 6 )Balbt IssueJFranchise Commmee ; 7 KamtytCdy Central Corntrtinee
( t3 )Suppon State of Canddates

SIGNATURE OF TREASURER (or person filing this report)

Routine Penalties Due For Late Fled Reports Range from $20 to 5800

SEE INSTRUCT IONS ON BACK AND COMPLETE THE FOLLOWING SENT

LECTION /(2)NON-ELECTION YEAR .

(report date) Indicate one

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

County & Local Gomm'raees, enter County in

CD Check if ,his is final (termination) report and attach Nol;:VWtTEsoution Form DR-3. wttidt Section is held
(You must continue to file reports until a Notice of Dissolution is filed.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reposing period . (This is the total
of all monies held by the committee. This amount MUST be the
same as the cash on hand at the end of the last reportyng period.
or must be zero H this is first report riled.) .._........................................................................S bT 2,
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Sc heduie A) ............................... .................. 14 .SSn , o O
Schedule F: Loans Received total (Arach Schedule F) .............................................---"-----"
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ..................................
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL .....S 44b, L2,
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule 8: Expenditures total (Attach Schedule B) ...........................................................
Schedule F : Loan Repayments total (A;,ach Schedule F) . . .. . .. . . .. . .. . . . .. . .. . .. .. .. .. .. . . . . . . . .. . . .. . .. .

CASH ON HAND at the end of this reporting period (if final report. balance must
be iero) (Attach DR-3) ......................._........._................_............ ..........._...................... ......S-
T

UNPAID BILLS (From Schedule D Attach Schedule D) ..........._ ....................-..--.- .--...--- "-.".--"" -."--- ".S
IN KIND CONTRIBUTIONS (From Schedule '_ Attach Schedule E) ................................................. 5

OUTSTANDING LOANS ;From Schedule a= - Arach Schedule F) ..................................................... 5

CANDIDATE COMMITTEES ONLY :
YES NO
CONSULTANT BREAKDOWN (Schedule G Allached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) S
 t1 MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. D&T7) I RECEIPTS
(Inclvdng canddele's personal ham)
CHECK THIS BOX IF
COMMrrTEE NAME (Must be same as on Statement o(Orgaraizallon) AMENDING FORM

`e Tar;e -I(- G ,' ~t( e iz -

STATE CANDIDATES NOTE: IF A CONTRIBUTION 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 BOAFUa.

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

PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP J IF F

(if applicable) TO CANDIDATE' FUN
AND PAC CHECK (if applicable) RATS
NUMBER INCO

t
-z A (3 "-:r To?a
t b o3 -2 2~d S fi , * S IA17te 2d 2
IQs 17e,~ tylc tAe< - .A

ao
t-~eines, ,TA 56J1o~

l~c, 4 rZ,p~ u L~ Cl t

SUB-TOTAL

TOTAL (it 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 retal)ves) and affinity (relatives by i of _1
na Page
marriage) (See Page 2 of forms packet .) . 11 surname of contributor is the same as candidate . but there is (tot Schedule A)
Iarnilial relationship. enler'not applicable' in the relationship column .
 B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT
(Rev .09197) EXPENDITURES
STATZ PAC COMMITT11 " : NOTE FDA CONTRIBUTIONS MADE T0 STATEWIDE CA LEGISLATIVE
CANDIDATES. LIST THE CANDIDATE IDENTIFICATION NUMBER IN TFE DESIGNATED COLUMN AND THE Q CHECK THIS BOX IF
PAC CHECX NUMBER FDA EACH EXPENDITURE A UST OF 1D NUMBERS IS AVAR"ABLE FROM THE IOWA AMENDING FORM
ETHICS d CAMPAIGN DISCLOSURE BOARD.

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

CANDIDATE NAME AND ADDRESS TO NROM PURPOSE

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION)
EXPENDED rig appkable) asbursernenq WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
IDS
10_26_a1
_ CK# 1 z
a b
ID#

CKa

ID8°

CKN

ID

CK91

IDS

CK9

IDS

CKN

IDN

CKN

IDS

CKII

SUBTOTAL S

TOTAL (It last page of this schedule)

THIS BOX APPLIES TO CANDIDATES' C0MUITTEES ONLY:

°urchasos of cortain campaign property costing 5500 or more must also be Inventonad on Schedule H. (Refer to Schedule H instructions .)

E :pendilures to personyet ,tilies providing consulting. advertising. fund-raising . pofTrn% managing. agenl=Ing services must also be detail Itemized on
to
Schedule G by the amount . purpose . and date of each type of ezpend-`we made brta+e persontonlity, on behad of the candidaIe "s comrtttilee . (Refer
Schedule G instructions and lowa Code 56 .60111)

Page ___-4-- ol _ 1 -

(for Schedule B)
 E IN KIND
(Rev. 0697 CONTRIBUTIONS

Q CHECK THIS BOX IF

AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FOR

RECEIVED
(MM/DD/YR) I NAME AND ADDRESS
OF CONTRIBUTOR
76 CANDIDATE
' (rf )
OF IN KIND
CONTRIBUTION
FAIR MARKET
VALUE
FUND-RAISER
CONTRIBUTION
S

1, ~so
- I1

SUB-TOTAL

TOTAL (lf last S, ; O

Z O
page of this
schedule) v
55

Disclosure law recuires candidates to disrjose the relatiornshin of anvrotz`ve rnakina an in lord contribution to the Page of
ommines . Reiationship must be shown to the third degree of corisangui-y (blood relatives) and atfiniiy (relatives (for Schedule E)
y marriage) . (See Page 2 of tomes packet) If sun," of contributor is,-4 sarne as =60-ale. but there is no
..ulial relationship . enter 'not applicable' in the relationship column.
i-