FOR INSTRUCTIONS, SEE BACK OF FORM

DISCLOSURE SUMMARY PAGE

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

CC= -~- --r6 cc . 11 - -A~ct- . AgQ7~~
IMPORTANT : Indicate type of committee you are reporting for. 01

( 1 )StatewidefLegislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate

( PAC ( 6 )Ballot Iss e/ ncNse Committee (7 )County/City Central Committee
( ) u Slate ofjCandid1at s

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

(n~ft
REPORT
t AM FILING A " d FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR.
(report date) Indicate one Q

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

t4-t . a 1
County & Local Committees, enter County in
[J 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 Notice of Dissolution is filed.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting 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 reporting period,
or must be zero if this is first report riled.) ............................................... .. .................... . . .....$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A)..................................................
Schedule F: Loans Received total (Attach Schedule F) .......................................................
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ............ ...................... 'ZP--
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL ......$
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ...........................................................
Schedule F: Loan Repayments total (Attach Schedule F) ........... .............................. ..........

CASH ON HAND at the end of this reporting period (if final report, balance must
e
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) ............................... ... .. ... ........... ....$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
 For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Rev, 06/97) 1 RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same s on Statement of Organization) AMENDING FORM

STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAI ACTION COMMITTEE). LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST 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 -4 IF FOR
IRCCCIVCD Of applicable) TO CANDIDATE' RECEIVED FUND .
(MMIDDIYR) AND PAC CHECK (Ifapplicable) RAISER
NUMBER

0 N t 6
CK#
~ , -1
1
f ~ _
ID#

-CK#
ag
~, h LLIS-~ --!St5-0-
ID#
CK#

ID#

CIA#

CK#

CK#

ID#

CK#
ID#
CK#
ID#
CK#

ID#
CK#
SUB-TOTAL

TOTAL (lflastpage ofthis schedule)

' Disclosure law requires candidate committees to disclose the relationship of any relative making a rnntributlon to the
committee. ReladonsNp must be shown to the thud degree of consafVuinfy (blood relatives) and affinity (relatives by of
Page --(f-or
marriage) (See Page 2 of forms peckeL) . If surname of contributor Is the same as candidate . but there Is no Schedule A)
familial relationship, enler'not applicable' in the relationship column.
 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 09/97) EXPENDITURES
STATE PAC COMMITTEES: 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)

(1~
J 10
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER

I a. . CK# ra t

ID#
~5 P
Mo IN HS
V ja(, C K# l1
`o~~ '1 N\O tN _ 3
ID#
Co 6-0

ID#

CK# '

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $ .(gyp

TOTAL (!f 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 persons/entities providing consulting, advertising, fund-raising, po", 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 persoNentity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
FOR INSTRUCTIONS, SEE BACK OF FORM
SCHEDULE
THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY H
(Rev. 07/03) I CAMPAIGN
PROPERTY

COMMITTEE NAME (Must be same as on Statement of Organization, Reset Form ATTACH SCHEDULE H TO
EACH REPORT, MAKING
CHANGES AS REQUIRED.

Q CHECK THIS BOX IF

PART 1- ONGOING INVENTORY OF CAMPAIGN PROPERTY PART II - SALES OR TRANSFERS OF CAMPAIGN PROPERTY ** AMENDING FORM

Date Purchased
(Schedule B) Purchase Current
or Date Received Description of Property Price or Est. Value at Fair Date Name and Address of Purchaser/Donee Description of Property Sold? Sale Value of
(Schedule E) Value When Market This (MWDDNR) Y/N Price Donation
MM/DDNR Acquired* Report

7 ~,

TOTAL VALUE CAMPAIGN PROPERTY THIS REPORT PROPERTY SALES & TRANSFERS TOTAL TOTALS $ $
(TRANSFER TO SUMMARY PAGE) $ (TRANSFER TO SUMMARY PAGE) $
" If estimated, show est beside figure . (Attach Additional Schedules if Needed) Page ~_ _ of ---- Pages
(For Schedule H)