CT-18-2004 09 :16 FROM : TO :15152813701 P .

1/4

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 0712003) REPORT

For Office Uge Only

S)' ."'
IMPORTANT: Indlcato typo of committeo you are reporting for: Comm. # _ - -
LoUr)erf In~~_ l __
( t )SIatewidelLaglslative Candidate ( 2 )
( 5 )County PAC ( G )Ballot Issue/Franch SCarmcd
( 8 )Sup port Slaw or candidates Computer
CANDIDATE COMMITTEES ONL Audilptt

TELEPHONE DATE SIGNED

Late filed reports are subject to possible civil and criminal penalties .

4Z 14 M~J
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

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

(r ort date)
Indicate one W
Loral Committees, Pnter Date of Election
OCHECK IF AMENDMENT TO REPORT DATED

County ,% Loral Committees, enter Countyin

g 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

-1--
by the committee . This amount MUST be the same as the cash on hand at the and
of the last reporting period, or must bo zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 4
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) . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedulo H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -----------------
_(Schedule H applies to Candidates' Committees One
SUB-TOTAL . . . .4$
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
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) . . . ._ . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .__ . . . . . . . . . . . . $ 3~-t ~- 13
~NJT, _
**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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ -_-_~ b, WIF
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES L.
.-_-.-.4NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H-Attach Schedule H)
OCT-18-2004 09 :16 FROM : TO :15152813701 P . 2/4

For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN

A MONETARY
(RDv .07/03) RECEIPTS
(Imludirig candldatc's pclsonal fun(is)
Lo CHECK THIS BOX IF
COMMITTEE NAME (Mimttko saas as on Statement of Organization) AMENDING FORM

STATE CANDIDATES NOTE : IF n CONTRIRU'fIUN IS RECEIVED FROM ASIA lE Pnc (1-'UI-1I IGnL AC'l ION CUMMI'I'fL(-);. 615'r THE PAC: IDENTIFICATION
NUMBER AND THE PAr CHCr:K NuMLIrr: IN THC bF_SIGNATEU COLUMN . A LIST OF ID NuMSt_ks Is nVnILnl31_E FROM 'I HE IOWA rTnICS AND CAMPAIGN
UISct_oSURE BOARD

CAUTION; Seeainn 688 .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for snllc:illnU eurtlribuliatt; or
for any comrrterciitl purpose by any person other than statutory political comrnitlHrrs .

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 (irapplicat)le) RAISER
NUMBER INCOME
ID A ( N /~C_ ,
,0o'a7 ct, .7

AO

ID# 19
CK#
-tA ,
IDS

al. 1t ~` CK

ID#

CK#
_ 1

ID# -_r_~Ytf~ sft IoDn I `

1 CK# "IY11v~~V

Ifs#
1) ssx .,--PO~
0
'S

CK1$

J
-4 V7 SoA mcA
ID# C \~ Y,,1

` ~L1 CK#s-,

ID#
obq P -P\L- -
~I
~.~ .

f Cwt'
C,K#
a~ C z

1A . S-o35'~ . ,vo
ID#

I f ,o~a.
P1:w
CK# -7 t"4
.WM , 4W 1~-
SUB-TOTAL3
$, -

TOTAL (if last page of this schedule)

" Disclnsuru law ruuultW: candhlalc cofnnllttw;s to disclose the relAllpnshlp of any rolallve making a contribution to the
committee RuIcUi<wship must bu shown to lho third dcgrr.o of cnnsangulnfly (Wood relatives) and affinity, (relatives by
.
marriage) . If surname of contributor Is the same as candidate, but there is no Pa47e --A_ of
familial relationship, enter "opt applipahle" in the relationship column. (for Schedule A)
OCT-18-2004 09 :16 FROM : TO :15152813701 P .3/4

For Instructions . See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Ruv .07/03) RECEIPTS
(Including candidalo's purrunal rurids)
Q CHECK THIS BOX IF
COMMITTEE NAME (Must be serve as on Statement of Organization) AMENDING FORM

C- .~-,)~ ~` ~) 15 ?.K Vw
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
DI :CLOSURE BOARn

CAUTION: Section 68B.32A(8), Iowa Code, prohibits the use of inforn-lation copied from reports and statements for soliciting contributions or
for any colnmorcial purpose by any person other than statutory political committoes.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD(YR) AND PAC CHECK (if applicable) RAISER
UMBER INCOME
ID*
b010-I
gSzS~®~. .`~0
CK#
Srv3a 1~0 .r~o

CK#

Ll
ID# W&qk~, Va tt
I

CKO

4(Il(* C K# kl
\4
r~ll5 ~. Sod?~ ~ ~~4,0

CK# ~~

ID#
43~ - 1 .. S
5 ;~. 3po
~CiJ rOQ 1-7
GK#
A
IDII

CK# Z~-
'-r e pc.,
ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

$3,50 tad

DISclpctlrc law r0gUll'1)S rlndldaw Colmnlttrns to diack-ae tho inigtionshlp of alit' Iolutivu snaking a contribution to the
curnmiltoo . RUIAonsllip sr1L15t bo Otown to Iho thlid dogIco of consangulnity (blood relatives) and affinity (reladves by
. If surnalno of contributor is the same as candidate, but there Is no
marriage) Page
familial ratationghip, enter "not applicabla in the relationship column . (for Schedule A)
OCT-18-2004 09 :16 FROM : TO :15152813701 P . 4/4

FOR INSTRUCTIONS, SEE SACK OF FORM ~'" ;)iSCHEDULE

1

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 07/03) EXPENDITURES

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

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

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

t
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Dlsbursoment) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
DA
I

(-2* CK# $ jq_j~

~~ CK#
10 v~- 050 
ID# Mt~
\ ti~cs~
CKA
I 25'
ID#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $ CC
TOTAL (if last page of this schedule) $ c(\

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, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, end date of each type of expenditure made by the person/entity on behalf of the candidate's commlllee. (Refer to
Schedule G instructions and Iowa Code GBA.402(3)(i) .)

Page ___L__ of -_

(for Schedule B)