I

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAPE DR-2 DISCLOSURE
(Rev. 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of O nizatio~ EP 1 7 2004
For Office Use OnIV
Comm. #
IMPORTANT: indicate by ff type of oommittee you are reporting for. ." , ,.,. .. ,. , Logged In
( 1 )StatawId@RegIsIatWJudge Standing forRetention Candidate ( 2 'P1f tats Party
(4 )County Central Committee (6 )County Candidate ( s )Citycandidate ( 7 )School Board or Other
Scanned
Political Subdivision Candidate (a )County PAC (9 )City PAC (10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue _ . Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name Political Party (f applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (ifSenate or House) penalties .

,I-/ s y (, -1_ yzG -f

SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A _12Ne- '7" 14 -e, REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by #

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

kChedt If this is final (termination) report and attach Notice of Dissolution Form DRS. County & Local Committees, enter County in
which Elecdon is held
(You must continue to file reports until a DR-3 is filed.)
0.11l .4S-ha i- d._'s were'

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.) .............................. .... S
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Dv
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in4dnd below) .......... .
r-,66,0

Schedule F: Loans Recelved total (Attach Schedule F) ........................... ... ... ...................... C9

Schedule H: Total Sales of Campaign Property (Attach Schedule H) ...................... ... ......... O

(Schedule H applies to Candidates' Committees Onlyl

SUB-TOTAL . ... .$

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

40
Schedule B. Expenditures total (Attach Schedule B) ("also see debts and loans below) .... A#
=~Z' ~ I

Schedule F: Loan Repayments total (Attach Schedule F) ............. ......... .......... .................... D
CASH ON HAND at the end of this reporting period (f 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 d

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?) ©YES ONO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) S

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NUMBER .
DISCLOSURE .
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for .

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 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev. 07/03) I 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 & 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 (d applicable) (Disbursemerd) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
IN
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SUB-TOTAL / $
TOTAL (iflast page of this schedule) $ 570
V -VV

THIS BOX APPLIES TO CANDIOATEW 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/entlfies 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 68A.402(3)(1) .)

(for Schedule B)

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