FOR INSTRUCTIONS, SEE BACK OF FORM FORM

React F=m
DISCLOSURE SUMMARY PAGE DR-Z DISCLOSURE

COMIYMTTEE NAME (Wst be same as on Statement of Orgeni¢etion) (Rev_ 0712004) REPORT

S~~ , I
HIPORTAMd Indrate-by # type of corrrvillee youwe reporngfor:: --
(1)Stalewiden egislstive/Judge StandiM for Retention Candidala (2 )State PAC (3)State Party
(4)Courky Certraai Corrrr~ILee (S )Comity Candidate (6 )City Candidate (7 )School Board or Other
Political Subdivision Candkide (S )County PAC (S)CityPAC (1D)School Board or Outer Po§6cal
Subdivision PAC (11 ) Local Ballot Issue
CANDIDATE COMMITTEES ONLY:
Candidate Na P i cal P jif applicable)
vlcs 4 d CV4 i 04,r,; Late reports are subject to
possible civil and criminal
District (if Senate or House) penalties .

CeTo&v' Z6. zaL4

IG T F PEROO11 FILE PO TELEPHONE DATE SIGNED

l
I AM FILING a 0~: X' 706 ORT FOR (1) ELE O~Ic LECTION YEAR.
(report date) tridwate by 0

LICI4ECK IF AMENDMENT TO REPORT DATED I K04 to"ACormiftees, enter Date of Election

Check if this is final (termination) report and attach of Dial F&m DR=3. County & Local Convnittees, enter County in
which; Election is held
(You must continue to file reports until a DR-3 is fled.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the begiming of the reporting period . (Total of all fi ids 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 fast 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) . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .
1Schedule H aplles to Cat~l dates' Committees OnIA
SUBTOTAL .. ... $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) (`*also see debts and bans below). . . .
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ._ . . .
CASH ON HAND at the end of this reporting period (it 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
For Instructions, See Back of Form Keset }'ortn SCHEDULE

CONTRIBUTIONS - MONEY TAKEN IN

A MONETARY
(Rev . 07103) RECEIPTS
(Including candidates personal funds)
0 CHECK THIS BOX IF
COMMITTEE NAME (Mlrrst be safnels on Stateynent of Orgenizekon) AMENDING FORM

STATE CANDIDAIMS 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 BOARD.

CAUTION : Section 688 .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
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER
_ INCOME

z O
ID# -L'!7-
(pi 77777
^~-'7 getATZ ;v~ iYiTt`
l 3 r'ic~ N, w r ' l 1'f ST: s7~ 1 ~4~

Q
I D# (, 0 5 tf -'* 44rSS ~~2~~ Jt'! I
o

CK# `ZCD ~S! .f~ J

>~p (OCR
..~ ID#
V~ wc c7 S:74 4-Z S ,-7Ar ~, .

CK#
ItI I _b, 0 , .. -
L7 i
.
CK#

ID#

CK#

I D#

CK#

1D#

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 . (fo Schedule A)
 FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE

B MONETARY
EXPENMTURES - MONEY SPENT FROM COMMITTEE ACCOUNT
(Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTK)NS 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 o Statementyof Organization)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDDYR) AND PAC
CHECK
NUMBER
/ol4b4 I D# ' ' 7;,bte--C 41 )
CK# (tat

CK# .s

... 1;J3C..v~ (yyQ~

(S'.1
ID# "

IO ;rB CK#

ID#

CK#

ID#

CK#

1D#

CK#

I D#

CK#

SUB-TOTAL $

TOTAL (if 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, 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 persoNentity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A.402(3)().)

(for Schedule B)