Disclosure Summary Page DR-2: For Instructions, See Aack of Form Be
Disclosure Summary Page DR-2: For Instructions, See Aack of Form Be
OCT 2 8 :2004J
m (0-~-7
_
3 y .z /L` .- ;-1 7 -U
SIGNATURE O TREASURER (or person 11111 g this report) TELEPHONE DATE SIGNED
Late fled reports are subject to possible civil and criminal penalties .
SEE INSTRUCTIONS N BACK AND COMPLETE THE FOLLOWING SENTENCE:
I AM FILING A 69 F~j~Irr'~ x. 9'.m REPORT FOR AN/A (1) ELECTION l(2)NOWELECTION YEAR.
(report date)
Indicate one L/J
Local Committees, enter Date of Election
[]CHECK IF AMENDMENT TO REPORT DATED
County & Local Cornrrmfes, enter County in
U 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.)
"UNPAID BILLS (From Schedule D - Attach Schedule D) . ..... ... ..... ... ................... ........ ............... ... ...$
`"N 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
- Reset Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN
(Rev. 07/03) I RECEIPTS
(Including candidate's personal funds)
~sCIf
STATE CANDIDATES NOTE_ IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER
INCOME
ID# a- U
ID#
0 46.,, 3 33?
/d//6/0 `f CK#
.5-a o 33
io#
` 0 33
)706- E]
ID#
Ib~lsfoy cK# ~
l7 9
'
rte
l/+-r!C - .5 a b 3a
4 t~ c
l ~~l S~bLl' CK# 609
El
_ a-, .5 a U 1-lv
ID# .
9
I~A /~u-
CK# -7 1 v S- p
301 0 Ya
/0A -. -1 3 1 LEI
ID#
Disclosure law requires candidate committees to disclose the relationship of any relative makirxf 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 - oZ __ of _ K ___
familial relationshiD . enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE
Reset Form
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Rev . 07/03) 1 RECEIPTS
(Including candidate's personal funds)
~SGh d~
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 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 ~' IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
CK#
S~~OGfJ
ID#
El
CK# l o~ S'
9
S-d,UL/ o lg73
1D# /,
CK#
%ij,
ID# ~ l,l Cr t
CK#
.~aOL8 -97 ,5:~7
ID# T
CK# 7 ~^ S
.S-d, 1~ ~ Srr
ID# -
V4 .1
/D CK# Ilrl, Ia
ID#
33
SUB-TOTAL ~
$.i"Oa
TOTAL (iflast page of this schedule)
' Disclosure lawrequires 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 sumame of contributor is the same as candidate, but there is no Page of
familial relationship . enter "not applicable' in the relationship column. (for Schedule A)
For Instructions, See Back of Form SCHEDULE
Reset Form.
A I MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITT NAME (Must be same as on Statement of Organization) AMENDING FORM
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 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
6k L ~,
//
0 CK# 9
- .tea v 33
ID#
%e)/
~-l
vV CK#
ID#
/0111
S~o~b
a yb 9
0/l6/-I
j ~f CK# 13 6 3
~- 5 a D Yb ~ l ~ s`cl
Vob -f
ID#
~bll~~b CK# ~0 41 V
a
ID#
i CK#
6- JD3
ID# 1 za.-
'
~, 6 0 ~l CK# q
l w . .-,. .sa0 kb
ED
ID#
~3 a
ajy~
//&/0 ~` CK#
c.~ ~.. A- sa c ~~
lD# '
CK# .360 - 7
d, 0
ID#
J SUB-TOTAL
' 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
familial relationship . enter "not applicable" in the relationship column. (for Schedule A)-----
For Instructions, See Back of Form SCHEDULE
Form
-Reset, A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(including candidate's personal funds)
CHECK THIS BOX IF
COMMITT NAME (Must be same as on Statement of Organization) AMENDING FORM
~sCh d~ e-
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 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 v IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM1DDlYR) AND PAC CHECK (if applicable) RAISER
77
NUMBER INCOME
.fib ~
- 777
CK# 7~f3a - - us<f~' Sa
5033
$ 0
ID# 0 -
Oq -
7 3,0,;1
ID#
a
//6ld CK#
Sa0ye , L-V 3a
ID#
ED
ID# ~1D-La AtG-r - oc .~,
,~' lJn
~sa
CK#
ID#
, P IV
0//Z/ --`~`- t.~
CK#
ID# q,.
El
1D#
-
ts-Y-
CK#
sa y
CK#
~'`- S-o1 dbl ~ 6 ~~
SUB-TOTAL
' 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
familial relationshiD. enter "not applicable" in the relationship column. (for Schedule A)
For Instructions. See Back of Form SCHEDULE
Reset Form
CONTRIBUTIONS - MONEY TAKEN IN A MONETARY
(Including candidate's personal funds) (Rev. 07/03) I RECEIPTS
~sGh
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 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND
DISCLOSURE BOARC CAMPAIGN
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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER
INCOME
I D#
C
l 1~ "~ i3
CK# x993 S ,~ k- sa U
33 ,/
ID# gJ D
CK#
ID#
a ;167' 8~ 8
~3101 --c
S-dos El
o/ CK# a3 o8
ID#
/K~
El
.L l/,O/
CK# 8-ll 6tl , ~D- 4" G03
S~ '~33
ID# ~a5 s V'..~ PA c.
I~/l~/b Pa a8/~
I 5 a0 "~oY3
ID# ko-~ --
0 ~ CK# / /7
~d
~ S~ dbl
0//7/0 ID#
CK#
CK#
l~ - a
SUB-TOTAL
' Disclosure law requires candidatecommittees 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
familial relationship . enter "not applicable' in the relationship column . v (for Schedule A)
For Instructions . See Back of Form SCHEDULE
Reset Form
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) I RECEIPTS
(Including candidate's personal funds)
Q CHECK THIS BOX IF
COMMI NAME (Must be same as on Statement of Organization) AMENDING FORM
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 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
777 777 7
1/
/D CK# 3a csb -7
~< . oZ
CK#
.o 1s
sa v ~b El
- .~
El
ID#
ID# 6ag
l ~f~//a Ac
S oo~ a o
/~ CK#X3/8 /~e .~k~n~
3 a
°~d
ID#(ooSa ,dam L
3/b y CK#
bvrh 91- ~b363
-0(,,r7
ID#
i D/d3~o y
CK#
ILI
l~/ate
/C ~ CK#
Saa3 7 ~~ 0 LEI
SUB-TOTAL
U
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 sumame of contributor is the same as candidate, but there is no Page -_?of
familial relationship, enter 'not applicable" in the relationship column. (for Schedule A)
For Instructions . See Back of Form
Reset Form,
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITT NAME (Must be same as on Statement of Organization) AMENDING FORM
~4
'00 c1h oN
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 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMlDD/YR) AND PAC CHECK (it applicable) RAISER
NUMBER INCOME
ID# o-wz-. SG _ T
A,l r-.I eS
F, SZ mow; S -a6v
a nTo
161as1
y CK# $~~b`n'
-~ ,~-
0
/3
ID#
121
r i . v e-
ID# (o crv
3 :33 /
o l d40 y C.
30
/ ID# p q U
l 1963
ID#
CK#
CK# E:1
ID#
CK#
SUB-TOTAL
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. (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM . I` "" l I SCHEDULE
-_
CK#
$ SOD
ID#
CK# 7S
ID# --
CK#
ID# -
24
,,° -° cK#
I D#
CK#
1D#
CK#
1D#
CK#
SUB-TOTAL $
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 person/entity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A.6(3)(i) .)
(for Schedule B)
FOR INSTRUCTIONS, SE` BACX QF .FORM SEH©ULE
E
l COMMIll,EE NAME (Must he same "an Statement o OManfmEltxr) (Rev. OBIQ7y1 CONTRIBUTIONS
~tilwVtJ
~r
*DMdOWta law t q*as cwxldes to dedoae ma rd ronftaf ar rwn noM a in wme acntrmuron ato pop ~.~of l
caemdese. mPAMfthip ust be Mwwn to the third doWwof corngdilq (blood ralsliwse) am aft* (noisllws (for Sdraure E)
bY manlsge). (See Page 2 at tip. . paclaeti) If swneme at carAdbutor is the aeme as , art twm is no
tam mimliorsskilp, erasr `not appllrwhW In the ndedbaatrip cohsm.