FORINSTRUCTIONS, SEEBACKOFFORM

DISCLOSURESUMMARYPAGE
COMMITTEENAME( t i f u

be sa

s o

St at e

t of Organi zat i on)
.
baeb4 e

r

C. r
V
IMPORTANT: Indi cat e t ype of commi t t ee you are report i ng f or:
( t

at ewi de/Legi slat i ve Candi dat e ( 2 )St at ewi de PAC( 3 )St at e Part y ( 4 )Cou nt y/Local Candi dat e
( 5 )Cou nt y PAC ( 6 )Ballot Issu e/Franchi se Commi t t ee ( 7 )Cou nt y/Ci t y Cent ral Commi t t ee
( 6 )Su pport y5 lajeof Candi dat es
SIGNA UR

TREASURER( or person f i li ng t hi s report )
I AMFILING A
( report dat e)
FICHECKIFAMENDMENTTOREPORTDATED
SUBTRACTTOTALMONEYSPENTTHIS PERIOD
_. s3-zE7 7
TELEPHONE
Rou t i ne Penalt i es Du e For Lat e Fi led Report s Rangef rom $20 t
SEE INSTRUCTIONSON BACKANDCOMPLETETHEFOLLOWINGSENTENCE:
REPORTFORAN/A( 1) ELECTION /( 2)N
)
( ] Checki f t hi s i s f i nal ( t ermi nat i on) report and at t ach Not i ce of Di ssolu t i on Form DR-3.
( You mu st cont i nu e t o f i le report s u nt i l a Not i ce of Di ssolu t i on i s f i led . )
STATEMENTOFCASHONHAND
Indi cat e one
CASHONHANDat t he begi nni ng of t he report i ng peri od . ( Thi s i s t he t ot al
of all moni es held by t he commi t t ee . Thi s amou nt MUSTbe t he
same as t he cash on hand at t he end of t he last report i ng peri od,
or mu st be zero i f t hi s i s f i rst report f i led . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
ADDTOTALMONEYTAKENIN THISPERIOD
Schedu le A: Cash Cont ri bu t i ons t ot al ( At t ach Schedu le A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedu le F: Loans Recei ved t ot al ( At t ach Schedu le F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedu le H: Tot al Sales of Campai gn Propert y ( At t ach Schedu le H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedu le Happli es t o Candi d at es' Commi t t ees Only)
SUB-TOTAL. . . . . . S
Schedu le B: Expendi t u res t ot al ( At t ach Schedu le B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedu le F: Loan Repayment s t ot al ( At t ach Schedu le F) . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
UNPAID BILLS( From Schedu le D - At t ach Schedu le D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
IN KIND CONTRIBUTIONS ( From Schedu le E - At t ach Schedu le E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
OUTSTANDING LOANS( From Schedu le F - At t ach Schedu le F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
CANDIDATECOMMITTEES ONLY:
CONSULTANT BREAKDOWN( Schedu le GAt t ached?)
VALUEOFCAMPAIGNPROPERTY( From Schedu le H- At t ach Schedu le H)

$
FORM
DR-2
( Rev . 01/98)
DISCLOSURE
REPORT
For Of f i ce Use Only
Comm . a _
Index
Au di t ed
Compu t er
A
s C~
NOV

4 2004
QMId
2
&;
IONYEAR.
Local Commi t t ees, ent er Dat e of Elect i on
/UOJ

Z4 zoo
Cou nt y &Local Commi t t ees, ent er Cou nt y i n
whi ch Elect i on i s held
7 -7 . SS
/v, 1~/ 3. 6 ~&
CASHONHANDat t he end of t hi s report i ng peri od ( i f f i nal report , balance mu st
be zero) ( At t ach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
6 000, ay
YES NO
Eor1ns·r.o·1ons, SeeFaokor Eorr
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ForInstructions,SeeBackof Form
CONTRIBUTIONS- - MONEYTAKENIN
(Including candidate'spersonal funds)
COMMITTEENAME(Mustbesameas on Statgnjentof Organization)
STATECANDIDATES NOTE: IFACONTRIBUTIONIS RECEIVED FROMASTATEPAC(POLITICAL ACTIONCOMMITTEE), LISTTHEPACIDENTIFICATION
NUMBERANDTHEPACCHECKNUMBERINTHEDESIGNATED COLUMN. ALISTOFID NUMBERSIS AVAILABLEFROMTHEIOWAETHICSANDCAMPAIGN
DISCLOSUREBOARD.
CAUTION: Section 68B. 32A(6), IowaCode,prohibits theuseof information copied fromreports and statements forsoliciting contributions or
foranycommercial purposebyanyperson otherthan statutorypolitical committees.
SUB- TOTAL
TOTAL (iflastpageof thisschedule)
' Disclosurelawrequires candidatecommittees to disclosetherelationship of anyrelative making acontribution tothe
committee. Relationship mustbeshown tothethird degreeof consanguinity (blood relatives) and affinity (relatives by
marriage) (SeePage2 offormspacket. ) . If surnameof contributoris thesameas candidate,butthereis no

Page

of _
familial relationship, enter"not applicable" in therelationship column.

(forScheduleA)
SCHEDULE
A MONETARY
(Rev. 06/97) RECEIPTS
CHECKTHISBOXIF
AMENDING FORM
DATE PACID NUMBER NAMEANDADDRESSOFCONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TOCANDIDATE' RECEIVED FUND-
(MM/DD/YR) ANDPACCHECK (ifapplicable) RAISER
NUMBER INCOME
I D# `
/09
CK#
=3 ,f '3 5Fo. . wr~t e P
~OLJv
S, l stto~
ID#
CK#
lots-
00
CA A 'S1
I C'
( oL~
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CK#
C-XL7t G 5v,00
y
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6~- St(d~
ID# t '
CK#
I D#
CK#
I D#
CK#
I D#
CK#
ID#
CK#
I D#
CK#
I D#
CK#
THIS BOXAPPLIESTOCANDIDATES'COMMITTEESONLY:
Purchasesof certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule Hinstructions. )
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule Gby the amount, purpose, and date of each type of expenditure madeby the person/entity on behalf of the candidate's committee. (Refer to
Schedule Ginstructions and Iowa Code 56. 6(3 ) (1 ) . )
(for Schedule B)
FOR INSTRUCTIONS, SEEBACKOFFORM
Reset Form SCHEDULE
EXPENDITURES
B
MONETARY
-- MONEYSPENTFROMCOMMITTEEACCOUNT
(Rev . 09/97) EXPENDITURES
STATEPACCOMMITTEES: NOTE: FORCONTRIBUTIONSMADETOSTATEWIDEOR LEGISLATIVE
CANDIDATES, LISTTHECANDIDATEIDENTIFICATIONNUMBER INTHEDESIGNATEDCOLUMNANDTHE 0 CHECKTHISBOXIF
PACCHECKNUMBER FOR EACHEXPENDITURE. ALISTOFIDNUMBERSIS AVAILABLEFROMTHEIOWA AMENDINGFORM
ETHICS&CAMPAIGNDISCLOSUREBOARD.
COMMITTEENAME(Must be same ason Statement ofOrganization)
,/CANDIDATE NAMEANDADDRESSTOWHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBETRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WASMADE
(MM/DD/YR) ANDPAC
CHECK
NUMBER
ID# 7-7. to 3 ,7sb,wa,+^ Zz,nr b,; :
E"-,e I - I , O
CK# j p
LI'
LJ
$
CK#
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S,'u , 3 u='^
1 7
uv C-b ,
ID#
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,
ID#
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. 41
2 -
CK# 1 0
-77
I D#
-} -
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~Lam .
~~1 _LIS
CK#
IL) 7
1 0v~ r .
D-. ~. tt a L ~- A 503 1 '7
ID# '
CK#
SUB-TOTAL . . $rV~~3
. 66
TOTAL(iflast page of this schedule)
FORINSTRUCTIONS,SEEBACKOFFORM
COMMITTEENAME(Mustbe same as on Statem

t of Organization)
1 1 1 . e
SCHEDULE
E

IN KIND
(Rev. 061 97)

CONTRIBUTIONS
CHECKTHIS BOXIF
AMENDING FORM
TOTAL(if last
page of this
schedule)
*Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the

Page _-(-of
committee. Relationship must be shown to thethird degree of consanguinity (blood relatives) and affinity (relatives

(

r Schedu e E)
by marriage).

(See Page 2 of forms packet. ) If surname of contributor is thesame as candidate, but there is no
familial relationship,enter "not applicable" in the relationship column.
DATE
RECEIVED
(MMIDDIYR)
NAMEANDADDRESS
OFCONTRIBUTOR
RELATIONSHIP
TOCANDIDATE
* (if applicable)
DESCRIPTION
OFIN KIND
CONTRIBUTION
ESTIMATED
FAIRMARKET
VALUE
~ IFFOR
FUND-RAISER
CONTRIBUTION
/
/O~ , 1
s Auc; re 5o2w"i
3COG, tip F
< i C-4-4, iOiy CiL
1 r3
Z -( E. ettl-
zs
ILCo-7fKJ //q
502o
30c~1 0, c)U
F7
F7
F7
71
F7
F7
F7
F7
0
FORINSTRUCTIONS, SEEBACKOFFORM
THISFORMIS USEDBYCANDIDATES'COMMITTEESONLY
COMMITTEENAME(Mustbesameason Statementof Organization)
PART II- ITEMIZEDBREAKDOWNOFUNREIMBURSEDEXPENSES PAIDBYCONSULTANT
TOOTHERS IN PERFORMINGSERVICES OFCONTRACT(These expenses should NOTbe
PARTI - NAMEANDADDRESSOFCONSULTANT

reported on Schedule B,as they aredirect paymentfrom theconsultant. )
Nameof Consultant
J_acvh
Mailing Address
'0
city
ESTIMATESOFPERFORMANCE
State

Zip Code
TOTALANTICIPATED
COMPENSATION FOR
CONTRACTPERIOD(MMIDDIYR)

PERFORMANCE
Page of
(for ScheduleG)
SCHEDULE
G BREAKDOWN
OFMONETARY
(Rev. 02/96) EXPENDITURES
BYCONSULTANT
QCHECKTHISBOXIF
AMENDINGFORM
r SL' ,U U- ~CJ
- 4 e 12
'° e_ o e
DATE
EXPENDED
(MMIDD/YR
NAMEANDADDRESSTOWHOMEXPENDITURE
Disbursement) WASMADE PURPOSE
AMOUNT
EXPENDED
s
SUB- TOTAL
TOTAL(If last page ofthis schedule) $

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