FOP INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 CISCLOSUR'c

COMMITTEE NAME (Must be some as on Statement of Organization) (Rev . 0712004) REPORT

For Office Use Only

IVeJ J ~~s Comm . &

IMPORTANT indicate by it type of committee you are reporting for irr Logged in ,cKJr
( t ,Statewide/Leorslative1Judge Standing for Retention Candidate (2 )State PAC (3 )State party Scanned
( 4 )County Central Committee ( 5 )County Candidate (8 )City Candidate (7 )School Board or Other
Political Subdivision Candidate (8 )County PAC (3 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PA() (1 11 Local Ballot Issue Audited 9Z
CANDIDATE COMMITTEES ONLY : :
Candlidate Name Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought 0 EC - 3 K04 ` District (If Senate or House) penalties .

v
SIC~IVATURE OF PERSON FILING REPORT TELEPHONE

I AM FILING A F_IN AL_ REPORT FOR ('1 ) ELECTION /(2)NON-ELECTION YEAR

(report date) Indicate by #

Local Cornmttees, enter Date of Election

a3,
7CHECK IF AMENDMENT TO REPORT DATED
%IC.rek :-Dog
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Commit ees, enter County in
which Election is held
(You must continue to file reports until a DR-~, is filed .)

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 sarne as the cash on hand at the end L4 43 , Iq 3 ./
of the last reporting period or must be zero if this is first report filed ) . . . . . . . . . . . . . . . . . . . . . . . . . . . .  . .$ ,1
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 IH . Total Sales of Campaign Property (Attach Schedule H) . . ., . , . . . . . ., . . . . . . . . . . . . .  ,
(Schedule H applies to Candidates' Committees Only)

SUB-TOTAL . . .. . $

gb~IW9 .y3--
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . S

'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?) 71 YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $

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 20'd 7Hlol

FOR INSTRUCTIONS, SEE SACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETA?Y
(Rev, 07!U3) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLnTIVE

CArii)IDATES, LIS'i t)-IG CANDII)r\TE ID_NTIFICATION NUrVIBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
=AC CHECK NUMBER FOR FAChi EXPENDITURE . A LIST OF ID NUMBERS IS AVAiLA6LE FFK0M iHE IOVVA AMENDING FORrv1
E-hiiC$ & CAIdPAIGN DISCLOSURE DOARD

COMMITTEE NAME (Must be sarno as or Statement of Organization)

C CJi Zer\ -~-o r A)ev o

CANOIDATE NAME AND ADDRESS TO WHOM PURPOSE Afv1C)UPJT
DATF ID Nume_R EXPENOITURL (D ESC RI BETRANSACTI0N) EXPENDED
EXPENDED (f applicable) (Disbursement) WAS MADE
(MM!DD[YR) AND PAC
CHECK
NUMBER

PID ' eig S ~1DS .c)U

CKn
("1p~ Ior+- ~ e S~ SD >-01
ID#

-av CK#)7o6 064- Acc oh^ i

CK"
M

I D# ®~-' 3-N-oti
Cor!'~c,~~or
CK# r-fi j 33,E
eqo

I D# a~ Ll - 4 -p y
Cprr-ec~_:or

CK# R,
Pa4
r

ID#
co rr'ecrk o , °~- S
1 C1 ~01-(

CKn IID.W7~
I D#

CK#

ID#

CK#

sue-TOTAL I
S~ y9,43

TOTAL (if last page of this schedule) ~~~, t,f3

$a6

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 Instructiors )

Expenditures to person slentities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedulc G by the amount, purpose, and date of each type of expenditure made by 1he personlentity on behalf of the candidate's cornmittee (Refer tc
LSchedul : G fnstructlons and Iowa Code 55A.402(3)(i),)

__-__ Page )-. af - _)

(fcr Schaduie 15)

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