01/19/2005 06 :05 FAX 3192326845 Black Hawk Union Council 002

FOR INSTRUCTIONS, SEE Et&4CK OF FORM

DISCLOSURE SUMMARY PAGE
COMMITTEE NAME (Must be soma as on Statement of Organization)

CWA --- Council of the State ofIowa -- COPE Fund

IMPORTANT: Indicate by 0 type of aornrnife you are reporting for.
(1 )Statewide/Logistative/Judge Standing for Retention Candidam (2 )State PAC ( 9 )State Party
(4 )County Central CornmRtae ($ )County Candidate (6 )City Candidate (7 )School Board or Other
Portical Subdivision Candidate (8 )CQvgkPAC (S )City PAC (10 )School Board or Other Political
Subdivision PAC (11 ) Local Ballot

Late reports are subject to

possible civil and criminal
penalties.

TELEPHONE

January 19
I AM FILING A
D
REPORT FOR (1) ELECTION /(2)NON4ELECTION YEAR .
(report data) Indicate by 0

Local Committees, enter Date of Election

OCHECK IF AMENDMENT TO REPORT DATED

Check if this is final (termination) report and attach Notioa of Dissolution Form DR-3- County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is tied .) which Election is held

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.) ....................... ... ........$ 6.00

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A: Cash Contributions total (Attach Schedule A) (`also see in-ldnd below) . .. . .... .. 0
Schedule F: Loans Received total (Attach Schedule F) ............... ..... ...... .............................
Schedule H: Total Sales of Campaign Property (Attach Schedule H) .. ........ ........................
ISchadule H applies to Candidates' Commlltees Only)
SUBTOTAL .....$ 6 .00
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) ..._ 0
Schedule F: Loan Repayments total (Attach Schedule F) .. .. ...................... ..........................
CASH ON HAND at the and of this reporting period (iffinal report balance must
be zero) (Mach DR-3) .. ........... ... .. .................._ .....__._ ._ ._._ ._ .___ ......._ ...__. ...... ................____...._ ._.S 6.00

"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 (3:Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $