Disclosure Summary Page: For Instructions, See Back of Form"

File with :
Iowa Ethics and Campaign

Disclosure Board
510 E. 12`h , Ste. 1 A
Des Moines, Iowa 50319 FOR INSTRUCTIONS, SEE BACK OF FORM"
Fax: 515-281-4073
DISCLOSURE SUMMARY PAGE
COMMITTEE NAME (Must be same as on Statement of Organization)
FORM

IMPORTANT: Indicate by # type of committee you are reporting for :
co" ml -~ DR-2
(Rev. 12/2005)
DISCLOSURE
REPORT
(1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate (7 )School Board or Other For Office Use Only
Political Subdivision Candidate ( 8 )County PAC (9 )City PAC ( 10 )School Board or Other Political
Suhdiviainn PAC (11)I nral Rallnt Iccup Comm . #
t.ANUIUA I t (.UMMI I I ttb UN Y :
Logged In
Candidate Name Political Party (if applicable)
Scanned
Computer
Office Sought District (if Senate or House)
Audited
Late reports are subject to possible civil and criminal penalties . Pursuant to Iowa Code section 68B.32A(7) the candidate, for a candidate's committee,
and the chairperson, for any other type of committee, is the individual responsible for filing timely and accurate reports .
- 7 - /0-a?
SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED
I AM FILING A rl44'/ REPORT FOR (1) ELECTION /(2) ELECTION YEAR .

(report date) Indicate by #
0 CHECK F AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

gL Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . i1'fa _ ,26o-
t &
(You must continue to file reports until a DR-3 is filed .) County & Local Committees, enter County in
whi h 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 C
of the last reporting period or must be zero if this is first report filed .) $ .- J
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) >i 7S '
Schedule F : Loans Received total (Attach Schedule F) 0
Schedule H: Total Sales of Campaign Property (Attach Schedule H)
(Schedule H aoolies to Candidates' Committees Onlyi!
SUB-TOTAL .3-K .2 $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD ~,
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below) 3J 7V
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) $ I)
""`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) $
CONSULTANT BREAKDONN'i (Schedule G Attached?) YES NO
CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .

For Instructions, See Back of Form

I Reset Form ` SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
U CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
P 17i/1 0 Co mI
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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
Oc)
1D# Go .,,~rnocl~ ~S 3Sv ( "t'Y3d
CK# 7s/3 5-,'--v c,-5 /a-?nlS oii , $ lam
©,b A4A4 ti-f PM &`. -fSrY,L
ID#
Po Lz -~
CK# q io ) ~,2g lv 3 CI l y
~71~e~ ~~
I°#
Oki ~1~ . r 1 ZeG'f L
CK#
I D#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
1D#
CK#
SUB-TOTAL $ l
TOTAL (if last page of this schedule)

$ s7~
* 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 IRe

r F01M I SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07103) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE fl 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 on Statement of Organization)
_tfpt. Cdjt(
CANDIDATE
,
rv j, C o ,41
NAME AND ADDRESS TO WHOM
Pkt .
PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
2 1D#
C? O
CK#
-06 4~ $
CK#
!~ CK#
ID# (f
413
CK#
CK#
ID#
~( ~y yCrt Q
C 7 CK#
1D#
CK#
1D#
CK#
SUB TOTAL
$ !4w "t
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 person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .6(3)(i) .)
Page D_ of z
(for Schedule B)

Disclosure Summary Page: For Instructions, See Back of Form"

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Iowa Ethics and Campaign

I AM FILING A rl44'/ REPORT FOR (1) ELECTION /(2) ELECTION YEAR .

STATEMENT OF CASH ON HAND

""`UNPAID BILLS (From Schedule D - Attach Schedule D) $

For Instructions, See Back of Form

TOTAL (if last page of this schedule)

FOR INSTRUCTIONS, SEE BACK OF FORM IRe

COMMITTEE NAME (Must be same as on Statement of Organization)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

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