FOR INSTRUCTIONS, SEE BACK OF FORM FORM DISCLOSURE SUMMARY PAGE DR-2 biscLOSURE (GDTESNANIE ste ane on Soprgnta! Crepe) (Rev. 01/2003)|__ REPORT For Office Use |imPORTANT: Ina ittee you are reporting for: [2] type of (1 )StatewicerLagsatve Cancisato (2 )Statewise PAC (3 )State Party (4 \CountyrLocal Candidate [3 Jeaunty PAC 16 JBalo ssuoiFrancnise Commitee ( 7 }CountyGiy Cectal Commitee 8 JSvopor Sua of Candidates CANDIDATE COMMITTEES ONL| (Candidate Name Political Panty Office Sought District (f Senate or House) = —_———— Cotsly SE TehuLO SL3B-2Y 3-193 GRATIS AACR ROT TETRA ~ CER Ewa Late filed reports are subject to possible civil and criminal penalties. SEE NSTRUCTIONS OW BACK. AND COMPLETE THE FOLLOWING SENTENCE: 1AM FILING REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR. (report date) Indicate one [2] DcHECK if AMENDMENT TO REPORT DATED, [Fs coniaes otra eon ‘County & Looal Commies, enter County in neck if this i rmination) report an ltice of Dissolution Form DR: Check this is final (termination) report and attach Notice of Dissolution Form DR-3. | County & Local Comm {You must continue to file reports until a Notice of Dissolution is filed.) ‘STATEMENT OF CASH ON HAND CASH ON HAND atthe beginning ofthe reporting period. (This the total ofall monies held bythe committee ‘This amount MUST be the same asthe cash on hand at the end Gf he lst reporting period, or must be zero th sist report led) s LI87SG ‘ADD TOTAL MONEY TAKEN IN THIS PERIOD Jé 00 ‘Schedule A: Cash Contributions total (Attach Schedule A) (‘also see in-kind below) = ‘Schedule F: Loans Received total (Atach Schedule F), ‘Schedule H: Total Sales of Campaign Propery (Attach Schedule H) chedul SUBTRACT TOTAL MONEY SPENT THIS PERIOD seh 7 F400 Schedule 8: Expenditures total (Attach Schedule B) ("‘also see debts and loans below)... _ 7 7+ @ Schedule F: Loan Repayments ital (Attach Schedule F).. CASH ON HAND at the end of this reporting period (i final report, balance must bbe zero) (Attach DR-2)... . $ 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 G Attached?) Yes No VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) soFor Instructions, See Back of Form ‘SCHEDULE A MONETARY CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 0697) | RECEIPTS (intusing cancidate's personal funds) C1 cheek THis 80x iF i ey aaa aE a ue cad bye yi Habs STATE CANDIDATES NOTE: bf CONTRIBUTION Is RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION NUMBER AND THE PAC CHEGK NUMBER IN THE DESIGNATED COLUMN. A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN SISCLOSURE BOARD. CAUTION: Section 888.32A(6), lowa Code, prohibits the use of information copied from reports and statements for soliting contributions or {for any commercial purpose by any person other than statutory political committees DATE PAG ID NUMBER RECEIVED (applicable) (umbor"R) | AND PAC CHECK NUMBER. 'NANE AND ADDRESS OF CONTRIBUTOR RELATIONSHIP] AMOUNT | T1FFOR TO CANDIDATE: | RECEIVED | FUND- (applicable) | RAISER [income OF 14 a3 | om Jen Yo3 |e oF oki be ck DF coke Toe | cke ibe coke DH Ks TF cK 10# Ke cont ETS + Disclosure law requires candidate committees to dleclose the relationship of any relative making a contribution to the commit. Relatonshp must be shown tothe third degree of cnsanguinty (oid relatives) and afi (eatwes by J ‘mamage) (See Page 2 of fom packet}. f surname of cantibutor i the tame as candidate, but there iso Pose. {famital relationship, enter “not applicable" nthe relationship column. Ter Seheduio AyFOR INSTRUCTIONS, SEE BACK OF FORM SGREDULE ] B oNeTARY | EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT feiieen |orenniees STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE To STATEWOE OR LEOSLATIVE | CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE (CHECK THIS BOX IF PAC CHEEK NOMBCR FOR EACH EXPEROTTURE, ALISTOE IO NUMSERS IS AVALAGLE PROM TN OWA “AMENDING FORM ETHICS & CAMPAIGN DISCLOSURE BOARD. CANDIDATE ID oxy 2/3 [COMMITTEE NAME (iust bo same as on Statement of Organizafion) IME AND ADDRESS TO WHOM (DESCRIBE TRANSACTION) EXPENDED OATE: ID NUMBER. EXPENDED | (ifappiiceble) (Cisbursement) WAS MADE @mw0DrvR) | "AND PAC CHECK NUMBER, PURPOSE AMOUNT, 1DE cKit 10F TOTAL (if last page of this schedule) Z| ‘SUB-TOTAL | S Schedule G instructions and fowa Code 58.6(2)0)), "THIS BOX APPLIES TO CANDIDATES’ COMMITTEES ONLY: Purchases of certain campaign property costing $500 ox more must also be inventoried on Schedule H, (Refer to Schedule H instructions.) Expenditures to persons/entties providing consuting, advertising, fund-asing, poling, managing, organizing services must also be detail temized on Schedule G bythe amount, purpose, and date of each type of expenciture made by the persorventiy on behalf ofthe candidate's commatee. (Ror to Pag a (for Schedule 8)