FOR'NSTRUCT'ONS,SEE 8ACK OF FORM

DISCLOSURE
SUMMARYPAGE
,, u,l/,,f
January1,2010,all statements and repoftsfiledby new commlttees
stateoffice mustbe filed electronicallyand etrectiveJanuary1,2012, all
^0,, tfl}ftt,o
20t0ruil
dnd repoftsfiledby all commifteesforstateotrire mustbe filed , ;";r:,;r:,
May 1, 2010,all statementsand repoftsfor StatepACsand State
Partiesmustbe filed electronically.

MME (Musfbe sameas on

COMMITTEE

by # typ€ of committeeyou are reportlngfor

;"f;Y, I o,...o,,*=
(Rev.1212009)
| REPoRT

Comm.#
CANDIDATECOMMFTEESONLY: LoggedIn
Scanned
Computer
Districl(if Senateor House) Audlted

Latereportsare subjectto posslblecMl and c-rlmlnal

penaltgs.PuFuqnt to lowa Code sectlons688.32AO)and 68A.401(3),the candidate,ior a
candidate'scommiflee,and the chairpereon,for any othertype of commlttee,ls the IndMdualresponsibte'f6r
flfingtlmelyirid accuraterepo]ts.

SIGNATURE
OF PERSONFILINGREPORT TELEPHONE DATESIGNED

IAMFtLtNG
o fi n/ h L FoR(1)ELEcnoN
REpoRr (2)NoN-ELEcnoN
vEAR.
(reportdate) tndicateoV* LIJ
EcueCx IFAMENDMENTTo
REPoRTDATED LocalCommittees,enter Dateof Election

if this is final(termination)
reportandattachNotlceof Dissolutlon
FormDR-3. le^t/^| 0
7-)@Check
\ (Youmustcontinueto file reportsuntila DR-3is filed.) County& LocalCommittees,
enterCountyin
Elec{on

STATEMENT
OF CASHON HAND
CASHON HANDat the beginningof the reportingperiod. (Totalof all tundsheldby the
committee.ThisamountMUSTbe the sameas the cashon handat theend
of thelastrepoilingpedodor mustbe zeroif thisis firstreportflled.) ...................
$ o
ADDTOTALMONEYTAKENIN THISPERIOD
Schedule total(AttachSchedule
A: CashContributions A) ('alsoseein-kindbelow).............,....
Schedule
F: LoansRecetued total(AttachSchedule
F)....................
Schedule
H: TotalSalesof Campaign (AttachSchedulE
Property H)................
(ScheduleH aoollesto Candldates'Commlttae Onlvl
suB-ToTAL................
$
SUBTRACTTOTALMONW SPENTTHISPERIOD
total(AttachScheduleB) (*also seedebtsand loansbelow)............
ScheduleB: Expenditures
Schedule total(AttachSchedule
F: LoanRepayments F)....................
period(iffinalreportbalancemustbe zero)........................,.
CASHON HANDat theendof thisreporting $

CONSULTANT BREAKDOWN (ScheduleG Attrached?) _ YES

C.ANDIDATEGOMMITTEESONLY:
VALUE OF CAMPAIGN PROPERW (From Schedule H -Attach Schedule H) $
STATE COMMITTEES: Submit a reconciled campaign account bank statement in January of each year.
FOR'NSrRUCI'ONS, SEE84 CK OFFORM
SCHEDULE
COMMfTTEENAME(Musfbe sane as on Statementof Organizaflon) E IN KIND
CONTRIBUTIONS
ilAy.V/o*[ h I ngto" FanSupenvisar
n cHecrrHrsBoxtF
AMENDING
FORM

DATE t{tsr4 | toNUfilP DESCRIPTION ESTIMATED { IF FOR

RECElVED MMEANDADDRESS TO CANDIDATE OF IN KIND FAIRMARKET FUND-RAISER
ruil/DDATR) OF CONTRIBUTOR " (if aoolicable) CONTRIBUTION VALUE CONTRIBUTION
$
Forno*orrrn
iltlro [Ylax Wanfh,*B$" Sei$ 9c.,e. 78.u
Hor>*:toan
E/alrc lvtax Warfhi nghn Se,f+ Pn.s* 88, oo

5/etlta lvrarWo*hi"g*w, 5c lf lleoPria{tge ?7rta

r/aln IAor.Won{ni .,g*on 6el$ ftJSt Pl';nhrj I ?o' oo

Tra if
rfu/n fllat Wontl'r; ngto'' :ts Dfp,-o't
^Pt"6 l6e.o0

tY.anr-oe.
slatlt . rhax t{bFhh^g{a^ tut? ld,i nror
| 17, ob

5* (f .J"epr co'
sfufn fitax \{"nthi ''5foa Tn'but-
23t.6

sFl, Inrr' U,b'+hing*on &rT Pnatiu'citl

buls
168,o6

SUB-TOTAL $

TOTAL(lf last $
page of thls
schedule) lfrtlO t1
*Disclosure law requirescandidates
to disclosethe relationship
of anyrelativemakingan in kindcontributionto the Pase-| ot I
committee.Relationship muslbe ehownto the thirddegreeof consanguinity (bloodrelatives)andaffnity(relatives (for Scheddle E)
by maniage). (SeePage2 of formspacket.)lf sumameof contributor is the sameas candidate,butthereis no
enter"notapplicable"
familialrelationship, in the relatlonship
column.