FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DISCLOSURE

COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 1212005) REPORT

X-q.rj Jq Fer 5 eNGt(f Comm . #

IMPORTANT: Indicate by # type of committee you are reporting for: = Logged l
( 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 Political Scanned
Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Subdivision PAC Computer
( 11 ) Local Ballot Issue
Audited
CANDIDATE COMMITTEES ONLY : ~ISC
Candidate Name iOSURF_~MPA 1,

?or
arty (if applicable)
Cam, r -uw -01,
Office Sought
FILED .. t (if Senate or House)

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 .

&G S, o Y8 2. 'e.1 o
TELEPHONE DATE SIGNED

I AM FILING A JZ;1 r
ZN REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .
(report date) Indicate by # FLI

E]CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

F1 Check if this is final (termination) report and attach Notice of Dissolution Form OR-3 . County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed.) 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.) .... .. ..... ... .. . . . .. .. ..... .. . .. .. ... .. . $
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 H: Total Sales of Campaign Property (Attach Schedule H) . ... ... .. .. ... ..... .. ... .. ... .. ... .. .. ..
(Schedule H applies to Candidates' Committe es Only)
SUB-TOTAL ............ $ -14 1

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B: Expenditures total (Attach Schedule B) (*"also see debts and loans below) . ..... .. ... 0102
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) . . . .. . . .. . ... ... .. .. ... .. ... ... .. .. . . .. ......... ... .. ... ... .. .... . .. . .. . . .. ... .. ... ..... .. ... .. .. ... .. .. . . . .. . .. . $ Itio .LiS
'"'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 BREAKDOWN (Schedule G Attached?) YES V 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 SCHEDULE
R.c'~Ct ~r1rr{1
A I MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE_NAME(Mustbe same as on Statement of Organization) AMENDING FORM

a Fd r S eiyrt T'-e
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 .

NOTE: ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD.

CAUTION : Section 68B .32A(6), 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
5~~(0~0(o
CK# 11311 70 13i1 Fo~ a}~DrS Nl~- $ 9`t100 0
Q N 'F N O
ID#
oeh y~
511 -7/04, CK# 10 7 s JAllot! d rk
a -v~4d as ,v`
N 1000 0
INNS .~ ~o~
ID# rr~ tke_ 1(tos cr+afv v a~ k c 2,
51)1106 CK# 3,07 rtide, tvN 4%/q . $b00
Dens loo ,Np1 -1l4 S0 -1 01."(
ID#
0 Pa,
slaaloc , c K# (o`T ~L 3 nvz S ;L ~ht 0 A, 4100
Q e~ iMQNvtJ S SQL ~I
ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

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
familial relationship, enter "not applicable" in the relationship column .
 FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 07/03)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS 8 CAMPAIGN DISCLOSURE BOARD.

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

c~ N d 01 -40 r /Y a, 1C
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# ptct,o w~'t N*A)
W e5* "r~a S~t~* Law
~'~ISIO(o
CK# Y~~bc 3`l 'd6 Sw 11 rr~ (2--e ` $ .161 00
es M d isllr&S, 2l4 $6 "'5
1D#
5~~6~ 0 1a
Car i-tr' P PtN 1'` "q 5 ~ ~ pq t IN
CK# 6C)S 173y F V fa^'d t-YL r
t5 Il
ID# /Aw6e1 J A veZ w% G u ~S~rf CA/ q e, p b
1716 o CK# I 00 7 386 7 T1Vf~'0 Ard '
,.
~Qr cacti ,.~~ S03 a1
ID#
Cq~~
10117 I o 1. CK# 1(Jb to 3oAq w o Jco" RAwjct I wU
cs o s runs , Z
ID# wice MwY
SI aal0(6 CK# sago s r t yrh o Ice S"PP l .os '~0
100 cl
IJcs Mo1NC S, TI$ 5*01
ID# a-r4 I c t, /'1a r
(,
CK# lao'8 50 "10 So l yl-" GQScS 0 P4 9por
Des Mol~vvs, iR Sdv.2a
ID#
5 Po s,- o('%Ctct 5+f, -.10 s ~ ~, ,o,
CK# 10 l p 1 9 Rolls 76

ID# US Qo S t of-Ice Sp
5) ;016(o CK# d ~I ~409~ .a CJ
a$ R.OIIS
SUB-TOTAL $ 4 1 Lict
- TOTAL (iflast 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.402(3)(i) .)

Page _-_

(for Schedule B)
 FOR INSTRUCTIONS, SEE BACK OF FORM Rc c;t l unn SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
D CHECK THIS BOX IF
AMENDING FORM
ETHICS 8 CAMPAIGN DISCLOSURE BOARD .

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

4NA 5 *-P
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDD/YR) AND PAC
CHECK
- .
NUMBER
ID# Web* %Qnlk
f~ 3 o S w LT I, S 4" 6 wblT
CK# ~}u0 WA $ . ~00
pcs AID IKe%,T,SjVS
I D# 0.06t i' W eU*- { :, oN
S .-'1'erw>r~l `~
lei a.6 S w Cc ~'
to CK# ~aovNfi f1-So'~I,S
ioesmo'nm . Copy CkWSe,
-
V,5 Qac t C I (Lo o o fi
ID#
1G~
51 3 11 0 CK# dt
o
5 -t-4r~ 5
ID#pzb`
5131/ob r VJat ca C4 G1`0 r
'7 S~ 4f 'h Ca.N c~~ A ~, Q"O
CK# in`~I7 urv
oe_S M.o t K .s, TA-Se'3(s C tieLc S
Ocb~~ '3' e4 'V L%
wg'La
Acoe
ID#
CK#

1D#

CK#

1D#
CK#

SUB-TOTAL $ 5

TOTAL (if last page of this schedule) $ ~~

4 1

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.402(3)(i) .)

(for Schedule B)
 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E I IN KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 06/97) CONTRIBUTIONS

0 CHECK THIS BOX IF

AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED _1 IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MMIDDIYR) OF CONTRIBUTOR ' (if applicable) CONTRIBUTION VALUE CONTRIBUTION

~G ~5 r eo1lc .-N pet~atnfl

371? 133 :d S~_
Z1- 5o3t,3
C
Ca~~~

C ~ I ts~Y~ Pgp,q,V\D
TV, AA5
K~"~J(1hOCh1C ~ S<"J Z .. 3

I I I i
SUB-TOTAL
1

TOTAL (if last

page of this
schedule)

'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page / of
(for Schedule E)
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives
by marriage) . (See Page 2 of forms packet.) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .