FOR INST UCTIONS, SEE BACK OF FORM

JAN 1 8 2005
DISCLOSURE SUMMARY PAGE

COMMITTEF~ ( ust be same as on Stateme t of Organizat

IMPORTANT: Indicate type of committee you are reporting for.

( t )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate

( 5 )County PAC ( 6 )Ballot 1 Fro chise mittee ( 7 )County/City Central Committee
( 8 )Support late" Candid s /

SIG14ATURE OF THE SU (or n filing this report) TELEPHONE DATE SIGNED

Penalties Due For Late Filed Reports Range from $10 to $400

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

7 + .! L
I AM FILING A 2 REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one

pCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

County 8. Local Committees, enter County in

(] Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . which Election is held
(You must continue to file reports until a Notice of Dissolution is filed .)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the total
of all monies 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 riled .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ y~-
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule C : Fund-raising Events total (Attach Schedule C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule H . Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H applies to Candidates' Committees Only)

SUB-TOTAL . .. . .$

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B : Expenditures total (Attach Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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) . . . . . . . . . . . . . . . . . . . . . . .__ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

t" f -
UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
IN KIND CONTRIBUTIONS (From Schedule E-Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 3 7t:/ .~ 7S
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY:
... . . . . .n-1-- .I- r AN-k-4.7% YES NO
 p. 3

FUR INSTRUCTIONS, SEE MANUAL

sCHEDULEI
MONETARY
CONTRIBUTIONS - MONEY TAKEN IN A RECEIPTS
CANDIDATE
(including candidate's personal funds) For office use only

CANDIDATE'S COMMITTEE NAME (Mu t be sameas on t Cement of Organization)

r2,4115 r

NOTE : IF A CONTRIBUTION IS RECEIVED FROM A PAC (POLITICAL ACTION COMMITTEE), LIST

THE PAC IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN . LIST OF I .D . NUMBERS
IS AVAILABLE AT NO COST FROM THE CAMPAIGN FINANCE DISCLOSURE COMMISSION,

Section 56 .10(8)(a), Iowa Code, states : "Information copied from reports and statements shall not be used by any person other than
statutory political committees for the purpose of soliciting contributions or for any commercial purpose ."

DATE PAC I .D . NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

RECD (if applicable) (it proceeds from fundraiser, show fundraiser sponsor) TO CANDIDATE RECEIVED
(if ap hcable)
vv -

r
/q 3,A- T E PAC
.
3 )l EXsrFP A E
3 -7

3 - 2,z,10 Sr r6 720 z . ~v
. f ~5 Dirrl~S -4 - 502

3z 7 - sfLt S7- ~~ o~
©' z sr )V% ,SZ
f

Z,
~ G6y~ p~
.3is` - /Ot UC~
l

/1 f T POPP

PAP -
-j 1 40, 0 r

irl S ~'Gs oil ~ o00 ~

61 ,
(~ :7

-~:mar
" z
T

,~
~dl T,-
v
f
v
2
w
SUB-TOTAL $ I ~d
TOTAL (it last page of this schedule) $

Disclosure law requires candidates 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) . See instructions for
a more detailed description of relatives covered by the law .
K-0094371140-OD54-LI(Rev .1992) Page / of
(for Schedule A)
 p. 4

FOR INSTRUCTIONS, SEE MANUAL

SCHEDULE
MONETARY
CONTRIBUTIONS - MONEY TAKEN IN A RECEIPTS
CANDIDATE

(including candidate's personal funds) For oflice use only

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

NOTE : IF A CONTRIBUTION IS RECEIVED FROM A PAC (POLITICAL ACTION COMMITTEE), LIST

THE PAC IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN . LIST OF I .D . NUMBERS
IS AVAILABLE AT NO COST FROM THE CAMPAIGN FINANCE DISCLOSURE COMMISSION .

Section 56 .10(8)(4), Iowa Code, states : "Information copied from reports and statements shall not be used by any person other than
statutory political committees forthe purpose of soliciting contributions or for any commercial purpose ."

NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT

DATE PAC I .D . NUMBER
RECD (it applicab)e) (If proceeds from fundraiser, show fundraiser sponsor) TO CANDIDATE RECEIVED
til applicatle

3lrv ~) -
!y ~s /~to ~.rl~ s ~f1- o 0 _
,L t;CAL O~ .~ )r)

COUAI R `T'S j r 1-L Z

c)62
~ 'Z
1

U Wa lg. w

SUB-TOTAL $ /

TOTAL (it last page of this schedule) $

Disclosure law requires candidates 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) . See instructions for
a more detailed description of relatives covered by the law .
K-009477/140-0054-L1(Rev .1992) Page of
(for Schedule A)
 p .5

" FOR INSTRUCTIONS, SEE MANUAL

SCHEDULE
B MONETARY
EXPENDITURES
EXPENDITURES - MONEY SPENT CANDIDATE

For office us e one

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

DATE NAME AND ADDRESS TO WHOM EXPENDITURE AMOUNT

EXPENDED (Disbursement) WAS MADE PURPOSE EXPENDED

1o zs /D13L,(/)-1w6-7-01L1

1510 /z z 3 ~'
r i- . D/Sow fI 5 -7

^- ,
sT
131/ ixi
~oi~T T4 .S,2G S

f3u~z i~G id4/

--
i
- N,4ti'.~ Y~y
r3 Iz
t~l L (,-V Cro 2V oGJff -- 21GC O

TOTAL (if last page of this schedule)

Expenditures to consultants (persons/entities providing consulting, advertising, fundraising, polling, managing, organizing services,
etc .) must also be detail itemized on Schedule G by the amount, purpose, and date of each type of expenditure made by the
consultant on behalf of the candidate's committee . See manual for more specific instructions .
CPF-121D511AD-0055/(Rev . 1990) Page / of
(for Schedule B)
 P .6
D INCURRED
COMMITTEE NAME (Mustbe same as on Statement Organization) (Rev . 08198) 1 INDEBTEDNESS

/A 7- Q CHECK THIS BOX

IF AMENDING
NOTE: Debts previously reported that remain unpaid must be included on this
Schedule, as well as any new obligations incurred in this period .
Reset Form FORM

An "incurred debt" is a debt for

DEBTS/OBLIGATIONS REMAINING THIS REPORTING PERIOD goods or services ordered or
(DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) received, but not paid for by the
end of the reporting period .,
regardless of whether an invoice
has been received .
DATE DESCRIPTION OF GOODS OR BALANCE OWED AT
INCURRED NAME AND ADDRESS OF PERSON SERVICES PROVIDED OR CLOSE OF
(MM/DDIYR) TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING
PERIOD"

.. lCi .W C LiL
1

Y ,,4

1 4
1-

SUB-TOTAL $~

X
TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD $

s
'If actual figure is unknown, show "estimated" beside the figure . Page __ of
(for Schedule )

CANDIDATE COMMITTEES NOTE :

"Incurred indebtedness also includes each persondentity with whom the candidate's committee has entered into a contract during the reporting period for future
or continuing performance, Enter the name of the consultant who provides or procures services for items such as advertising, fund-raising, polling, managing, or
organizing services . Report on Schedule G the nature of performance and the estimated performance reasonably expected of the consultant.
 OCT-SB-2004 12 " 12 IR ETHICS CRMPAIGN DISCLO 15152813701 P .01
FOR INSTRUCT ONS, SEE HACK OF FOAM SCHEDULE
E IN KIND
' COmwTTEE NAME (Must he same as on Statement 0f 0rpanize60N (Rev. 06/97)I CONTRIBUTIONS

(] CHECK THIS SOX IF

AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MM/DD/YR) OF CONTRIBUTOR ' (ifep iltable) CONTRIBUTION VALUE CONTRIBUTION

/ t' f -''~c~c'i~

17
/Cr

/C .

xYK
L3

t'C DG'C T/~.~ ul Xk

X xX

l i I i 1 I I

"Dlsciosure law requires candidates to disclose the relationship of any reladvemaking an in kind contribution to the
committee. Retaflorahip must he shown to the third degree afconszngulnity, (blood relatives) and afnlty (relotlvea (for schedule E)
by marriage) (See Page 2 of forms packet .) If surname of contributor is the same as candidate. bulthere is no
familial relationship, enter "not applicable" in the relationship column .