I

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev. 12/2005) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
Comm . # ) 67
IMPORTANT: Indicate by # type of committee you are reporting for: Logged In
( 1 )StatewidelLegislative)Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candi to ( 6 )City Candidate (7 )School Board or Other
Political Subdivision Candidate ( 8 )County PA A' r. PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 1 Local Ballot Issue Audited -
J E

CANDIDATE COMMITTEES ONLY:

File with :
Iowa Ethics and Campaign
Disclosure Board
510 E . 12"', Ste . 1A
Des Moines, Iowa 50319
Fax : 515-281-3701
Late reports are subject to possible civil and criminal penalties. Iowa Code section 68B .32A(7)
the candidate, for a candidate's committee, and the chairperson, for a`n ther type of committee, is the
individual responsible for filing timely and acc)Oate reports.

l~ f~_wl Isis ate= ~1 qs 11 0 ~ o

IGNATURE OF PE HUNG REPORT TELEPHONE DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .

(report date) Indicate by # I0

[]CHECK IF AMEICMENT TO REPORT DATED Local Committees, enter Date of Election

Check if this is final (termination) report and attach Notice of Dissolution Form DR-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). . .. . . . . . . . . . . . . . . . .. . . . .
95- 0 .00
0-00
Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Q . 00
Schedule H: Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H aoolies to Candidates' Committees Only)
SUB-TOTAL . . . . .. ... .. . . . .... . . . . .$

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) . . . . . . . . . . . . . . . . . .
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) . . . .. . . . . . . . . . . . . . . . ... . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . .. . . . . . . . . . . . . . . . . . . .. . . . . . . . .. .$

""UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . ... . . .- . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ O. I~ U

IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ ~~

'*OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . ... . . . . . . . . . . . . . . . .. . . . . . . . . .. . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .$ sO+ ~C7

CONSULTANT BREAKDOWN (Schedule G Attached?) - YES Jel
CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ 0800
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year.
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN

Reset Farm
A
(Rev . 07103)
I MONETARY
RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

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-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#

CK# p, v~~!. 3akI =11 vo

sh SU y3
ID#

) -11- R ,~70 156

ht~dje.
1 D/1 ~ o~ ~ ~~ t~ S . I~,enned st. ,5-D. av

bran I~ ~ ~,a~ G~11u~ ,

s
~.,.c~rw. '
I~ 1 C116 (o cK# S+
S 15-6,
ID# gL~-Lff.r)
.r
~~Lv-c~-eer PKC1
Oe
pc+ f~crSnR

1(~~1G ~06 CK#

~pCSo2 ~W< i5Fssa 3

ID#
Jcfr~ sr,rtn OU
cK# i
e .r~ .5'6

,.
lr

f E li t '!

ID#

CK#

SUB-TOTAL

TOTAL (iflast 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 oonsanguinity (blood relatives) and affinity (relatives by
Page of
marriage) . If sumame of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
 FOR INSTRUCTIONS, SEE BACK OF FORM Resct onn 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 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)

Ze E. c;~- ri . U
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MWDDIYR) AND PAC
CHECK
NUMBER
ID# /h~3 N~caSS ~lrrl7inci Cy-S
/U//q/66 CK# lvaq 903 ItJ- a~~ S-I-, $ ly~~) - rl - 90
l~ ,~~610
ID# /Lo&J ~

1D# d, -3

ID# lGL Is
lblo`~S~(o Sao H J
C'K#

1D# A'4, c Hif cool-e C) C)

130 1 Xh PLC ~.c. ~~Y~~~ca~ser`
CK#

ID# r r ' r C,
IDO . o v

C1K#

SUB-TOTAL $'

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 personstentities 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 R eset 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 & CAMPAIGN DISCLOSURE BOARD .

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

w o\
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# '-

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $
TOTAL (lf 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 .402(3)(i) .)
Page lv4 of

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN-KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev. 06/97)1 CONTRIBUTIONS

O CHECK THIS BOX IF

AMENDING FORM
Reset Form

DATE RELATIONSHIP DESCRIPTION ESTIMATED ~ IF FOR

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

F-1
-
J_,~,r, F . 6s*s_bpr $ ho-7 9
_ ~C~i, e,
~t set
f r, r1 TA 6i5l11~76

10 /l'7/ ai adt'IG
~Nt
'
°\ Gke,
:-
.
Se l Ply- w ~~
or S~
oo
~/0' r' 7

El
.
Shn E: .
~01,3016 :~X_. .

F-1
F-1
F-1
F-1
F-1
F-1
F-1
SUBTOTAL

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
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for Schedule E)
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.
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
Reset Form
COMMITTEE NAME(Must be same as on Statement of Organization)
F LOANS
(Rev . 07/03) RECEIVED
& REPAID

[]CHECK THIS BOX IF

NOTE : This schedule reports money loaned to the committee which is deposited in the committee account . AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $ ,:~* OO
PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD PART 11- MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD
(Original source of loan, such as a bank, must be shown if a third party is (Loans forgiven must be reported on Schedule E -- In-kind Contributions.)
involved. Include loans from candidate's personal funds.)
AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP
RECEIVED (Include Endorser's Name, If Applicable) TO CANDIDATE OF LOAN (MMIDD/YR) (Include Endorser's Name, If Applicable) TO CANDIDATE* REPAID
If Applicable* if Applicable)
MM/DDIYR $

TOTAL (PART I) $ ^ " U TOTAL CASH REPAYMENTS (PART//) $ " UU

From Schedule E--TOTAL LOANS FORGIVEN $ ~~

00
TOTAL OUTSTANDING LOANS END OF REPORT PERIOD $

*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
Page
relationship column when it applies. (for Schedule F)