FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

(Rev . 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Orlly
Independent Insurance Agents of Iowa PAC Comm . # I b1052
IMPORTANT : Indicate by # type of committee you are reporting for : = Logged In 016
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties .

_fib 62 -.1 (o "'

SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

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

(report date) Indicate by # F1

Local Committees, enter Date of Election

K IF AMENDMENT TO REPORT DATED 10/19/2004

-
F1 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a DR-3 is filed .)

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
18,657 .21
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) . . . . . . . . . . 5,290.00
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) (**also see debts and loans below) . . . . 17,580 .00
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report balance must
6,367.21
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

**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) $
 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 RI 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)

Independent Insurance Agents of Iowa PAC

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#
Mark Shackelford Silent Auction-Bid Item
9/15/2004 5200 Metcalf Avenue Incorrect amount on original 480 .00
CK#2804 Overland Park KS 66201 report-shown as $240 .00 $

ID#

CK#

1D#

CK#

1D#

CK#

I D#

CK#

ID#

CK#

ID#

C K#

ID#

C K#

SUB-TOTAL $ 480 .00

TOTAL (if last page of this schedule) $ 17,580 .00

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) .)
9 9
Page __________ of ----------

(for Schedule B)
 N0 .473 P .2i18
OCT .19 .2004 4 :14PM 515 222 0610

FOR INS'rRUC770NS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 olscLOauRE
COMMITTEE NAME (Must be same es on Statement of Orgar~etioa) (Rev . 07/2004) REPORT

For 01`1121 We Only

Counm. S
IMPORTANT: Indicate by*type of oomfoltee you Ore reporting fo-,-= Logged In
(i )Stafwide/Leglslatlvaijudge Standing for Retention Candidate (2 )State PAC (3 )State party Scanned
( a )County Central Committee (5 )County Ca ndldate (B )ClayCa ndidato (7 )School Board or Other
Political SubdMelon Candidate (Q )County PAC ( 9 )C4 PAC (10 )School Board or Other Political Computer
Subdivision PAC (11 ) Local Begot IssUO Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name Political Party (ifapplicable)
Late reports are subject to
possible civil and criminal
Dlsaid (f Senab or House) penalties.

1~; I - to o t.o 0 \ o-I~t . o~f

TELEPHONE OATS SIGNED

'6PORT"FOG'R ( ELECTION / 2 NON- .ECTION YEAR,

(report date) ED
enter
]CHECK IF AMENDMENT TO REPORT DATED Local committees, Date of Election

[] Check if this is final (termination) report and attaO{! . ~.- County& Local Cornmlttsas, sneer County In
(You must continue to file reports until A DR4i`sfiled.) which Election Is held

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting
period . (Tome of all (ands held by the
rnmmittiee. This amount MUST be the same as the cash on hand ebbs and
of the last reporting period or must be taro If this is first report filed.) ..... ........., .. ,.....,$

ADD TOTAL MONEY TAKEN (N 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) ,., ............, ., ...., ... .... 
tS~.hedule H aQnlles m Candldatett , Gamml~s only),
SUBTOTAL ,....;
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ('"also see debts and bane below),. 1'1 , r3_~t O. O o
Schedule F: Loan Repayments total (Attach Schedule F) .......... ...... ............. . ..... .................
CASH ON HAND at the end o! this reporting period (Iffinal report balance must
be zero) (AtTwch DRS) ............. ... . .... ......... ..... ............. . .. ... ........ .

"UNPAID BILLS (From Schedule D -AtOsoh Schedule D) .... . ..... .............. ...... .. ..... .. .. ........ .... .... ........ §
"IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) ... ..., ..... ... ., ., ......... .., ., §
U, Le-S 0. c~o
OUTBTANDING LOANS (From Schedule F -Attach Schedule F) ....... ... . ... ..... ................ ...... ..... .... . $
-OUTSTANDING
CANDIDAI CO M11TEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES ~ NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Atmch Schedule H) S
 NO .473 P . 3i18
OCT .19 .2004 4 :15PM 515 222 0610
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS - MONEY TAKEN IN A MONETARY

(Rev. 07/00) RECEIPTS
(Including candidate's personal funds)
CHECKTHIS BOXIF
COMM)TTEE&AME (Must be some as on StsfemeVf Organlzebon) AMENDING FORM
+i .rs~r .i o.C a emAor
o\ :Sr1~.l~c % C-
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A 6TAT~ PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHB PAC C"ECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLEFROM THE IOM UHCS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 688 .92A(0). Iowa Code, prohibits the use of Information copied from reports and statements for aollcflng contributions or
for any commercial purpose by any person other then statutory political committees
.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED Of applicable) TOCANDIDAT ' RECEIVED " FUND-
AND PAC CHECK Of applicable) RAISER
NUMBER INCOME
I D#
~'a $ CK# p. o , r 42~1 10 NF
$

IDN
0t"
CKIt ~~9 ~~ ~ \ aat1 ~~o

IDff
Q-~g 02 OCT . A+-0-"kAQ Edo1
Wetv
- CKIN

CKO 'ey1S~( WGC~'H~Y~ ~~ `7

l.J er7l ~.s ~cti.m~ .Z'A S~a~l~

CKS 1~ a S.
~1a °W3 e 21
_
ati,
ID#

CKiR
c~ L4 r,
A 0 3117 f ~O
IDO __

to ~Ile~ ~'l S
ID#
CKAI

IDIII

S4ssco
IDlit

CK# Son j-0rC4L'.S

SUB-TOTAL

TOTAL, Of last page of Mltr sdhedule)

" blsclasure raw requires candidate committees to disclose the ralallonshlp of Itny relsilve making a contribution
commlaee . Relationship must be shown to the third degree or aonsanaulnlty (bbod Teiglbes) and aftinlgq (relatives to the
. If surname of contributor is the some es candidate . but then
marriage) by
If no Page of
familial relationship, errter'not applicable' In the relationship column .
(for Schedule A)
 515 222 0610 NO .473 P . 4i18
OCT .19 .2004 4 :15PM
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN
(ROV .07103) I RECEIPTS
(Including candidate's personal funds)
a CHECKTHISBOXIF
CO MNJ jTTEE ME (Must be same as o Stele ent praanlzedon) AMENDING FORM
z

STATE CANDIDATES NOTE, IF A CONTRIBUTION 18 RECEIVED FROM A BTATB PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LISr OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS ANDCAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 08B .82A(6), Iowa Code, prohibits the use of Information copied from reports and statements forsoliciting oontributichs or
for any commerolal purpose by shy person otherthen statutory political committees.

DATF PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (W applicable) TO CANDIDATE' RECEIVED FUND"
(MMIDPIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
1c  ~~~P f
I D# ~aS
'
L- c . , oat ~ts °~ . Lr y+:~
CK# i;

ID# i S

CKfe w ask-0r Gttil"" irl Cs s

~~ c7

IDS

CK# 19 rDo
t.A ew .~ ®sees , ~ R , tL4 T-,14
_ _
IDS

-eYl I'D 4' Cute

h.a-lof-,~ r~H ,~oOa o1
ID#

f CK#

IDS

CK# S .r . r 13Sf

IDS _

rya 1 .-1a. . xA ~i or3~

ID# a
p.al ~r V
CK# r3t c t Acuw Sk+`6e-Q;t" a
~t ea`t
IDS
t~ral

~afr ~' " ~~1 ~v3~s

CK#

SUB-TOTAL

TOTAL palest page or this aeheduls)

Disclosure low requires oandldate committees to disclose the relationship of any relallys making a contrtbution to ..rr.~,.e
the
committee. Relationship muel be shown to The third degree of coneangulnity (blood relatives) and affinity (relatives by
marriage) . If sumerne of contributor to the some as candidate, butthere is no Page of
familial relationship, enter "hot applicable' In the rlationehlp column . (for Schedule A)
 515 222 0610 NO .473 P . 5i18
OCT .19 .2004 4 :16PM
For Instructlons, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN
(Rev, 07ro3) I RECEIPTS
oncfuding candidate's personal funds)
[] CHECK THIS BOX IF
COMMITTEE NAME (Mustbe same as on Statem PPOrlganixadon) AMENDING FORM
=SL-rCvkCv-Ueje e^1-s - ~ 1:~~
6 11 "-l;,.-Al Aw-Lia+" Ct :btwr.:A%Qe-
STATE CANDIDATES NOTE ; IF A CONTRIBUTION IB 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 ETHOS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section BHB.32A(6), Iowa Code, prohibits the use of InIbrmation copied rmm reports and statements for sollolting contributions or
for any commercial purpose by any, person other then statutory political committees .

DATE PAC ID NUMBER NAMEAND ADDRESS OF CONTRI13UTOR RELATIONSHIP AMOUNT 4 IF FOR

RECEIVED Of applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDDfYR) AND PAC CHECK (If applicable) RAISER
NUMBER _ INCOME
IA# ~ r
rrt~`.,s ~ t1L
04
CK# --I $--t w a0-. t.a..+t
100
~`v-~a~ ate . ~R ~00 (
IDS
gT
CK#
Sa I LP
IDI# C~~ j-l`de ha.U~ .

W .a~-ate \t\~
CK# Mme^
s~A» ., rxR st y a i too t/

ID#

CK# la ev to e, 31t

-.
I D# r.4o a
-, M (ti4cCJ,'~
CK# 40k 41 Ce-h 00
L-ta~ t46owIL , = A St 031 I
ID#

CK#

ID#

ID#
~,r1o /L,Ci~.l~ew+
C
t4a ®~t
~~<<~.
~ s ~'
r ex~ ~A Sd ~ t.r"q

CK# V6~ok -t 3"F 00

ID# _

Q o~ Y1~ 4r L ~~~-NfR
04
C~"I t^ CK# Q J. a)c 1Lf~
~l.~~"Cr \ ~ i ~N ~o
SUB-TOTAL .
195
TOTAL (7f last page of this schedule)

' Disciosure law requires candidate commlnses to dlse ose the relationship of any ralafivp making a `~
contribution to the
comrnlnee . RelationeAlp musl be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by Ì]
marriage) . If sumarne of contributor Is the same as candidate, but Htare Is no
familial relationship, enter 'not applicable" In the relationship column . Page of `_
(tor Schedule A)
 4_16PM 515 222 0610 NO .473 P . 6i18
OCT .19 .2004
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
a CHECKTHISSOXIF
COMMITTEE NAME (Must be same as on Stat ant or Orgenlza6on) AMENDING FORM

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECOVEP FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A WST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHOS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 69B .32A(6) . Iowa Code, prohibits the use of InIbrmation copied from reports and statements for sollolling contributions or
for any commercial purpose by any person other then ibtutory political committees.

DATE PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDIYR) AND PAC CHECK Of applicable) RAISER
NUMBER INCOME
ID#
;,~,
-a9-0'f CK# I 0e Ccllerga
IDS

El
1"C u s s SQ O('ef
CKS
ID# []
..,.,. ,
Vw S a s110
D/NCPr ~hGsi6ti~
Ch#
T. A
ID# -~

CK# ell P
IDS
CK# P O, Qox ~S
SVlnbZ
ID#
CK# C) . lac x 1 la 4
IDS
CK# ~. , ~3otc

- _
IDS
I S - ~ CK#
x'7"7 I Lo o~"t p' .~

IDS _

CKO
.o, , ^.I~

Po
ID#
CK#
GV M .a~% !~ N 1-
- N So 5310
SUB TOTAL
S LO S
TOTAL (Ifleat page of this schedule)
S
" Dlstaoaure low requires candidate eammlttess to disclose the talatlnnshlp of any relative making a oontridutlon to the
oommhroe . Relationship moat be shownto the thirddegree or consanguinity (blood Ialatlves) and affinity (relelives by
. If surname of contributor Is the same as candidate, but there Is no
marriage) (4
Papa of
familial relationship. enter "hot applicable" In the relationship column . (for Schedule A)
 NO .473 P . 7i18
OCT .19 .2004 4 :16PM 515 222 0610

For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS - MONEY TAKEN IN

A MONETARY
(Rav.07103) RECEIPTS
(Inoluding candidatels personal #Linda)

COM TTEE N Must be same as on Statement of ~rgt atffon

0 AMENDING
CHECKTHIS BOX IF
FORM
,~ev "E 1414200 s t,

STATE CANDIDATES NOTE : IF A CONTRIBUTION 18 RECEIVED FROM

A STATE PAC (POLITICAL ACTION COMMITTEE), UST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAI ASLI: FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD,

CAUTION: Section ®t39 .32A(6), Iowa Code, prohibits the use of Information copied from reports and etatements for solloltlng contributionsor
for any commerolal purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADORE880F CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if appllcabla) TO CAN DI DATE' RECEIVED FUND-
(MMfDDfYR) AND PAC CHECK Of applicable) RA4SFR
NUMBER INCOME
ID#
4 ..f.o`f 1 M LA)
s
CK# ~ D . Q.pk ~ 1 'uC0
XN ~oS3~o
ID# ~
Ialrd/ ~ ck lrry
CK# A ~~U tJc~
.-~~~ sosas _
-
ID#

CK#

ID#

CK#

ID#

CK#

100

CK#

ID#

CK#

CK#

CK#

ID# -_

CK#

S(JB-TOTAL 0O
I_$---)
TOTAL (if last page ofthla at:heduls)
I$~ao
' Disclosure low requires candidate committees to disclose the relationship of any relative making a conlrlbution to the
committee. Relatlolmhip must be shown to the Ihlrd degree of consanguinity (blood rolglNes) and affinity (relatives by
marriage)of . If surname of contributor Is the some as candidate, but there Is no Page -S S
familial relationship, enter °not applloeble' In the relationship column . gar Schedule A)
OCT .19 .2004 4 :17PM, 515 222 0610 NO .473 P .8i18

FOR INSTRUCTIONS, SEE BACK OF FORM

SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT MONETARY

(Rev. 07103) 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 CH ECK THi6 BOX IF
ETHICS & CAMPAIGN DISCLOSURE BOARD . AMENDING FORM

COMI1~TTEE IVMI: (Must be same Ais on statement of Org zaNon

CANDIDATE NAME ANDADDRESS TO WHOM PURPOSE

DATE AMOUNT
ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION)
EXPENDED (If applicable) EXPENDED
(Olsbumernenr) WAS MADE,
(MM/DD/Y2) AND PAC
CHECK
NUMBER

CK# 3t'F `7

C~ w
f CK# ~o.~.ta~ 'Qoa. ISO Vuw`irllo.wl"I C
~Y1iLQ 1 t 1 ~ 5~~~
ID#
carwra~>1
Rte$ ,~ aa~.o
CK# ISO

ID# 414 +o~~r ~~e w pv~,r

CK# Q^I %:~k IQa>.',1 L
Qe3\rl sO o

33
_
ID# gay- r
c~- Cz w~+',~
CK# C. N 1L,.Un~ . 4Z l"~D
Q10-o. .,'ZN Soo
ID# 91
J
-1~-'
CK#
(Qo,..+koa ,'L q

c~ ~ ; .Y, ~( ,D~ smell a

IR# ~S~'
_ ~..4 r sz~kv- n

CK4 -2.? -199

Sa"'I lpl

SUBTOTAL $
TOTAL (if 1w(page of this schtltdUle) $

THIS BOX APPLIES TO CANDIDATES , COMMITTEES ONLY:

Purchases of certain campaign property costing $500 or mora must also he inventoried
on Schedule H . (Refer to Schedule H Insinrctlons.)
Expenditures to parsonslentitles providing consulting, advertising, fund-raising, polling, managing,
Schedule G by the amount, purpose, and deb of each typo of expenditure organizing services must also be detail Iternbced on
Schedule G Ihstructlom and Iowa Code 88A,g02(3)(I) .) made by the persoN®ntky on behalf of the candidate's committee. (Refer to

of Pegs -_~ -
I

(tor 8ehedula t3)

 NO .473 P . 9i18
515 222 0610
OCT .19 .2004 4 :17PM

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 07103)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES : NOTE : FCR CONTRIBUTIONS MADE TQ STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN TI-Ir DESIGNATED COLUMN AND THE CMECKTPE BOXIF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
E1HICS E CAMPAIGN DISCLOSURE BOARD.

COMMITTEE'~NAME (Must be same as on Statett~ent oP CkTartizelr~'on))

~+h ..
~'~+ k ~5u~a+~wcG ~'.er. S o
l[vic"o\ pnki,LZ~r

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Dlshuraement) WAS MADE
(MM/DD(YR) AND PAC
CHECK
NUMBER
__
ID# k 344 C ~~ +' sue. .

CK#

;t:;Lb
. fr'AM VLF '~ R Lam'

CK# ,~ I~

ID#

CK# r.-,t7V1 (~Qw kr tL~-o v I

IDO
C"

r C.fl'.e~l~
g1,hCl\ ~.a c~ i ~~r~P(a~C+
c~eG~
CK# eDTT$3
~ ~'~ S o~Stif

~a, C~sK
CK#

QSo
mss ~awr ~~
,
~u3vCo
SUB-TOTAL $
\ Sexes
TOTAL (if JaStpags of 9014 Schedule) $

THIS BOX APPLIES TOCANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property coating $SOD or more must also be lnvanfoded on Schedule H . (Refer to Schedule H Instructions)

Expendlturesto personsliantitlee 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 mode by the personlentlty on behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code B8A,g02(9)(p .)

(for Schedule B)
 NO .473 P . 10i18
OCT .19 .2004 4 :18PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM F~ SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev . 07103)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES , NOTE : FOR CONTRIBUTIONS MADE TO STATEWDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN Tilt DESIGNATED COLUMN AND THE L.J CHECK THIS EOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS Is AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

COMMITT~EE~~ " ME (Must be same as onytotement of Otta~apl un

(a+1 e s o f
M j.P.aeHGa'~'! ~ some as

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (1f applicable) (Dlabursernen0 WAS MADE
(MM/D") AND PAC
CHECK
NUMBER
ID# SL4 LQ~m?F4F -lv ~1eC~ .L " d~rr V'~t~~°" K

CK# $o ao~ r3a c ~; ~~- a

ID# S~,I~ , r S~vt ctkCl -
1 0Ot56
CK#

ID#_GStp

CK#

~
CK# 0~7 Q (
a . . ~, .tea a ~ $
ID# I%.t
.
Csa+r1r o>^
C?Q,..ca\ '~k T A rm s o 3
ID# 1x5tp eItd~~, r. l~a~n
c(00 VZO%-% ' \
tom,, s c ,1wc,CA 01~ la l
~~
ID# ry~,cb 1.Ir, lloe~~2, J?vt 00.E e y1 e~Q .
l0_\a, ~kl~ o
EU4 CK#
5a3 I
- - SUB-TOTAL $ ~atal,tD
TOTAL (Itlast page of M19 schedule) S

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of cartaln campaign property coating $500 or more must also be Inventoried on Schedule H . (Refer to Schedule H Instructions.)

Expenditures to porsone/enifties providing consulting, advertising, fund-raising. polling . nmnaglng, organising services must also be detail Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure mada by the person/entity on behalf orthe candidate's committee, (Refer to
Schedule G Instructions and lows Coda 68A.g02(3)(q .)

(for schedule B)
 NO .473 P . 1 1i18
OCT .19 .2004 4 :18PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B
(Rev, O7109)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES : NOTO : FOR CONTRIBUTIONS MADE TO STA7ElMDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE IWSIGNATED COLUMN AND THE L.J CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS 15 AVAILABLE FROM THE IOWA AMENDING FORM
ETHIC& 3 CAMPAIGN DISCLOSURE BOARD.

COMITTEE NAME (Must -be some as on Statement of

GJ~~a~ CL,\ ~~a ~,r^MI +1TS

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED Of applicable) (DlsbursemenQ WAS MADE
(MM/DDIYR) AND PAC
CHECK
NUMBER

56 b-c ~wa~ C~+~ P! .

CK# RL

ID# 1Lv3?.

CK# a
o-213-s

q-'x_04 (",K# Vk~?

-Q %S5

CK# o~ ~ Y p0~'.,2'
~,I err,
1a ~A
ID# g3c J.~ S~+,arc~.
3 oao trCws^w ~Uloans Roams ~ 1~.Rb .. AA O n
CK# .I ~So
,~~sa~ Saoti
ID# r' Lg Q
. ,~a.colo
C1-4F- 104 "a
ID# (1 I S ~~dmaw. . r S+.a 01x1~*-,~F M3 Cgx h (-;, ~ti
CK# %S4

CK# vt .~.s, TA J. 'moo 0 (no

SUBTOTAL $
TOTAL (Iflastpage of Ws s¢heduls) $

THIS BOX APPLIES TO CANDIDATES' COMMriTERS ONLY.,

Purchases of certain campaign property costing $500 or more must Also be Inventoried on Schedule H . (Refer to Schedule H Inahactlons,)

Expandityrea to persons lentities pro viding consulting, advertising, fund-raising, polling, managing, organizing services must Also be detail Itemized on
Schedule G by the amount, and date of tech typo of expenditure made by the person/entfty on behalf of the Candidate's committee. (Refer to
Schedu le G Ihetructlona and lam
owa Code 88A.402(;I)(I).)

Page L+ 'f-3

(for Schedule B)
 NO .473 P . 1 2i18
OCT .19 .2004 4 :18PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT 13 MONETARY

(Rev . 07103) EXPENDITURES
STATE PAC COMMITTEES, NOTE : FOR CONTRIBUTIONS MADC 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 semo as on Statementpf enization)

Cr,,QCec-D's.+ ~h9vA cR ~.~r 'a

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE - - AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (D*prsemehd WAS MADE
(MMIDONR) AND PAC
CHECK
NUMBER
ID# (,~4

P c' " ~,ryk tq c O

d4 CK# r;~1jq
vn ~4o4 r~ t s o531r, $

kn 9,q e1 19-A Q -POJ-

CK#

- .__
CK# ~g~lre ~ Q ~~ Slo r3 C~~.,1r
`~ot », sA

t 3R -7
ID!#

CK#'D83c

I D# tAk4 to

CK# Q-,Ra

CK# a%'a'F ~1aoF~~P 1u Re 4~ , ~s 4

r

ID#

CK#rd1el3
~C FAa~rtlti$9~ ~0 ~0

SUB-TOTAL $
TOTAL (If last page of this schedule) $

THIS BOX APPLIES TO CANDIDATE

-21 COMMITTEES ONLY :

Purchases of certain eampelgri property costing $500 or more must also be inventoried on Schedule
H. (Refer to Schedule H Instructions.)
Expenditures to personslontities providing consuldna. advertising, fund-raising, polling, managing, organWng
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 orthe candidate's committee.
(Refer to
Schedule G Instructions and Iowa Co de B8A.4 02(3)n .)

(forSohedule B)
 NO .473 P . 1 3i18
OCT .19 .2004 4 :19PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OP FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT S MONETARY

(Rev. 07103) EXPENDITURES
STATE PAC COMIHITTEhb : 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 .

COM EE I$AME (Must be some asQn Statement cff f8nizetlon)

~t

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (ff applicable) (DJsburs&MAW WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
10# <=4='rn'N-ANM 4M lbt4ac*

g" 1~-oV
L la o~
a.
CK# d1."I%U $
4" t~+~ ,an o r3 (

ID# t3t. ,4
Sa o
'A
4110-
e~ayF3.erv C~Sn~l1 aa-
CK# DE S% 1 sS ~~ ~

ID# ~3a U vt~-

a~ -a*
rg~ ,~~ s~3 ( a
LAI g ao
CK#
~,s

G as~.4:'v-~ Q-Rf.
ID# ~rSg~r
C vt~ ~~
CK#~~a( CDC

knww
~e;aZ t~, .~s,~ X0311
- _
ID#
.In,~abr--
4-
°1.17.4 ~-tlS j% C.R,et4Ktt~'No'em .-L som

IQ#
gotl ukx a s4
CK# ~~I s

SUB-TOTAL $ qSSO
TOTAL ((t lest page ofthls schedule)
L s
THIS BOX APPLIES TO CANIDIDATES' COMMITTEES ONLY:
Purchases of certain campaign property costing $500 or man must also be Inventoried on Schedule H. (Refer to Schedule H Instructions.)
Expendlturen to personstentlties providing consulting, advertising, fund-faielng, polling, managing, organWng selvicee muetaleo be detail Itemized on
Schedule G by the amount, purpoee, end data of each type of expenditure made by the pemordentity on behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code 88A.402(3)(I) .)

(for Schedule B)
 4 :19PM 515 222 0610 NO .473 P . 1 4i18
OCT .19 .2004
. .m.,. .

FOR INSTRUCTIONS, SET: BACK OF FORM f , ' . SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIRE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE LJ CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EX(PENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE K:WA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

COP41JITTEE NAME (Mstbearyl o w on Stetenrt o Organization)

CANDIDATE NAME AN DADDRESS TO WHOM PURPOarft AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (11'applicable) (Dlsbursemeng WAS MADE
(MMIDDfYR) AND PAC
CHECK
NUMBER
-_
ID# VloZ) a 77-a PrOL4421- ~r~

C' tI Ota
w. x QA%j' ZA u
l - _
ID# ~~ ~nv~-Rs o ~a`rIWSYaw ~
~ ,-t`
CK,# 'c1918 e"" ~Clo1: C~.,ir't1a.~y=.or. o~Cx~
ks Is
9w~~~A 5019uY4 _
ID# f log roc r
\ wa

& A~,~~ .~0~138

ID# l4~-r ~~?s S ~ -
"~a
~ytu%\04.S Z6Awc)AC~% P
a Q7 -13 & r
ID# ,a aa c«~,M7Nee. 4-0 P\ .

.SA $o
I D# 141\0

CK#'a l

g, oK
CK#agar ~~'a~ 3(
CQ~at ~-~pi~s~SA ~~9c{
~, a$vc( CK# ~4I Lo ti I~v~
SUBTOTAL $. 1 ,d
TOTAL (iflast page ofthis sohedulo) $
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY;
Purchases of certain campaign property costing $300 or more must also be Inventoried on Schedule H . (Refer to Schedule H Instructions.)

Expenditures to persons/a fes providing consulting, advertising, fund-raising, pplling, managing, organizing services must also be detail itemiz ed On
Schedule G by the amount, purpose, and date of each type of expenditure made by the porsan/entlty on behalf of the candidaWS committee . (Refer to
Schedule G Instructions and Iow a Code 60A.402(3)(I) .)

Page of .

(for Schedule B)
 NO .473 P . 1 5i18
OCT .19 .2004 4 :20PN 515 222 0610

FOR INSTRUCTIONS . SEE SACK OF FORM I', : -

i
"
" ~r,~~'
SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 07103)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES; NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST TW CANDIDATE IDENTIFICATION NUMBER IN THP DESIONAT ED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE, ALIST OF ID NUMSERS IS AVAILABLE FROM THE IOWA AMENDING FORM
MICS A, CAMPAIGN DISCLOSURE BOARD.

COMMITTEE,NAME
L (Must be some es n Ststemerrf 10 enizeNon)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION EXPENDED
EXPENDED (ff applicable) (Disbuiaerneng WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# N%*34

CK# aat'4 $ o
~111JWU'~b ~~~0~~

ID# I L+ Q"

CK# rc-ABaa
~,~.. .~ Cr'rj , 15:: a is k1 «P
ID# w,

_ CK# o1'1a`l'

Ip#
q_ ts:-aef CK# saoo "-' cx'i ~

OJ d(\L~,.~ ~~c.,~Sw ~O (pG~~11

- _
ID#

CK#

- _
ID#

CK#

ID# -

CK#

S UBTOTAL

TOTAL WisespageofMiaso*ed0N) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchaese of certain campaign property costing 4500 or more must also be Inventoried on Schedule H. (Refer to Schedule Instructions
H .)
Enpendltures to persons/antltles providing consuhlng, advertising, fund-raising, polling, Managing, organizing services must also be detail Itarnlzed
on
Schedule G by the amount, purpose, and data of tech type of axpehditure made by the person/entity on behalf of the candidate's oornnlttNs . (Refer to
Schedule G Instructions and Iowa Coda B8A.d020)(0.)

Papa

(for Sohsdule B)
 NO .473 P . 16/18
OCT .19 .2004 4 :20PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

E NAME (Mustba seine as on SMtarnent of orgelrlzetlorr) E IN KIND
COMMI (Rev. OBm7 CONTRIBUTIONS
~h~ end~-h Snsu~-aric~ Qy~"f's t~2aw~.
'2011WcOW Ar-for Cornmf-!"te
[~ CHECK THIS BOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED IF FOR

RECEIVED NAME AND ADDRESS TO CAN PIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MM/DDYR OF CONTRIBUTOR " tapplicable) CONTRIBUTION VALUE CONTRIBUTION
Now<<T-%'~Omdallf me7u det - _ Pioneer a~an _
-a4-af u -tOmdahl ~,~

l~S~lu
nsv lie ~l9 .SaO~
~c blv))el~ "~~ AF."7

l --D 55 ~ICket.S

Y
`~ /503 lake houses

La
ZAITW so
Hnxtderd r~ciyred~brlr!
-I-d-~
o r~so
"

~sy A ue AW r3 0

rR Sayb6
0

ir~~ld l"~Sr .sa .~5'so

q0 %44#7

~~+9
star ?~ l03 r~ G'o%ra4o
am~cl ~i
o rvlras~ "
~ x y , ~I+l Ave. w.
Newton,A- 5o:W9
go- ~.e~
- I,S - 04 RDS h1a~ au~n f~lcr~ ~ ;')'~1.Z2 FP1d~ ~
IM
(~ ^.~25 fl'IOVLUI 7A ~ j0? .1~o
~ui-+artr~
y ,a~, a ~f
N; s rl~r~~rl,
MO ~, P,ar l . ~~nro
lYhrd r, xr~ saas~

SUB-TOTAL

TOTAL (if last

page ofthis
schedule)

'Dlsclosum law rnqutres candidates to disclose the relationship of any relative making an In kind contribution to the
Committee. Relationship must be shown tothe third degree of consanguinity (blood relatives) and afflnfty (relatNea (b r 8ahedule E)
bY mwMege), (See Page 2 of forms packet,) Ifsurname of contrlbulor Is the ammo as candidate, but there is no
familial relationship, enter `let applfeable" In the relationship column .
 NO .473 P . 1 7i18
OCT .19 .2004 4 :21PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE]

IN KIND
l7r (Rev. 007 CONTRIBUTIONS
nc~ 1 ~M_VS~AIIGiC e m O ~e
p7~tx64N-
llt7~
~-_ I'
d CMBCK THIS Box IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MMIDDIYR of CONTRIBUTOR (ifapplicable) CONTRIBUTION VALUE CONTRIBUTION
Phi ~~lasdG 2rvii~
{tielbb aI~ .~ . 0
-I -'ao all(
Po~ s~ 511
/IZTC66 Cl Ljo rai s .
100
s~cY>r i6i
air Ge' .~ S~o2 _

arb ~- lVi s~
M~ cws .~.
i~ bay, " 'o
~t F~
-'T~ 5~b is lID

tl ck s
-M SZ7746 -
- . ~
Gll~ !#'vier ,Trte.rc . .
,g ,;,e Hers a1 ht
F rrkl~r~ l~P
o' ~ Psf~~ .T.o .SRo.ST ' ?9 lessen
sl~r~p1~ SSoduJ: S o-F I'B ak_v CLt-

T
3a~'Cr.~nd Ave,, for Bcvr Q&`~"'
- )q 513o I
racer
.ts~dl irfryCfud Ez
wee w6-e*~- T /0/1d/14
" ' . Sao
"1S~smQ0a -74 .4-2bb
x _
Ram 'dt r
a ~C~Gk hU.jZi'
Ing t ~c.~
a3~$lvCrsltr Ave, 3G>d ~Q

rr~ i s~ ~' ~hC

100
rr `r EZ
D ~3D-~L~D
ldn
~-`3°' rISle 0 ,Ts~riaert 9o1Peluh 3t~°
2 a . _ e e
IW, 1A 441 y6
SUB-TOTAL

TOTAL (if last

page of this
schedule)

"Disclosure law requires candidates to dleelose the felatlonehlp of any relative melds an In kind contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives
by montage) . (See Page 2 of forms packet,) If sumame of contributor Is the came es candidate, but there is no
familial relationship, enter "not applicable" In the relationship column.
 NO .473 P . 1 8i18
OCT .19 .2004 4 :21PM 515 222 0610

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

IN KIND
COMM TTRR N (Mustbe same as on Statement of 0 Nzatlo I (Rev . CONTRIBUTIONS
.erp-ah ,o..,k

D CHECK THIS BOX IF

AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER

sO
M/1313") OF CONTRIBUTOR " f malleable) CONTRIBUTION VALUE CONTRIBUTION
S
ct ~, A~,snn~ `cork

~a^3cf5 U .veisl~~~""
SO
,So3:1 Q

ED

El

F-7

71

ED

'Dfsctosurs law requires candklstss to disclose the relationship of anyrelative maidnta an In Idnd contribution to the
COMM". Relationship must be shown to the thirddoor" of consaryulnlty (blood relatives) and affinity (relatives (for Schedule E)
by marriage). (See Paos 2 of forms packet,) If surnameof contributor is the same as candidate, but there is no
remlllat relationship, enter°not applicable" In the relationship column.