JAN-20-2006 02 :22 AM CAPITOL BINDERY 402 342 5511 P .

03

I
FOR INSTRUCTIONS, SEE SACK OF FORM FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Moat be same as on %&&wmnf of Orpnlzedon) (Rev . 1212006) REPORT

EX h®ce Use ordv

comm .
IMPORTANT: Indicate by A type of aommMes you am reporting for ~ Logged In
( I )SletwMdaUgielagvWJudge Standing far RMmMon Candkie (2 )$Me PAC 13 )State Party Scanned
(4 )County Central Cornmlnes (e )County Candidate (9 )City Candkiate (7 )8dhool Board or Other Poisical
Subdivision Candidate (e )County PAC (e )City PAC (10 )School Board -or Other Political Subdivision PAC Computer
(11 ) LOW 1361101 Issue Audited

Late reports ere sub* to possible Clot and crirnlnal penalties, Pursuant t0 Iowa Code section aga.3?A(T) the candldela, for a candidate's committee,
and the kiwiirper~pn, for any other typo of committee, Is the Individual responsible for NN timely and ecrxtrate reports.

SK1A l~lkE OF PElWft

~ FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A ®~wf1 REPORT FOR (1) ELECTION 1(Z)NON4ELECTION YEAR.

(report dab) Indicate by #

©CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date dElection

Check If this is final (termination) report and attach Notice of Dissolution Form DR-3, County a Local Committees, enterCounty In
which Election Is hold
(You must continue to file reports until a DR-3 is filed.)

STATEMENT OF CASH ON HAND

all
CASH ON HAND at the beginning of the reporting period_ (Total of funds held by the
eommittae. This amount MUST be the same as the cash on hand at the end
of the test reporting period or must be zero if this Is first report filed,) ................. ........ ............ .....5
ADD TOTAL MONEY TAKEN IN TH13 PERIOD .
Schedule A: Cash ConMbutlons total (Attach Schedule A) ('also see in-kind bemv). ................. . 7 /
Schedule F: Loans Received total (Attach Schedule F) '-
Schedule H: Total Sales of Campaign Property (Attach Schedule H) .. .................................... ..... ..
JSehedul H apNss to Candidates' Commkteoe Opt )
SUB-TOTALr:::......6
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Fivenditures total (Attach Schedule B) ("also see debts and bans below) ............ s z z- ~ I
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 DR3) . .... . ........ ....... ........ . .... ........... ........_............... ....... ................. ........ ..... .. . . . . ..S

"UNPAID BILLS (From Schedule 17 -Attach Schedule D) . .... ............ ........ .... .... ..... ..._ ...._ .. ..... ... ..... ........ ....5
'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) ... . ....... . .... ... . ....... . ....... . ....... . ........ ....$ 1740 4T
"OUTSTANDING LOAM (From Schedule F - Attach Schedule F) ..........._ . . . ... ... . .... . .... . ... . .. . . .. . . ... . . .. .... .... .5
CONSULTANT BRLAKDOM (Schedule G Attached?) -YES
CANDIDATE MTT'EES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) S
STATE COMMTTEES: Submit a rooonelled campaign account bank statement In January of each year .
JAN-20-2006 0 2 :23 AM CAPITOL BINDERY 402 342 5511 P .04

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candldate'e psmonsl funds)
~] CHECK THIS BOX IF
COMMIME NAME (Must be same as on Statement of Organization) AMENDING FORM

STATE CANDIDATES NOTE, IF A CONTRIBUTION 18 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.

CAUTION: Section 68B.32A(6), Iowa Code, 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 PA ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR

RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
IN ( 1 l .~~

C KO
SLY` wr lr .~
IDM

CK#

ID# , ctrl( C(n/Yynd r 2, _

-,~ CIC#

IQs
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Oa~~
CK#
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ID#

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i
ID# '

CKiV

ID#

CK#

ID#

CK#

ID#

CK#

Disclosure law requires candidate committees to disclose the relationship or any relative making a oontribudon to the
committee . Relationship must be shown to the third degree of consanqulnlpr (blood relative®) and affinity (relatives by
marriage) . If surname of contributor le the some 95 candidate, but there Is no Page of
familial relationship, enter "not applicable" In the relationshlp column . (for chedute A)
JAN-20-2006 0 2'23 AM CAPITOL BINDERY 402 342 5511 P .05

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B
(PAY, 07/03)
MONETARY
EXPFNDITURES
STATE PAC COMmiTTEl18 : NOTE : FOR CONTRIBUTION$ MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D 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 es on Statement of Organization)

_
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

S
CHECK

w
NUMBER
wl e n;y d S'cF -1' F
ID#
v- O

Pvin A I
i;il r

o,~
cK# IJ
-r.s I ~2
1 7.

H ~c~ ~ ~ 5 Sam met 1 LR..t's

CK~D

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

1D# -

CK#

SUB-TOTAL
TOTAL (IF last page o! this schedule) $ .S ,
.7
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY ;

Purchases of certain campaign property costing $1300 or more must also be Inventoried on Schedule H . (Refer to Schedule H Instructions.)

Expenditures to personatentltles provldlng 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 0 Instructions and Iowa Code 6BA .402(3)(I) .)

(for Schedule B)
JAN-20-2006 02 - 24 AN CAPITOL BINDERY 402 342 5511 P .06

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

E IN-KIND
E
COAAM1 , E (Must be same as on Sfsfem@nt of Orpankadon) (Rev, QM7)` CONTRIBUTIONS

h a.! '-
© 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
MIIA2WR OF CONTRIBUTOR " M Ilt a ble CONTRIBUTION VALUE CONTRIt3 ION
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'Disclosure law requires candidates to disclose the relationship of any relative making an In kind contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives '(for- Schedule E)
by marriage) . (See Pap@ 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 .