FOR INSTRUCtIONS, SEE BACK OF FORM

link Form
DISCLOSURE SUMMARY PAGE
COMMITTEE NAME (Must be same as on Statement of Organization)

IMPORTANT: Indicate by # type of committee you are reporting for :

( 1 )Statewide/Legislative/Judge landing for Retention Candidate ( 2 )State F
(4 )County Central Committee ounty Candidate (6 )City Candidate (7 ),
Political Subdivision Candidate ($ )County PAC ( 9 )City PAC ( 10 )School Board or Other Political
Subdivision PAC (1 1 ) .Local Ballot Issue
Audited

Candidate Name Political Party (if applicable) File with :

-
bl-C Ako ( jeA C(C Iowa Ethics and Campaign
Disclosure Board
Office Sought
©r-
District (if Senate or House) t
510 E . 12 ", Ste . 1A
Des Moines, Iowa 50319
Fax : 515-281-3701
Late reports are subject to possible civil and criminal penalties. Pursuant to Iowa Code section 68B .32A(7)
the carxl' te, candidate's committee, and the chairperson, for any other type of committee, is the
individual r s nsib for filing timely and accurate reports .
S(~ x((00 3 1.5 f 65 . (f at
SIGN TELEPHONE DATE SIGNED

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

(report date) Indicate by #
CHECK IFAMENDMENTTO REPORT DATED Local Committees, enter Date of Election

0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3.
(You must continue to file reports until a DR-3 is filed .) County 8 Local Committees, enter County in
which Election is held Q

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) . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . ., ., . ., . . . . . . . . .

l l? s . t-~o
(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) . . . . . . . . . . . . . . . . . .
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... . . . .$ Q

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .$ ~.E 0
'"'OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .$ S
CONSULTANT BREAKDOWN (Schedule G Attached?) - YES ?SNO
CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ D
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .
For Instructions, See Back of Form SCHEDULE
Form
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candidate's personal funds)

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

0 CHECK THIS BOX IF
AMENDING FORM
CI't" kgo4M
dog- 5-- k+~
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 - PP ID NUMBER --NAAE %1:GLGT~I-.T ~~Zs7 :udI:IniL"L - RELATIONSHIP AMOUNT J IF FOR

RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK Of applicable) RAISER
NUMBER INCOME
ID#
CKO 12-3

ID# C
T- ik
CK# ~-3 L'K Y S-r-A:L '

ID#
CK# 3 C, 9 .S v -ice
~,~6Z l

ID#
ST2-dL% Z EKEr CC. L 57&AW1- lee-, OC
ci- # 81
a d#4 I s 3a~
ID#
C)5. b6 LtA~7 C ~~ ItoWd t.. kJ boo .
CK# sot) & yc -3( 7
sue' - 7l

CK# Pa y l YQ _
06
ID#

CK#
ID#

CK#

ID#
CK#

ID#
CK#

' 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 Page / of
familial relationship, enter "not applicable" in the relationship column . (for ScheduleA)
 FOR INSTRUCTIONS, SEE BACK OF FORM RC90 FO"n 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)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MWDD/YR) AND PAC
CHECK
NUMBER
ID#
c6 we)a~ 5 ~ ~6cri~xf )0*y $ ~iyoo
D~(d5- .

.fir au ,

s.
?o
0~~C.
t%~ jru 63c Rl ow OD
61(- ID#
CK# fi3r
-
I D# )4
44 :s T-" tq YfAi'
CK# wk Ire IJAor .-c ,

(a .
ID#
C"T~~7 p_ peln(A'V'D frmn l(J6
CK# (-75 q 4E . 6 (e6Aw-v 4-3 -7
s mo lu . u s D l
ID#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

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 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 88A .402(3)(0 .)

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
D INCURRED
COMM I E NAME (Must be same as on Statement of Organization) (Rev . 08198)I INDEBTEDNESS
`1'
( 2 e1rUS fJ Y( 04
( -rC) t- ~S [] 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 . 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/DD(YR) TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING
PERIOD'

SUB-TOTAL $

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

'If actual figure is unknown, show "estimated" beside the figure . Page of
(for chedWe D)

CANDIDATE COMMITTEES NOTE :

'Incurred indebtedness also includes each person/entity 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.
FOR INSTRUCTIONS, SEE BACK OF FORM
SCHEDULE
COMMITTEE NAME(Must be same as on Statement of Organization) F LOANS
(Rev . 07/03) RECEIVED
& REPAID

NOTE : This schedule reports money loaned to the committee which is deposited in the committee account. [::]CHECK THIS BOX IF
AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $ 0 .EO

PART I - MONETARY LOANS RECEIVED THIS_ REPORTING PERIOD PART II - MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD
(Originalsource of loan, such as a bank, must be shownif a third partyis (Loans forgiven must be reported on Schedule E -- In-kind Contributions.)
involved. Include loans from candidate's personal funds.)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (Include Endorser's Name, If Applicable) TO CANDIDATE OF LOAN (MM/DD/YR) (Include Endorser's Name, If Applicable) TO CANDIDATE' REPAID
MMIDD/YR) M licable* If Applicable)
$

TOTAL (PARTI) $ -500-o0 TOTAL CASH REPAYMENTS (PARTII)

From Schedule E -- TOTAL LOANS FORGIVEN

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
relationship column when it applies . Page of
(for Schedule F)
 FOR INSTRUCTIONS, SEE BACK OF FORM

I
SCHEDULE

THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY H CAMPAIGN

(Rev. 07/03) PROPERTY

COMMITTEE NAME (Must be same as on Statement of Organization) ATTACH SCHEDULE H TO

EACH REPORT, MAKING
CHANGES AS REQUIRED .

Q CHECK THIS BOX IF

PART I - ONGOING INVENTORY OF CAMPAIGN PROPERTY AMENDING FORM
PART II - SALES OR TRANSFERS OF CAMPAIGN PROPERTY **
Date Purchased
(Schedule B) Purchase Current
or Date Received Description of Property Price or Est. Value at Fair Date Name and Address of Purchaser/Donee Description of Property Sold? Sale Value of
(Schedule E) Value When Market This (MM/DD/YR) YIN Price Donation
(MM/DDNR) Acquired* Report

71a / qq5.f 131),-~ 000

TOTAL VALUE CAMPAIGN PROPERTY THIS REPORT ** PROPERTY SALES & TRANSFERS TOTAL TOTALS $ $
(TRANSFER TO SUMMARY PAGE) $ (TRANSFER TO SUMMARY PAGE) $ ,

* If estimated, show est. beside figure . (Attach Additional Schedules if Needed) Page / of Pages
(For Schedule H)