FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

(Rev. 07/2003) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only ,

& 90OCk Fogy POD/Tor_ ZOV Comm . # 1

Logged In
IMPORTANT : Indicate type of committee you are reporting for:
Scanned
( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party (4 )County/Local Candidate Computer
(5 )County PAC (6 )Ballot IssuelFranchise Committee ( 7 )County/City Central Committee
Audited
CANDIDATE COMMITTEES ONLY :
Candi ate Name :" PJ4Ri~al Party
(.1b(A /3 13fifojj'c)Ck ' ah'0Ck1TIC
Office Sought District (if Senate or House)

0141CH19S40) (20ulv74 14Ub17-0 k,

k/ I - 3qU- u~ '7 5 - (0 - a ooh

SIGNATURE OF REASURER (or person filing this report) TELEPHONE DATE SIGNED

Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A m qt 1q, 0OS a
REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one
CCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election
lYooefrlacR 'q,
"7 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 Notice of Dissolution is filed.)
eftl ctcA Sf3lc)'

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 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) ... .. ....... .... .. .. ... .. .. ..... ..
(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) .. .. 9-Q. 9b
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) ...... ... .. .... . .. .. . .... .. ..... .. ..... .. ...... . .... .. ....... .. .. $ /Y--p
*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 F-INO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)
 FOR INSTRUCTIONS, SEE BACK OF FORM ` 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 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 as on Statement of Organization)

6imm,- P F 4oo
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# NEW HRMPTO N _
IPIRU F (%4AIPj4tGN ~~~c.E.osuRE
~H C-REnOIIEW ~Ror~ $ l~.
cK# U
l~E~ H~mPwN, 6L50-
ID#
,IIV, P lga b e o c'k. To O~LDJC OU7-
cK# 8I1rvK ( 9 7 ~3~7~ S'r ~ ~
~E l5 (?~ T8191YSFE NEW PPM/97_01y, l C.- ~n P~ ~c~ / c o u rv~r- ~~, 3(d
ID ~rn G' fl~1Q~~GN 1196300yr
0&59

CKr
To PE ng(. /~Cwuiv/

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $

TOTAL (If last page of this schedule) $

99,96d
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) .)

(for Schedule B)
 Notice of Dissolution FORM
DR-3
(Rev . 07/03)

NOTICE OF
DISSOLUTION

For Office Use Only

Comm . #
Indexed
Audited _
Computer
Certified Date f Dissolution

COMMITTEE NAME

acgcock FOR PU ~ITC-R 6~00V

Official Name of Committee

Tl
~? 3s l SI
Street

NEW (/)qm PTV nr, --EOW/9

City, State, Zip Code

2Q4 -c/r' -~ 7
Area Telephone
Code

WHEN TO FILE:
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following :

1. All debts, loans and obligations have been paid or transferred ;

2. All campaign funds have been spent ;
3. All campaign property sold or transferred (candidates only); and
4. A final report disclosing all transactions closing the committee .

For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed.

0"
Signature of Can ate or Treasurer (if candidate's committee)/Signature of Chair or Treasurer (if PAC)
5- (P A005-
Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM

This form is not applicable to statutory political committees .