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13 17S 1 Lu "UNPAID BILLS (From Schedule D - Attach Schedule D)

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13 17S 1 Lu Oct 29 04 03 :18p ESTHERVILLE PRINTING 7123624201 p .2 FOR INSTRUCTIONS, SEE BACK OF FORM FORM DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 07/2003) REPORT For Office Use Only Comm . # Logged In IMPORTANT: Indicate type of committee you are reporting for 1-1 Scanned (t )Statewide/Legislative Candidate (2 )Statewide PAC( 3 )State Party (4 )CountyA-ocal Candidate (5 )County PAC ( 6 )Ballot IssuelFranchise Committee (7 )County/City Central Committee Computer -_-~ Audited CANDIDATE COMMITTEES ONLY: Candidate Name Political Party ~_~ rtvr, 8~L:41Er RPbfut~r`;'rT;th Office Sought District (if Senate or House) U110- to I? 7<eonc' 7 SIGNATURE Or TEE-Rio-ierson filing this report) TELEPHONE DATE SIGNED Late filed reports ar nd criminal penalties. SEE INSTRUCTIONS ON BACK AND COIV1 NCE: ELECTION l(2)NON-ELECTION YEAR. [CHECK IF AMENDMENT TO REPORT DAT~d L Local Committees, enter Date of Election L [~ Check if this is final (termination) report and atta orm DR-3 County & Local Committees, enter County in which is held (You must continue to file reports until a Notice of Dissolution is filed.) Election 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 Contribufions 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) . 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) .. .. ... .. .. ... .. ....... .. ... .. ... ... .. .. ... ..... ... .. .. .. ... ... .. ... .. .. .... ... .. ... .. $ 13 17S 1 lu "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?) NO VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) PRINTING 7123624201 p .3 Oct 29 04 03 :18p ESTHERVILLE For Instructions, See Back of Form SCHEDULE A MONETARY CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03) RECEIPTS (Including candidate's personal funds) CHECK THIS BOX IF COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM ~4) Pc 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. 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 PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND- (MM/DDfYR) AND PAC CHECK (if applicable) RAISER NUMBER INCOME ID# __;erC0a ;chI\5C r 4-1, +h 60 V 1'll e ~TA ID# -T:~ FED tQePrLbll'(oIN h;C)lner-, qt-) 1~~fl5~~l CK# Prs+ ..5~ o N ct ,5 r ID# Gc~cr L lake % fou= :T~ -6-1HISG ID# l,U1/a I mL i~ LiGk i~l^! E'Zr5 hl ~+~ vf .1c f ~ ID# s+ N i,i 51c -0 r CK# I 1 q,35 I i F I,U if c fivc \ Do_ - C"; C, C 1D# 33 y .s I-g p PpG L) 19C E, 756) cK# ~ 0 C711 to, bc, 5 IT)Lo) , n Ic, 1-f4 JCJ /c/o ID# _~ ID# keh^Fn 1-119 IT d 1 4P 1110C !'Q5 - '~(- i`C, ~o'y 1~7 CK# lk1 C, . - ~c CU b~: ~r _' + ru l, l e C', r-`'CIA C> C'? , 4 1 C~~~3I0 cK# SUB-TOTAL TOTAL (if last 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 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 Schedule A) 7123624201 p .4 Oct 29 04 03 :18p ESTHERVILLE PRINTING FOR INSTRUCTIONS, SEE HACK OF FORM SCHEDULE EXPENDITURES -- B MONETARY MONEY SPENT FROM COMMITTEE ACCOUNT (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. CO MITTEE NAME (Must be same as on Statement of Organization) r-en i3 LL4 ) F r -For Stde Pe a? 5crda~i 1" PG CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT DATE 10 NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED EXPENDED (if applicable) (Disbursement) WAS MADE (MM/DDIYR) AND PAC CHECK NUMBER ID# r4_Ct^ FceyJ Se rig j? FS FCLe.'G 2j ~ .'e3 //F~ C. eC -6~ CK#) 5ojL)Jo et- $ let), lom~ U 1 ID# SL~ 1 f~ n~~ e'tYcan cy~;, e-- ~~,~ c-S P sac p6,1V)CCA~ e s' ~ lch5/~~ti CK# ~a ~Lpt -7 7 ac> r\ rs Y-h Frcr ril e" ~IC/~~lle NL>y~t- !V/-/.I L-CL 17E CK#/o 7 Y 701'~=iG.1'Z'~ ~y Es,tli Frp t 11 F _TA,6133 ID# bl d ct)rV C--r\:r .s i,n 61'.9),', `16 j s Wr-/51(S1,,i, ~) er tit Ll~57~~r~ CK# 16 7(; 30-f i\ 91- onu&n ort-T-l .5 6.4 C{ts~ofl :s~~~~r~c) - rti"Ec~ ti ecvs Pap,(~,Y :91"T 6-4 it, 10//7/ey E .s1PS' Des . ; PT-0 -6-C-56 ducr-4, ID# CK# ID# CK# ID# CK# SUB-TOTAL 1 $ 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 personientity on behalf of the candidate's committee. (Refer 10 Schedule G instructions and Iowa Code 68A.402(3)(i) .) Page of ___ ______ (for Schedule B) p .5 Oct 29 04 03 :18p ESTHERVILLE PRINTING 7123624201 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE E IN KIND COMMITTEE NAME (Must be same as on Statement of Organization) (Rev .06i97), CONTRIBUTIONS . ' -- F tt^C' \ 7 Pr S" C'i L'L I~' e fle Q 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 (MMIDDNR) OF CONTRIBUTOR ' (if applicable) CONTRIBUTION VALUE CONTRIBUTION (r n _ r, - ~O i' aFS 1 5T i 6 ~t F-0 F- g y,, i;m fc tP o .ki) t A s l t C-4; A) Lo 6- -599-7 a 0 o 0 F-1 Q a TOTAL (if last page of this schedule) t 'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page j - 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 . 01/.19/2005 18 :28 7123624201 ESTHERVILLE PRINTING PAGE 53 a~ I I Check I0 1~4 W QS -Cc a P'-~ e -,E>+ 4 CC! v,)dr d,66 l tA Oc(n Pan e&P er,se -`'c h ed Ld e e i r-~o~W~r ~ vn CQrnCer~nry~g the Utcrory Ervt~,t-Prises Xc~r~ leas' mnrn~urs~ V-h~ c~omm i"tl 78 . ly -from 4hc Laura ~tA6h o^a,llq . =t 11 5'Io(o 04 C')(-) no X-l refit as if vcc (A Q-66 0-flp r Ua 3 I . Cl) C-)c k 1006 1 5 "t,\ 4--+Q FOR INS TRUCTIONS, SEE HACK OF FORM SCHEDULE G BREAicaom I COMMITTEES OF MONETARY THIS FORM 1S USED BY CANDIDATES' ONLY (Rev. 02M6) EXPENDITURES BY CONSULTANT CHECK THIS BOX IF COMMITTEE NAAAE(AW be same as on SWenrent of Orgarvmtean) AMENDING FORM K40f.\ Stl (Ft'4-- SfaJe s l PART II- FTEM¢ED BREAKDOWN OF UNREIMBURSED EXPENSES PAD 6Y CONSULTANT TO OTHERS IN PERFORMING SERVICES OF CONTRACT (These expenses should NOT be PART I - NAME AND ADDRESS OF CONSULTANT reported an Schedule S,sa tMy acs direct Psymsrrt from the consultant) Nam of Gorrsufant DATE EXPENDED NAME AND ADDRESS TO WHOM EXPENDITURE AMOUNT uic+Fq ~ :~[- Uf 5C-'~ IHM1D WAS MADE PURPOSE EXPENDED MaliIng Address 4 IM ,. 5'o :~o+.~, 5f, 5' i 1 .
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