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Fo r I n s t r u c t i o n s , Se e Bac k o f Fo r m- CONTRI BUTI ONS - MONEY TAKEIJ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )

COMMI TTEE NAME ( Mu s t be s ame a s o n S t a t e me n t o f Or g an i z a t i o n), ~

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C" , 1 7 Z1 1 ' 9 S r - ' 1 11 1- 1 17 77 e- i t

SCHEDULEA MONETARY( Re v . 1 3 1 9 7 ) I RECEI PTSI F CHECK

T HI S BOXAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r any comme r c i a l p u r p o s e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT 4 I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

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3/35

COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f O r g a n i z a t i o n ) I F AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y an y p er s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S E RNUMBER I NCOME

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Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r m SCHEDULE. - CONTRI BUTI ONS - - MONEYTAKEi J A MONETARY( Re v . 0 6 / 9 7 ) I RECE I PTS( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )

CHECK THI S BOX


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Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKESJ

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)ZC/-Q/ A1 0) C t r t C, 1 7 Z . P / 2S 6, n,me SCHEDULEA MONETARY( R ev . 0 6 / 9 7 ) I RECE I PTSQCHECK T HI S BOXI F AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTR I BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: S e c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y an y p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

DATE PAC I D NUMBER NAME ANDADDRESSOF CONTRI BUTOR RELAT I ONSHI P AMOUNT ~ I I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-( MM/ DD/ YR ) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN a N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mus t be s ame as on St at ement o f Or g an i r a ho n )

STATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S A VA I L A B LE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUT I ON: Se ct i o n 68B. 3 2 A( 6 ) , I o wa Code, p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r any c o mme r c i a l p u r p o s e b y an y p e r s o n o t h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

0 CHECK T HI S BOXI F AMENDI NG FORM

DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ 1 I F FORRECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

-I D# I Wg ? v7 - / 3 L 4 O ` ~ ' 3 r c k 5 d - ~Ul ~ l CK# De 5 ( Wt y \ eS ~ t N ~ G3 ( -

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Fo r I n s t r u c t i o n s , See Back o f Fo r m' CONTRI BUTI ONS -MONEYTAKEi - A

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be same a s o n St a t e me n t o f Or g an i z a f i on )

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SCHEDULEA I MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSI F 0CHECK T HI S BOX

AMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c omme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME

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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r m' CONTRI BUTI ONS - MONEY TAKEi . N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TT EE NAME ( M u s t b e same a s o n S t a t e m e n t o f O r g a n i 2 a h o n )_ _

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STATE C A ND I D A T E S NOTE I F A C ON TR I B U T I O N I S R E CE I V E D FROMA S T A T E P A C ( P O L I T I C A L A CT I O N C OM MI T T E E ) , L I S T T HE P AC I D EN TI F I CA TI O NNUMBER AND T HE P AC CHECK NUMBER I N T HE D E S I G NA T E D COLUMN A L I S T O F I D N U M B E R S I S A VA I L A B L E FROM T H E I O WA E T HI C S AND C A MP A I G ND I S C L O S UR E BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s

SCHEDUL EAI MONETARY( R e v 0 & 9 7 )RECEI P T S

CHECK T H I S BOXI F AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT ~ 1 I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED FUND-( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

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Fo r I n s t r u c t i on s , See Bade o f Fo r m' CONTRI BUTI ONS - MONEYTAKEI . . N

( I n c l u d i n g c a nd i d a t e ' s p e r s on a l f u n d s )COMMI TTEENAME ( Mus t be s a me a s on St a t emen t o f Or g a n i z a f f o n ),~~~Al l vn ~ ~~Z(nS~Ynm~~l te

SCHEDULEA MONETARY( Re v . 0 6 1 9 7 ) I

RECEI PTS

I F 0CHECK T HI S BOXAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I CA L ACT I ON COMMI TTEE) , L I ST THE PAC I DENTI F I CA TI ONNUMBER AND THEPACCHECKNUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L A BL E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD.CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code, p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i on s o rf o r any c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ l I F FOR

RECEI VED ( i f a pp l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SERNUMBER I NCOMEI D# F e A i e i ' a P0 uA l Ul CK# Ml l ~ kNS, ( f i r $ ~S-D S K2 ' A - 5 t i 1 4

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Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE"

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mu s t b e s a me a s o n S t a t e me n t o f O r g a n i a w t i o n )4dia l l on ); r - ChZ e 1 7 s I L I Z r " f k , t e e - e

SCHEDULEA MONETARY( Re v . 0 6 3 / 9 7 ) I

RECEI PTS

I F CHECK T HI S BOXAMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTR I BUTI ON I S RECEI VED FROM A STATE PAC ( P O L I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N TH E DESI GNATED COL UMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e es .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELA TI ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE" RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

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10/35

COMMI TTEE NAME ( Mu s t be s ame a s on St a t e me n t o f Or g an i z a t i o n)C17 2e/o ,m

CI F

AMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P O L I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAMEAND ADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

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Fo r I n s t r u c t i o ns , Se e Ba c k o f Fo r m SCHEDULECONTRI BUTI ONS - MONEYTAKE . N A MONETARY( Re v . 0 6 / 9 7 ) I RECEI PTS( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s ) OCHECK THI S BOX


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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r m' CONTRI BUTI ONS - MONEY TAKEi . . N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n ds )COMMI TTEE NAME ( Mus t be s ame as on St at ement o f OWni zat hon)G~l " Q~~Dn

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SCHEDUL EA MONETARY( Re v . 0&97)

RECEI PTS

CHECK T HI S BOXI FAMENDI NG FORM

STATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMASTATEPAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I STTHE PACI DENT I F I CATI ONNUMBER ANDTHE PACCHECK NUMBER I N THEDESI GNATEDCOLUMN . A L I STOF I D NUMBERS I S AVA I L ABLE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B. 3 2 A( 6 ) , I o wa Code, p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o se b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PACI D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ l I F FOR

RECEI VED ( i f a pp l i c ab l e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPACCHECK ( i f a pp l i c ab l e ) RAI SERNUMBER I NCOME

I D# C o , 1 ~ ' e v i v ~ ~ e Swa - t ~ al L~~ CK# i 33 ~h~D6M- I l k 5T> 3 l 3I D # Ran { ( Z p h ; n 5 ~ ~

q CK# 5~3 5 I v Govwl L~' *: L OI / i C t r h 5>2 - 1 t 5I D # I \ p ~" r V ( G j 1 1 2 . r 't CK# ~ , b 0 - >E ( ( ' - F E D - UV e 6 M o i ' v j ~ e S ~~ 3 ( 6I D # a v , ` 6

t ( a , ' 7 (CK# 5M TA- X316I D # U n t l c a i a r , Q Wt ~ M e c t . QI ` ~ } Z2U 7 e ~ - h ~ -CK# U v ' ~ A h c ~ 4 ~ ~ . ~ ' / ~ ~U3Z 2 .

I D#CK# Go d Q. A . , v - c A - - o ,p 5 J V - L 1 , A - 5VI D # ( ~ ~ ( ~ ~ ~


12/35

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS -MONEYTAKEo _ . N

( i n c l u d i n g c a nd i d a t e ' s p e r s on a l f u n d s )COMMI TTEENAME ( Mus t be sa me a s o n St a t emen t o f Ory a n i z a b bn )

C/ 22Pr ?S' ~Mrn

P2

STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I TI CA L ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I L A BL E FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Code, p r o h i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i bu t i o ns o rf o r any c o mme r c i a l p ur p o s e by any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA I MONETARY( Re v . t N/ 9 7 )

RECEI PTSQCHECK THI SBOXI F

AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT q I F FOR

RECEI VED ( i f a p pl i c a bl e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SERNUMBER I NCOMEI D# #4~I . . . . . . , . F VQ? _ e ( Gl r

t IP( 7 A r l t r l } w, -CK# DSM I aS

I D# m r _ ~ ~a e P - t MGCav 4- ~` ' CK# k l o c p 3 q ~ t i - ~S'Y9SM TA 5 b 3 t

I D# "er f - P, r i e v 'r L CK# ' t - 7b Swt , ' Qom' /r - k 1 0 SA So(3~

I D* _ zC_ ; 1 S f F wbQCK# 3 ` t a c l

5 / Ul ~A s l , ( 3(

I D# ~ a 5 aVv~ r ( c l dt CK# p S ~' A 0 3 ( 3I D* 0 a v , ` d Ur v 5 VCK# a Z 0 1 - 1a0 TpVC, , Fa t ~~I ' dl Yi d ajL a " r y e , 4 S' ? 5I D#


13/35

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - MONEY TAKENA

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u r K l s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or p a n i z a f f o n)j F-4 110A

~r

Z Pv~S

CZ/ "mI ~~e-e

SCHEDULEI IA MONETARY( R e v . 0 6 / 9 7 ) I RECEI PTSQCHECK THI S BOXI F

AMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : S e c t i o n 68 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r om r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r any c omme r c i a l p u r p o s e by a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSH I P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

I D# 7 7 7 t 3 ak ~' SI ( CK# 5o t Co [ 1 e4 ' e Ave - 5 -A- 1 A 3 ' 0 LI D# C h 4 t ` ~ t ( 0 l ev ~k CK# l $ I Z 5 +A n s~ 5 ? > 3 t o

I D# j owt I CK# 5 l O S t i t r t V + I ; I - - - l U O1 )SMTh

I D# C) or o4 6, l i n4 v hCK# ( , S 3 c / Ah AP1e- CJ~SN1 ZA 6 1 - ' , 1I D # k R i c l r + r d P f " , I M3caq4 0 5 3 - 7 Ff 5 rCK# ( 5M- ~ A 3 12I D# p1 & 7Cv , ~ - ~1 V l u f ~ ^ ( ~ bhCK# 407 ( o 5 + - - ~a5 r ~ 2 6 - - 5 b (


14/35

Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE _ . N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mu s t b e s ame a s o n S 7 a t e me n t o f Or g a n i z a t i on )

f -_ o l l nn4

C, h Z P r z s - CDmm7 r t _ , e e

SCHEDULEA I MONETARY( Re v . 1 ) 6 / 9 7 ) RECEI PTSI F CHECK THI S BOX

AMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D E NT I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON : Se c t i o n 6 8B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r om r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT d I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME

I D# V l a d 5 1 ~ 1 ~ ~ n e ~ ~/ ( 7 1 0 1 CK# 3 ' 60 ~ + - 4 ' A- 55M - , + 5 0 3 t 3I D# L4wq r a &, b r ,CK# 5L$ , G. I L f a , K SOC e d o r P a t ( - , ? P - 5 0 (1 ( 3I D# Wa d a t e

` ' CK# 5?FM pl ea s a n t - D,25 A k _ ' A 5 ' 0 : NZI D# De~ ~~~' e v t s ~ et nr ~ CK# 7 0 L U. ~ at ( CPX ' aS~ ~ - 5 ' a 3 ( 6I

I D# ~ o t C , r Z n ~ l e wl v lCK# -( e _ y y ~ L CC P( - h 1~ 3I D# G v 4 . A I R noCK# ( S ' ( D 3 , - J r? r -5W~ v o r i a t - ' h - S c~oUqI D#


15/35

Fo r I n s t r u c t i on s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE . - , N

( I n c l u d i n g c a n d i d a t e ' s p e r s on a l f u n ds )COMMI TTEENAME ( Mus t be s ame a s on St a t emen t o f Or g a n i r a b bn )L~J ~c?l l on ~i '

~~ ' 7 ' i e r ~ S C~r nml ee

SCHEDULEA I MONETARY( Re v . 0 6 / 9 7 )

RECEI PTS

CHECK T HI S BOXI FAMENDI NGFORM

STATE CANDI DATES NOTE: I F ACONTRI BUTI ON I S RECEI VED FROMASTATEPAC ( POL I T I CA L ACT I ON COMMI TTEE) , L I STTHEPAC I DENTI F I CA TI ONNUMBER ANDTHEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L A BL E FROMTHEI OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t s t h e us e o f i n f o r ma t i o n c op i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o rf o r any c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAMEANDADDRESSOF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ 1 I F FORRECEI VED ( i f a p pl i c a bl e ) TOCANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SERNUMBER I NCOME

I D#2I l 1 w l Q 5 $ 3 5SA^ - -CK# f h a s h , ~ n k r ~ . ~~ S~ 3S3I D#

/ l y~01 CK#I D#

_~ i l ~ f ~7 l CK# Za I 5E + I , , C4 - / c c )C ) 5 Y~ ? ' A ~o317I D# ~ ' a c Ka h e g 6 nCK# - ) O t 57c- 2 . G O- c - I - - U

5031I D# J o a n n e T q ~ a Y i c cZCK# 3> 3 Un I V, A v e -i n n ~- A 5031

1 I D# ~h ~c l ' G~ ' 5 A ohr. fCK# m- } UC~ ~f f Ij s1~, 1 - J - A 5 ?~ 3( 3I D# r n o l r ~ p ~


16/35

F o r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKE . _ . N

( I n c l u d i n g c an d i d at e ' s p er s o n a l f u n d s )COMMI TTEENAME ( Mus t be s ame as o n St at ement o f Or g an i z a t i o n )4~~a/ / an 4T-. , 6AZZt -) S i ~mml l t 'STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T IC AL ACTI ON COMMI TTEE) , L I ST THEPAC I DENTI F I CAT I ONNUMBER ANDTHEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I STOF I D NUMBERS I S AVA I L A B L E FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 )

RECEI PTS0CHECK THI S BOXI F

AMENDI NGFORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D#

1 0 1 CK# ) ) ` 7 5 S h o ~ z : ~ 2 C 1y r r ey l ~ , ' , c c I C II D# j 1 5 ~ PX ' Co r . r a i a r v e an CK# S wi ' SbI D # V C h ~ e ~ ~ c ~ c t l l s F a t ' h r r r - , i n -m lCK# ~sS M

.A v e - 1~uw ( C ' C ;- - - P A 5 - 0 0 0 3I D # ) r r I V 5

CK# 3 L - (wI - 1 i vi ew l c r n) )i u G1 CmI D # To ~ , r C, f 4 s n

~D f 3 o x ~ 5 ~ 1c K# c a m , , ~ ~ _JA 5U~l D# j - E - e l e . v \ -4~~CK# ~O l . p Gt r L( , v a s SA j AI D#


17/35

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKE . . . . N

( I n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )COMMI TTEENAME ( Mus t be sa me a s on St a t emen t o f Or gan i mbon )

Y- 4 / / DO

4y- CI ~7 -t e, 7y

Mr rn

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( P OL I T I CA L ACT I ON COMMI TTEE) , L I ST THEPAC I DENT I F I CAT I ONNUMBER ANDTHEPACCHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVA I L AB LE FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD .CAUTI ON: S e c t i o n 68 B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t s t h e use o f i n f o r ma t i on c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i on s o rf o r any c o mme r c i a l p u r p ose b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTS

CHECK T HI S BOXI FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ~ 1 I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

2l ~ g C ~ I CK# ~ .731 a ~ ( 6

l D# . ~GVt a~ - + t g h ~~ S .CK# 430$ Gi ' n c 4o AM a o) ) 5 ) n 1- , 4 5C :3 ( 6I D# E r i e - 5 k m k o r ( vCK# MS 3 r r j n + - 1 V L .0 l ' de r 5 3 3 c t o 7I D# ~~~a CI r OI J ~1 lCK# l ( ~ S ' y 5 0 1 5 . 4 - -- ' ~ A - 01 lI D*

-WW5 ` .CK# D5" - ~ _A 5 o 3 (I D#

c L i l 4 y k v - ~ `0 / v n l h , SOCK# VSm_ ~k 5 o3 (I D#


18/35

Fo r I n s t r u c t i o n s , Ses Back o f Fo r mCONTRI BUTI ONS -MONEYTAKEk . . N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be same a s o n St a t e me n t o f Or g a ni s at i o n)

1l l ~~

- r ~:

ZP / >S ~r n r n .

STATE CANDI DATES NOTE: I F A CONTR I BUT I ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACT I ON COMMI TTEE) , L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i o n 68 B . 3 2 A ( 6 ) , I o wa Code, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c omme r c i a l p u r p o s e by an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SCHEDULEA MONETARY( Re v . 1 ) 6 1 9 7 ) I RECE I PTS

I F 0CHECK T HI S BOXAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TOCANDI DATE' RECE I VED FUND-( MM/ DD/ YR ) AND PACCHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOME

I D# . SYeVI e YY l , c kel s~ 1 2( o Gl CK# l S ( 5 S~ h 5_5 5 - 0 vm I D# Gv i 1 1 i Mt , n n w1^I

CK# v 3 5 u v n n n w s + - d S -~ r i n r e l ~ ~ ~ r _ a l I ~I D# Hc l ` n ' I Gt - ~e9 ~( mCK# l ( 0 0 3 Ca w l wS - l s -Ce r r FtI D# ~eo e _ w e l d - .

t CK# g6BU C4~ GY ' l GOI D# c k n 5 o d W l` I CK# ~$ ~ 3 5 ? a 51 G~I D# Ma ~o ~ 3 l w n w n ~ f - I ~ t a ~( CK# 9 s 1 5 . 3 5 4 - \ 1 66t vNk 1 A_ S r 1 Z 6 S _I D#


19/35

F o r I n s t r u c t i o n s , Se e B a c k o f Fo r mCONTRI BUTI ONS - MONEY TAKEN( I n c l u d i n g c an d i d at e ' s p er s o n al f u n d s )COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i m# o n )

l ~/ f ad ~

L ~Tl Zc ' r ~S (~rnm~ l i P~~

SCHEDULEA MONETARY( R e v 0 6 / 9 7 ) IR E CE I P T SI F 0 CHECK T H I S BOXAMENDI NG FORMSTATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ONNUMBER ANDTHEPAC CHECKNUMBER I N THE DESI GNATED COLUMN. A L I ST OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON: S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mm i t t e e s .DATE

PAC I D NUMBER

NAME AND ADDRESS OF CONTRI BUTORR EC EI V E D

( i f a p p l i c a b l e )( MM/ D D / Y R )

AND PACCHECK-NUMBER

4r 1 , K 1 ~ t

K0 ( ~o t

CK#I D #CK#I D #CK#I D #CK#I D #CK#I D *CK#I D #

~- ~t ~ n c e S ( Z c ; l h e~s i

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- 7730Hnr~t i c kCl t v e- _ ~r A

5 w - ! ) a ; 'i s ~ b e e - F e d 6 e - ~ ~

l Wb 1 t i ' t ~~ J~%~~Ta r n i _ - ) i+- . h v n

1 1' 4

v - r l av _~

?y ' - t A grbu. r \l U ~s

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5-0313

J o C~_l 5 _k"wl pycr071A 2 1 ~ 1 - 5 -0- 5 4 6( , v 10xA_ t Nz Uwl n

a0

16

R E L A T I ON S H I P AMOUNT I F FORTO C A ND I D A T E ' RECEI VED F U N D -( i f a p p l i c a b l e ) R AI S ERI NCOME


20/35

Fo r I n s t r u c t i on s , See Ba c k o f Fo r mCONTRI BUTI ONS - MONEYTAKE N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t be s ame a s o n St a t e me n t o f Or g a n i z a t i on )Z, \ 1 ) '

t ea/ / o o 2- Y- 7/7 2en S .nm1 v P eSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD .CAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i e d f r om r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p os e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDULEA

[ RECEI PTSMONETARY( Re v . 0 6 1 9 7 )

0CHECK T HI S BOXI F AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI S ERNUMBER I NCOMEI D# R~ h n , ~ rCK# r

X 75Ap , ' t ~A< < I D# pe yf j

CK# L i t 4 4 g5bI D# - I ' o an n ~CK# 3 5 ~' ~ ~n w ,

X- A c: 31~I D# - CYCL f j ` e 1 ; 9 0 4 VYZ Ar y

1 9 TA 5- 0 ` 5 \ 3< < ~

~ I SAW' t -XO A \ - e - /~" c I , ~ ~ Su5 . -I

I D# `IU~e~~e52V1~I CK# f i t s , r t e s S t ~F l v

I D# p a A, Uf 1 1


21/35

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONf TRI BUTI ONS - MONEYTAKEN( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g an i r a #o n )

SCHEDULEA MONETARY( Re v . 0 6 / 9 7 ) 1 RECEI PTSI F 0 CHECK T HI S BOX

AMENDI NG FORM

STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARDCAUTI ON : Se c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c op i ed f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c ommer c i a l p u r p os e by a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SS OF CONTRI BUTOR

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CK# 3 ~ A q l 5 c -


22/35

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKr ' N

( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame as o n S t a t e me n t o f Or g a n i z a # o n )Col el i o n C i - 1 7 Z Ps ~ ~ j ' C

STATE CANDI DATES NOTE : I F A C ON T R I B U T I O N I S RECEI V E D FROM A S TA TE PAC ( P OL I T I C A L A CT I ON C OMM I T T E E ) , L I S T THE PAC I D ENT I F I C A T I O NNUMBER AND THE PACCHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o m m e r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE ' RECEI VED FUND-( MM/ D D/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOMEI D# CGy, 64 c l ~ ~ e - -1 6 2

I D# c - - ~ ~ ~ e y v t - I , d 5CK# 30 ~ J ~ 1 1 v k - S1-

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I CK# tI D# 4 04 6 ( A


23/35

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAK(N( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s a me as o n S t a t e me n t o f O r g a n i z a t i o n )P: ~ ' / / /v / )

-f V1 ` C, 1 7 Z P~ ' 7 S

Cem1 1 - 1 t f : F - e ,

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) IRECEI PTSI F CHECK THI S BOXAMENDI NG FORM

STATE CANDI DATES NOTE : I F A CON TRI B UT I ON I S R E CE I V E D FROM A S TA TE PAC ( P OL I T I CA L A CT I O N C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DES I GNATED COL UMN. A L I S T OF I D NUMBERS I S A V A I L A B L E FROM T HE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD .CAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o m m e r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

~ ~p ( l o ( CK# Z - 1 O ~ I ~ A& V+ o mI D # fGt - C c , v , - , 1 l ea

' ( c K# ~ a ZSLCay -I D* j ~ 1 1 ~ 2 I ~ F7v5 ( I ~CK#

( f , k AI D# j ~ \ ' - p `l i l t sC-11~ ~ ,1 ~ ~UL l 1 ' 1IL ql 4 e , gy p G j > r -CK# p j V - t - A- 5&3

I D# P> ; Cc ~ i 1 c L i ac K# S -f NM- ~ 5' C3 1 1I D# V' e - f r i 5 ` V wr ~ a vCK# ~ ~ ' ~ ~~ I w~ b a ~ ~ ( ~ 1 ~ 5 -070I D# a N I A s


24/35

Fo r I n s t r u c t i on s , See Badc o f Fo r mCONTRI BUTI ONS - MONEY TAKE' N( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME ( Mus t be s ame as on St a t emen t o f Or g a n i z a t i o n ). ZcJ

C/Zt / 7 S'

cz) rn r r % A l l ee-

SCHEDULEA MONETARY( Re v . 1 6 / 9 7 ) I RECEI PTSI F 0CHECK T HI S BOX

AMENDI NG FORM

STATECANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROMA STATEPAC ( P OL I TI CA L ACTI ON COMMI TTEE) , L I ST THEPAC I DENT I F I CAT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L A B L E FROMTHE I OWA ETHI CS ANDCAMPAI GNDI SCL OSURE BOARD.CAUTI ON : Se c t i o n 68B. 3 2 A( 6 ) , I o wa Co de , p r oh i b i t s t h e us e o f i n f o r ma t i on c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o rf o r any c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR

RECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f ap p l i c ab l e ) RAI SER

NUMBER I NCOME

l O ( G (D# G - .6 i i U 5 - E - $t CK# t ' 1 L 1I D# y oe t n 1 c , ~~ " ai 7 e b e coa I t i t D~ -CK# ^' t ? COV' G~ k 1 1 ' A

I I CK#I D#CK# )~_ 7 1 6 , f t ~ ~t cAN ) >A -O, l

- ' ~ t ~ S t c LTO' ~OGt 7o 5 J w l v ~ ~ ~ , i l v "

` CK# 3315 4 ~3L~~'

~ ~ Nt . S ~ ( l 3I D#


25/35

F o r I n s t r u c t i o n s , Se e Ba c k o f F o n nCONTRI BUTI ONS - MONEY TAKE' N( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g an i z a t i o n)

c J ~ ` ' ~ ~~o r )

4 - r - -

C; h - - z . ns (

Mmi l p , eSTATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED F ROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I D E N T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA ETHI CS AND CAMPAI GNDI SCL OSURE BOARD .CAUTI ON : Se ct i o n 6 8 B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y any p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

SCHEDUL EA MONETARY( Re v . 0 6 / 9 7 ) RECEI PTSCHECK THI S BOXI FAMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECE I VED F UND-( MM/ DDNR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEI D # J c h n j e I + t Q - rCK# A~t i ~AV, k~i Z $ / onI D # R_ev Ckc , ~ , ~- ~ i ~~CK# [ C4 l ~ s t H s r - - C1~ - s ~ - 5 ' U 1 yD# 5 v h~ o l CK# 1 a t 5 r -

6~~/VtC~A - 3 f l ~

fI D#CK#

a I v ~ I ~ - ~ n~ L v b l ~~ ,~ -I t v - C a~I D # ~U1S~ ECK# [ 7 Crn ~ ~ ' f t 6I D # Mar } , GcWct r~' hI r 2 Pr o > e c ~ c , ( -CK# ~ r ` 0 ' Z U- a aI D #c i


26/35

Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s a me a s on S t a t e me n t o f Org a n i r a h o n )

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) 1RECEI PTS J

I F CHECK T HI S BOXAMENDI NG FORM

STATE CANDI DATES NOTE : I F A C ON T RI B UT I ON I S RECEI V E D FROM A STATE PAC ( P O L I T I C AL A CT I ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COL UMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o w a C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o m m e r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D O/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

~ ` l ~ I G~ I D# 77 ar e l $CK# I ) S UD' 5 ~A ' k 5 ZI D# r n pAY1L~V -'c K# 1Mf ' L - a ~ - ~ d ' a ~ - -( ) i k kI D# C Onr ad Ai v nCK# 3I i ( . SVv ( ) , 4 6 V L ,

1 ) 5 t A 50315I D# R _ a ~ - pAr & A, L6 p5 w%ah, I CK# r 3I . z z . k ; h9 s l e Y AVe l 6t e a 6 d ^ GI D# Mi & k o , e lI D# 1 ~ , o b e r - } - - f h t , w t 5 t ~ y t i

~ I 3 ' 1 l a ~k l ~CK# 5W. Y A S ` 6 w~ 3( I D# f 1 1 t i e


27/35

Fo r I n s t r u c t i o n s , See Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t eme n t o f O r g a n i z a b b n )rl l a o

C,

ZP / ~ S

wmmew.STATE CAND I DATES NOTE : I F A C ON T RI B UT I ON I S R E CE I V E D FROM A S T A T E PA C ( P OL I T I C A L A CT I ON C OMMI T T E E ) , L I S T THEPAC I D E NT I F I C A T I ONNUMBER AND T HE P AC CHECK NUMBER I N T HE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GND I SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o m m e r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o m m i t t e e s .

SCHEDULEA MONETARY( R e v . 0 ) 6 / 9 7 ) RECEI PTSCHECK T HI S BOXI F AMENDI NG FORM

DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT ~ ( I F FORRECEI VED ( i t a p p l i c a b l e ) T O CAND I DATE ' RECE I VED FUND-( MM/ D D/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RA I S ERNUMBER I NCOME

1 / f D # &a4i l l { ' V f , , Q I %r l (31 v ~ $CK# S n t i . . J 7 , A 5 -0 3 1 4CK# ` G o ( o

I ~ jI D # C a t ~ l i ~ e S c { p p e n ~ - 1 e !cla ( & CK # 3 q . ~ . , L, ) . ~4 1

ONa1n t , TA 503 1 3I D # I 1 ' ) Q Y 1 Q = s Q b e l C Q I Q P t i J r ,CK# I 4 q ( 0 _ ) 5. z ) - e s mo i r \ e s ! : N 5 1 4

t . I D# Po, ( G . S a r , e - sCK# c l a - d Cal ~~ r r ` 1 Ck Dr . 5Do s ) A o l r u s . TA 5u3 1 41 -I D# t n ) G, + - ; t , L . V1 c , -CK# -70` 4 3 VQl r n c n 4 Dr , 0 ~5s o^ / l h~Q 1 0 T uI D# C Q r p l h . I < oc h h e , Iav_


28/35

Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - MONEY TAK(N( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or p a n i r a b b n )Ed V - C - c I i w )

CMMMR-CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( P OL I T I C A L ACTI ON COMMI TTEE) , L I S T THE PAC I D ENT I F I CA T I O NNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

CAUTI ON : S e c t i o n 6 8 B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i ed f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c ommer c i a l p u r p o s e by a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e es .

SCHEDULEA MONETARY( R e v . 0 6 / 9 7 ) RECEI PTSCHECK T HI S BOXI F AMENDI NG FORM

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D/ Y R) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME2. 0 ~ I D# EdLWQFai l o v l5 l 1 CK# 131 S ~` St S~l ~ / OUl b ws 1 - Y1 n e s , TA 5 ~ C - 3 II D#

CK#I D#CK#I D#CK# I

I D#CK#I D#CK#I D#


29/35

FOR I N S TRUCT I ONS , SEE BACKOF FORM SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 8 1 9 6 ) EXPEND I TURES

STATE PA C COMMI TT EES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR L E GI S L AT I V E O CHECK T HI S BOX I FCAND I DATES . L I S T THE CAND I DATE I D E N T I F I C AT I O N NUMBER I N T HE DESI GNATED COLUMN AND THEPA C CHECK NUMBER FOR EACH EXPEND I TURE . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA AMENDI NGFORME T HI C S 3 CAMPAI GN D I SCLOSURE BOARD .COMMI TTEE NAME ( M u s t b e s a me a s o n S t a t e me n t o f Or g a n i z a t i o n )/ ~ P 7 ' ( i 1 , e r ' e ~ d, f ` r l Z611 f5 ' eO7" l X ! T

CAND I D A T E NAME ANDADDRESS TOWHOM PURPOSE CATEGORY` AMOUNTDATE " - 1 D NUMBER EXPENDI TURE ( D ESCRI BE ( S E E EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE TRANSACT I ON) BELOW)( MM / D D/ Y R ) AND PA CCHECKNUMBERI D# r _ d F~ l l b v ~ ( Z e , ' m~ v v 5 e n ~ l e t n tCK# 3 i t + h s ~ . s6W P 5 $ 3 ` tI SO nSM 5G~( ~ -I D# C , l a r ( C 1 Mc Y Y1 - t ~ ~ ` P J V \ CGk gv l + f r 9

/ I I t U I CK# 1 5 2 y , t l T o h a wa t n d + a D I - Z 3 9 G I0 5M T h J o 3 1 2I D#

P0~ c K#I D # U . S P C , s t - I m o ( s 1 - ~~d v~

l ( z ( v t CK# e D72V 5M y ' ? t C i 3 1 ZI D # 0 . 5 . PdStYY~aS1r - QJ I r '

I (~~o~ c K# ~ 5 Z 5 2hA A ' C p 6 / t i p 1A ~os~ . ~ ~ ( 31 . 33I D # Ca Y - ~


30/35


31/35

FOR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( R e v . 0 8 / 9 6 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE OCHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS 6 CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )i DPf t t , - 9 A) , ~ z ~ ~ ! r 7 Ns ( ! e Mr n r T~

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE CATEGORY' AMOUNTDATE I D NUMBER " - - EXPENDI TURE ( DESCRI BE ( SEE EXPENDED

EXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE TRANSACTI ON) BELOW)( MWDD/ YR) AND PACCHECKNUMBER

CK# k555 PS AI D#

7 3 6 7 t = CraoA A~ ~ CK# 1 5 G ~1 D5 1 ~ ~ sA sU a l/

I D# - J P o5FYacLSVey - l e i a e ~/ v t CK# Y Y ~ a I ` r i 4 4 ' L v \ , ' 2 n d we VYW: ~ l I v n - C ~ 2 3 . ~0P ' e 5 O' I OL\ Y l e , ` fA,3~ 3 I G1

I D# P t _ ZCK# i 5 $ o b f f 3& i ~~1w~ - ~ ( ~ , d t gSM X' A 50 3 Q- --1 D # ~ , 05v1n0~1 U A ~ v c v r i l ~ y ` ,

aU G 1 CK# 15 SN` S03 8l o #G , I


32/35

r - UH 11VS I RUCTIONS, SEEBACKOF FORM SCHEDULEEXPEND I TURES - - MONEY SPENT FROM COMMI T TEE ACCOUNT B MONETARY( Re v . 0 8 / 9 6 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTR I BUT I ONS MADE TO STATEWI DE OR L E GI S L AT I VECANDI DATES , L I ST T HE CANDI DAT E I DENT I F I CAT I ON NUMBER I N T HE DES I GNAT ED COLUMN AN D THE CHECK T HI S BOX I FPAC CHECK NUMBERFOR EACH E X P E ND I T U RE . A L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPA I GN D I SC LOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )Op r e 2 j e - - &! " z 6 f i / - s i f O -Mr r n f Tf -k~

CAND I DAT E NAME ANDADDRESSTOWHOM PURPOSE CATEGORY' AMOUNTDATE I D NUMBER E X P E ND I T URE ( D ES CR I BE ( S EE EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e me n t ) WAS MADE TRANSACT I ON ) BE L OW)( MWDD/ YR) AND PACCHECKNUMBER

~~ (I D# , Oc v y v- ~ i n e v v ~ - v , E l ~ eS~ex r 1h5 : r l ~`f I U CK# 5~2 Go, 0 0 1 f ) C , L - ~ j a s ~ ~e $ I ) > , . S ~~~ s A sd ~ > .D #CK# ~ 5 ~ j ~ + i l l ~ht ~ wc w L C ~ s t t a r r - e i u ~ ~b ~ r 5 ~ ~ I ~ i - e Z I G ~I D # C V ~ e c ( 1 + a d j u~ r~ - r ( ~( ~V*CK# 1 3 a s c: v u + , e v e ` t X m ~

~ 1/ 1 4 / 01 CK4 5 C PU ( : ~ & I - 1 3 0 1 2 a Z ~ . 72-I D # ~oSMq 5 w. NrCK# ~ S 9 56Ge C a j k - l S ~ - a w ? S Z 3 4 _ 6 0P5 ~ k 6- 6 , 3 t aI D # . ~ ~ w a - I J o l e r -


33/35

FOR I NSTRUCTI ONS . SEE BACK OF FORMEXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTE ES : NOTE : FOR CONTRI BUTI ONS MADE TOSTATEWI DE OR L E GI S L A T I V ECANDI DATES . L I S T THE CANDI DATE I D EN T I F I C AT I O N NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBE R FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A VA I L A B L E FROMTHE I OWAE T H I C S & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e same as o n S t a t e me n t o f O r g a n i z a t i o n )

r 7 Z ~ 6 n l s

r n i T'

I D#5 / h / 0 1 CK#

51 q ; ( o k I D* - .CK# t L 0 l

I D#CK# 1~Ci 3

G l Y K - I I r r , V Y W IT ) 5 A I X TA- SO 3 t L

~l 7 ' ~ c l E Gr Ah c l AVMP5 l l n , + h - 5 ' 0 3 1 b- Y~ C c t m e ' - 0 L~70H Z n ~ ~ Y k o l ~

a v v e5 - - , Q u o6T3015 - 0 3 o ( pcep- p t , %7) c a~( GSM J +A ~o - `w~,Nt I C C o Qemuc V a F 5

M~~~c ~ r ~ PPI h a sF u n c l v t t K n C e g e r -v e ( w ' r e n v e l b p > 5

~ I y v ` _ A f we ~ V 1 5 72 -

AMOUNTEXPENDED

SCHEDULEB MONETARY( R e v . 0 8 / 9 6 ) I EXPENDI TURES

CHECK THI S BOX I FAMENDI NG FORM

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE CATEGORY'DATE I D NUMBER EXPENDI TURE ( DESCRI BE I ( S EEEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE TRANSACTI ON) BELOW)( MWDD/ YR) AND PACCHECKNUMBER


34/35

FUR I NSTRUCT I ONS, SEE BACK OF FORM SCHEDULEEXPENDI TURES - MONEY SPENT FROM COMMI TTEEACCOUNT B MONETARY( Re v . 0 8 / 9 6 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLATI VECANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND THE FE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n )

CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE CATEGORY' AMOUNTDATE I D NUMBER EXPENDI TURE ( D ESCRI BE ( SEE EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE TRANSACTI ON) BELOW)( MWDD/ YR) AND PACCHECKNUMBER

I D#CK#J~~ ~ v ~ , ~ ~ ~ , ~ $~( ~ r , ~ t ` ~. ~ t C ' l SI D# + ~ P ( ) - 7 I c r t o~~ ~5

~S w l CK# S+ -f f ! cavr , ~ > c 1 t \ no

I D# E~ j F - c u a~~CK# 1 ' ) , > - I -P C , 1 t i v ` t A 3 1 ~ a 1 / v t ,I D# Ic r ker PC , nf i n - o~ n eWS~ . e I - - -

( J 1 CK# ( ~ k ~ ; ~ qC&r t z hCi i lM/ t i 5 - 03 t L oQ~~- ~ l G

I D#

6 3 i - 1~1AW I n CjI CK# ( p ~ ~OC7PA >AI D# ~: a~~ Pr Y ' i i l ~ ~ ' 1 n 912_1


35/35

FOR I NSTRUCT I ONS , SEE BACK OF FORM

THI S FORM I S USED BY CANDI DATES ' COMMI TTEES ONLY

COMMI TTEE NAME( Mus t be same a s o n S t a t e r n e n t o f Or g a n l z a d o n )

PART 1 1 - I TEMI ZED BREAKDOWN OF UNREI MBURSED EXPENSES P AI D BY CONSULTANTTOOTHERS I N PERFORMI NGSERV I CES OF CONTRACT ( T h e s e e x p e n s e s s h ou l d NOT be

PART I - NAME AND ADDRESSOF CONSULTANT

r e p o r t e d o n S c h ed u l e B , as t h e y a r e d i r e c t pay men t f r o m t h e c o ns ul t a n t )

TOTAL ANT I C I P ATEDCOMPENSATI ON FOR

CONTRACT PERI OD ( MI WDDf YR)

PERFORMANCE

/ / 1 / 0 /a 1 _ 3 1 1 0 1

ESTI MATES OF PERFORMANCE

C- P I ' I < 7 / J c E~ .

Pa ge o f( f o r S c h ed u l e G)

SCHEDUL EG BREAKDOWN

OF MONETARY( Re v . 0 2 / 9 6 ) EXPENDI TURESBY CONSULTANT0 CHECK T HI S BOX I FAMENDI NG FORM

DATEEXPENDEDMM/ DDI YR NAME AND ADDRESSTOWHOM EXPENDI TURED l s b u i s s r n e n WAS MADE PURPOSE AMOUNTEXPENDED

i

SUB- TOTAL i

TOTAL ( I f l a s t p a g e o f t h i s s c h e d u l e ) S

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