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    F OR , , T . ' ' S T RU C T I O N S SE E BACK OF FORM

    OMMI TT EE NAME ( Mu b e s ame a s o n S t a t e m e n t o f Or g a n i z a t i o n )r

    I MPORTANT : I n d i c a t e t y p e o f c o mm i t t e e y o u a r e r e p o r t i n g f o r .( t ) S t a t e w i d e / L e g i s i a t i v e C a n d i d a t e ( 2 ) S t a t e w i d e PAC

    3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l Ca

    t e( 5 ) C o u n t y P A C ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o m m i t t e e 7 ) C o u n t y / C i t y C e n t r a l C o m m i t t e e( 8 ) S u p p o r t S t a t e o f C a n d d e t e t r -

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    Rou t i n e P e n a l t i e s Du e F o r L a t e F i l e d Re p o r t s R a n g e f r o m $ 2 0 t o $SE E I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NG SENTENCE :

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    ( r e p o r t d a t e )[ : ] CHECK I F AMENDMENT TO REPORT DATED0C h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h No t i c e o f D i s s o l u t i o n F o r m OR - 3( Y o u m u s t c o n t i n u e t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )

    STATEMENT OF CA S H ON HA ND

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    FORMDR- 2I DI SCLOSURE( R e v 0 1 / 9 8 )REPORT

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    L o c a l Co mmi t t e e s , e n t e r D a t e o f E l e c t i o nCo u n t y & L o c a l Co mm i t t e e s e n t e r C o u n t y i nw h i c h E l e c t i o n i s h o l d

    CASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a lo f a l l m o v i e s h e l d b y t h e c o mm i t t e e T h i s a m o u n t MUST b e t h esame a s t h e c a s h o n h a n d a t t h e e n d o f t h e l a s t r e p o r t i n g p e r i o d ,o r m u s t b e z e r o f f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . S

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    p CHECK T HI S BOX I FAMENDI NG FORMSTATE CANDI CATSS NOTE : I F A CON TRI OVT *N I $ RECI ENED FROM A STATE PAC MOUMAL ACTMCOMMI TTEE) , UST THE PAC I DWT I f I CAT I ONNJMaER AND THE PAC CHECK NUM" ER I N THE DESI GNATWCb t . i AW. A L I S T OF I D WJ MBERS I S AVALABLE FROMTHE I OWA V" CS AND CAMPAI ONOI S CL O SUf 9 0 AND .CAUTI ON : S a c b o n 68 8 . 3 2 A( S ) . I o wa Cod a . p o OWNt s t h e u s e o f k s k l e Tn s d w c o p i e d ! t a r o n p a r t i ~ a n d s t a t w r l a n t s f aso" c o r r t r i b v t i o n s o ,f o r a n y c o mme r c i a l p u r p o ar b y an y p e r s o n o t t e r t h a n s t a Rd w y p o ( i t i a f ' c o wTUpm

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    FORI NSTRUCTI ONS, SEEBACK~ , r ~ FORM SCHEDUL EEXPENDI TURES B MONETARY- - MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . o e / s 6 ) EXPENDI TURES

    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI S LAT I VECANDI DATES . L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE CHECK T HI S BOX I FP AC CHECKNUMBER FOR EACH EXPENDI TURE . A L I S T OF t D NUMBERS I S AVA I L A BLE FROMTHE I OWA AMENDI NG FORMETHI CS 3 CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t be 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)RC" t ~L6C- TI o . , 3 O+~ wAL i - ~ ' o o , A - )G. MMI r

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    FOR I NSTRUCTI ONS . SEE BACK . - FORMEXPENDI TURES- - MONEYSPENTFROMCOMMI TTEEACCOUNT

    STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI 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 NUMBER FOR EACH EXPENDI TURE. A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWAETHI CS 3 CAMPAI GN DI SCLOSURE BOARD .

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