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FOR I NSTRUCTI ONS, SEE BACK OF FORM

DI SCLOSURE SUMMARY PAGECOMMI TT EE NAME ( Mu s t b e s ame a s o n St a t eme n t o f Or g a n i z a t i o n )

j u d i c i a lA c c o u n t a b i l i t yCr o u p

I MPORTANT: I n d i c a t eb yS t y p eo f c o mmi t t e ey o ua r e r e p o r t i n gf o r: 1 2( 1) S t a t e w i d e / L e g i s l a t i v e / J u d g eS t a n d i n gf o rR e t e n t i o nCa n d i d a t e( 2 ) S t a t ePAC ( 3 ) s t a t eP a r t y( 4 ) C o u n t yC o n t r l lCommi t t o o( 5 ) C u n Cn n d i dt o ( G ) C i t yCa n d i d a t o( 7 ) S c h o o lB o a r do rO t h e r

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SI GNATURE OF PERSON F I L I NGREPORT

IAM F I L I NGAO c t r i b c r1 9 ,2 0 0 4

( r e p o r td a t e )

[ ] CHECK I FAMENDMENT TO REPORT DATED _ ,

[ ] Check i tt h i si s f i n a l( t e r mi n a t i o n )r e p o r ta n d a t t a c hNo t i c eo f D i s s o l u t i o nF o r m DR- 3.( Yo u mu s tc o nt i n uet o f i l er e p o r t su n t i la DR- 3 i s f i l e d. )

SUBTRACT TOTAL MONEY SPENT THI S PERI OD

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REPORT FOR ( 1 )ELECTI ON / ( 2 ) NON- ELECT I ONYEAR .

I n d i c a t eb y#1 7 1 1

STATEMENT OF CASH ON HAND

CASH ON HAND a t t h e b eg i n n i n go f t h e r e p o r t i n gp e r i o d. ( T o t a l o fa l l f u n d sh e l db y t h ec o mmi t t e e _Th i samo u n tMUST b e t h es am e a s t h ec a s h o n h a n d a t t h e e n do f t h e l a s tr e p o r t i n gp e r i o do r mus t b e z e r o i f t h i si s f i r s tr e p o r tf i l e d. ) . . . . . .. . .. . . . . . . . . . . . . . . .. . .. . . . .. $

( S c h q0 j u t eH a pp l i e s t o Ca n di d a t e s ' Co mmi t t e e sOn l y )

SUB- TOTAL . ... . $

Sc h e du l e B : Ex p en di t u r e st o t a l( A t t a c hSc h e d u l e B) ( " a l s os e c d e b t sa n d l o a nsb e l o w). .. .

Sc h e d u l e F: L o a n Re p a y me n t st o t a l( A t t a c hSc h e d u l e F ) . . . . .. , . . . . . . . .. " . .. ,. . . . . . . . . . .. . .. . . . . . . .. .. . .. . .

' " UNPAI DBI L L S( Fr o m Sc he du l eD- At t a c hSc h e du l e D) . . . . .. . . . .. ,. . . . . . . . .. . . . . . . .. .. . . .. . . . .. . . . . . . .. . . . . . . .. . .. . . . .. $

' I NKI NDCONTRI BUTI ONS ( F r o mSc h e d u l e E - At t a chSc h e du l e E ) . ,. . . . . . . . .. . . . .. . . . . .. . . . . . . .. . .. .. . .. . . . . . . ..$

" OUTSTANDI NG LOANS ( F r o mSc h e du l e F - A t t a chSc h e du l e F ) .. . .. . . . . . . .. . . . . . . .. . .. . . . . .. . . . .. . .. . . . . . . .. . . .$

CANDI DATC COMMI TTEES- ONLY :.

CONSUL TANT BREAKDOWN ( Sc h ed u l eG At t a c he d ? )

VALUE OF CAMPAI GN PROPERTY ( F r o m Sc he du l eH - A t t a c hSc h e d u l e H) $

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b e z e r o ) ( A t t a c hDR- 3) . . . . . . . . ., . . . . .. . . . .. . .. . .. . .... . .. . . . . . . . . . . . . . . .. . . . .. . . . . .. .. . .. . .. . . . .. . . . . . . .. . . . .. . . . . . . .. . . .$ . . ~ ` '

ADD TOTAL MONEY TAKEN I NTHI S PERI OD 1 , * ?( e 5 , 0 vSc h e du l e A: Ca sh C o n t r i b u t i o n st o t a l( A t t a c hSc h e d u l eA) ( ' a l s os e e i n - k i n db e l ow) .. . . . . . . . .

Sc h e du l e F : L oa n s Re c ei v e dt o t a l( A t t a c hSc h e du l e F ) . . . . . . . .. . . . . . . .. . . . .. . .. . . . . . . . . . . . . . . .. . . . . . . . . .. . . . .d.

Sc h e du l e H : T o t a lSa l e so f Camp a i g nP r o p e r t y( A t t a c hSc h e du l e H) . . . . . . . .. . .. . . . .. . . . . .. . . . .. . . . . . .

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Fo r I n s t r u c t i o n s ,Se e Back o f Fo r m

CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TTEE NAME ( Mu s t b o s ame a s o n S t o t o r r x m to f O r y a n i i a t i o n )

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Rese t Fo r m

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TOTAL ( i fl a s tp a g e o f t h i ss c h o d u l a )

S TAT I CCANDI DATESNOTE: I FA CONTRI OUTI ONI SR r C ( ` I V ( ' DFROMASTATEPAC ( P OL I T I C ALACTI ONCOMMI TTCF ) ,L I Z-, TTHU PACI D EN TI F I C AT I O N

NUMBER ANDTHE PACCHLCKNUMBERI NTHEDE S I ONAT I ,. DCOLUMN. A L I S TOF I DNUMnr R , 61;; AVAI L A B L EFROMI Mr ,I OWALTHI CSANDCAMPAI GN

DI SCLOSUREBOARD.

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P . 2

CAUT I ON: S e c t i o n6 8B. 3 2 A ( 6 ) ,I o waCode , p r o h i b i t st h eu s e o f i n f o r ma t i o nc o p i e df r o mr e p o r t san d s t a t e m e n t sf o rs o l i c i t i n gc o n t r i b u t i o n so rf o ra n yco mme r c i a l p ur p os e b y an y p er s o n o t h e rt h a ns t a t u " p o l i t i c a lC o mmi t t e e s ,

- Di s c b au r el aw r e q u i r e sc a n di d a t eCo mmi t k t l t gt od i s c l o s et h er o l a t i o n S h i po f , n yml a t i v emak i n g a c o n t r i b ut i o n t ot h eCommi nn o. R o l o t i o n s h l pmun t b ) a n ow n t o t h et h i r ddog " o f c o r r i e n f l u i n i t y( b l o o dr o l a t l v a ) )an d a f f i n i t y( ml a t l v n sb yma r r i a g e ). I fs umamu o f c o n t r i b u t o ri s t h e s ome a s c an di d at e , b utt h e r eI Sn o Pag e ! 2 -

f a mi l i a lr e l a t i o n s h i p ,e n t e r " n o ta p p l i c a b l e "i n t h e r e l a t i o n s h i pc o l u mn. ( f o rSc h e d u l eA)

DATE PAC I DNUMBL R NAME AND ADDRESS Of CONTRI BUTOR RELATI ONSHI P AMOUNT 4 I FFORRECEI VED ( i fa p p l i c a b l e ) TO CANDI DATE" RCCCI VCO FUND-( MMI DO/ YR) AND PAC CHL CK ( i ta p p l i c a b l e ) RAI S ER

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CONTRI BUTI ONS - MONEY TAKEN I N( I n c l u d i n gc a n d i d a t e ' sp e r s o n a lf u n d s )

COMMI TYEE NAME ( Mu s t b o s a nl o a s on Sl o t o mo n t o f Oman i z a bbn )

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STATE CANDI DATCS NOTF : I FA C ON TI t I 1. i UT I ONI SRr Cr 1VF. D FROM A TATr PAC ( P OL I T I CALACTI ONCOMMI TTEE) ,L I S TTHCPAC I DENTI F I CATI ONNUMI I LRAND THE PAC CHECKNUMDFR I Nr HL DESI GNATEDCOLUMN . A L I S TOr ' I DNUMBERS I SAVAI LADLCFROM THI. I OWAETHI CSAND CAMPAI GNDI SCLOSUREBOARD .

P . 3

CAUTI ON : Se ct i o n 6 8 6 . 3 2 A ( ( i ) ,I o wa Co d o , p r o h i b i t st h e u s e o f i n f o r ma t i o nc o pi e d f r o m r e p o r t sa n d s t a t e mo nt s f o rs o l i c i t i n gc on t r i b ut i o ns o rf o ra n y 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 o r t h a n s t a t u t o r yp o l i t i c a lcommi f o s .

SUB- TOTAL

TOTAL ( I fl es t p a g e o f t h i s s c h e d ul e )

' D i n c l o n u r eI BWr e q u i r e sc a n di d a t oCommi t t e e t od i s c l o s ot h e r o l o b on s u po fa ny r e l a t i v emak i ng a c o n t r i b u t i o nt ot h ec ommi t t e e. Ro l u t i o n ," i h pmust W s h own t o t h et h i r dd o g n x ) o r c o n n A n g u i r v t y( b l o odr o l u t i v o o )p a d a f f i n i t y( m i a t i v o sb yma r r i a g e ). I ts u r n ame o f c o n t r i b u t o ri s t h e same a s c a n d i d a t e ,b u t t h e r ei s no Pag e o f _f a mi l i a lr e l a t i o n s h i p ,e n t e r" n o t a pp l i c a b l e "i n t h e r e l a t i o n s h i pc o l umn . ( f o rSc h e d u l e A)

DATL PAC 1 0 NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I FFORRCCC . . I VEO ( i fn p p l i c a b l o ) TO CANDI DATC" RFCEI VED FVND-( MM/ DDI YR) AND PAC CHECK ( i fa p p l i ca b l o ) RAI SCR

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FOR I NSTRUCTI ONS, SEE BACK OF FORM

THI SBOX APPLI ESTO CANDI DATES'COMMI TTEES ONLY :

Rese t F or m

EXPENDI TURES - MONEY SPENT FROM COMMI TTEE ACCOUNT

STATE PAC COMMI TTEES: NOTE: FOR CONTRI I I UTI ONSMADE TOSTATr WI DY. OR LECI SLATI VrCANDI DATES,L I S TTHLCANDI DATEI DE NT I F I CAT I O NNUMBERI NTHE D ES I G NA 1 ' I; 0COLUMN ANDTHEPACCHECKNUMBER FOREACHEXPENDI TURE. AL I S TOF I DNUMBERSI SAVAI LABLEFROMTHEI OWACTHI CS&CAMPAI GNDI SCLOSUREBOARD.

p . 4

SCHEDULE

B I MONET ARY( R e v. 0 7 / 0 3 ) EXPENDI TURES

CHECK THI SBOX I FAMENDI NG FORM

Pu r c h a s e r; o f a i r t m nc amp a i g np r o p e r t yc o s t i n g$ 5 0 0o r mor emusta l s ob o mv o nt o no d o nS c h o du l oH, ( R o t o rt oS c h ed u l eHms b u Cl l o n r c. )

E x pe n di t u r e st op er s o n s t e n t i t i e s p r o v i d i n gc o ns u l t i n g , a dv er t i s i n g ,f u n d - r a i s i n g. p o l l i n g ,ma n a g i n g ,o r g a n i z i n gs e r v i c e smust a l s ob e d o t a i li t e m i z e do nS c h ed u l eG b y t h e a mo u n t ,p u r p o s e , a n dd a t e o fe a c h t y p eo f o x p o n d b t u r e- a d o b y t h ep e r i n f o n t i l yo n b e ha l fo f t h ec a n d i d a t e sc o mmi t t e e. ( R e f e rt oS c h o du l oC i n u t r u c t i o n 5; md I o waCodu GAA. 4 0 Z ( J ) ( \ ). )

Page _ !- o f I -

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CANDI DA' 1L NAME ANDADURLSSTO WHOM PURPOSI L AMOUNTDATE I DNUMBER EXPENDI TURE ( DESCRI BETRANSACTI ON) EXPENDED

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