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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 I 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 S t a t e me n t o f Oi g e r n i z a t + onfkbH SAC, ' t l s ' - f

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 TH E PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECKNUMBER I N THEDESI GNATED COLUMN, A L I S T OF i D NUMBERS I S AVA I LABLE FROM TH C I OWA ETH I CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 88 8. 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 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 nt 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 se 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

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TOTAL ( i f l a s t p a g e o f t h i ss c h e d u l e )Di S Cl o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi n o e s t o d i s c ! o se t h e r e l n no n sn ; o o f a n y r e i a t i v e ma k i n g a c o n t , " o w t i o n t o t h ec o mmi t t e e . Re r a u o ns n i p mu s t De s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y I r e l a l l v C l ; Byma r r i a g e ) ( S e e P a g e 2 o f f o r m s p a c k e t . ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a nd i d a t e . b u t t h e r o i s n o P a g e~_o ff a m i l i a l r e l a t i o n s h i p . e nt e r ' n o t a p p l i c a b l e " t o t h e r e l a t i o n s h i p c o l u mn f l o r S c ne a u l e A

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FRO11F o 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

( I n c l u d i n g c a n d i d a t n ~ p e r s o n a l f u n d s )CO0MMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )STATE CANDI DATES NOTE : I F A CONTR I BUTI ON I S RECEI VED FROM A S T A T E PAC ( P OL I T I C A L ACT I ON C O MMI T T E E f , L I S T T HE PAC I D EN T I F I C AT I O NNUMBER AND THE PACCHECKNUMBER I N THE DES I GNATED COLUMN . A L I S T OF 1 0 NUMBERS I S AVAI LADLE F F ; OmTHE I OWA ET HI CS AND CAMPA I GND I SCLOSURE BOARDCAUTI ON: Se c t i o n 68B . 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 i a l e me n l 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 ns 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 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 .

FAY. NO. : 712298471 J - . t 1 . 1 9 23 1 2 : 1 1PM P3

t s c l o s u r e t a w r e q u i r e s c a n d i o a t e c o mmi t t e e s t o d i s c l o s e t h e t e l a t i o n 9 n i o o f . a n y r e l a l i r v e ma k i n g a c o r t : , D u v 0 A + o t h ec o mmi t t e e R e l a t i o n s h i p mu s t b e : h or n t o t r i o t h i r d d e g r e e o f c o n s a n g u i n i t y ( No o n r e l a h v a s l a n d a f f i n i t y ( r e ) a l t v e s Dyma r r i a g e) ( S e e P a g o 2 o f l o r ms p a c k e t . ) . I t su r name o f c o n t r i b u t o r i s t h e s a m e a s c a nd i d a t e b u t t h e r e i s n ot a m i l i a l r e l a t i o n s h i p . e n t e r - n o t a p p l i c a b l e " t o t h e r e l a t i o n s h i p c o l u mn

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FROMFo r I n s t r u c t i o n s , Be e Ba c k o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I 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 sa me a s o n S t a i r e mor i t o f Or g a n i z a t i o n)

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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 ONCOMMI TTEE) L I S T THE PAC I O EN TI F I CAT I O NNUMBER ANO THE PAC CHECK NUMBER I N THE DESI GNATEDCOLUMN. A L I S T OF I D NUMBERS I S AVA I LAB LE FAOLI THE I OWA ETHI CS AND CAMPAI GN01 SCLOSURE BOARD.

CAUTI ON: S ec t i o n 688 . 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 on c o pi e d f r om 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 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 s e by 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 co mmi nees .DATE

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s c h e d u l e )D i s c l o s u r e l a w I O Ou i t @S c a nd i d a t e I : O RI M l t t e e i t o d i s o l o s e t h e t e l a t i o n t r 1 , P o f z n y R e l a t i v e ma k i n g a c onMbu6OM I o mec o mmr t t e s . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n C a t t i n l t y f r e wWe s b ymamagel ( S OO P a g e 2 o f t e r ms o a c k e l . l I t s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a nd i d a t e . b u t t h e r e i s n ot a m i l i a f r e i a t i o n s n t p . e n t e r ' n o t a p p l i c a b l e ' t o t h e r e l a t i o n s h i p c o l u mn

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FR : I D f 1 : FAX N0 . : 7123298471 J u l . 1 9 2003 12 : 1 2PM P5

THI S BOXAPPLI ES TO CANDI DATES' COMMI TTEES ONLY :Pu r c h a s e s o f c e r t a i n c a mp a i g n p r op er t y c o s t i n g S500 o r mo r e must a l s o b e i n v e n t o r i e d on Sc h e d ul e H ( R e f e r t o Sc h e d ul e H i n s t r u c t i o n s ) !IE x pe nd i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r 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 g s e r v i c e s must a l s o b e d e t a i l I t e mi z e u OnSc h e d u l e G o y t h e amo u n t , p u r p o s e , and d at e o f e a c h t y pe o f e x pe nd i t u r e mac e o y t h e p e r s o r v e n t l t y on D e h a l t of t he c a nd i d a t e ' s c o mn - mee . ( R e f e rSc h e d u l e G i n s t r u c t i o n s an d I o wa Code 5 6 . 6 ( 3 ) ( / ) - ; -

Page . . L o f _/_( f o r ' s c t ) e a u l e i 3 )

r u H / I V - ' I f UGI RJNb . Jt t t j AGK OF FUHM SCHEDULEEXPENDI TURES B- - MONEY SPENT FROM COMMI TTEE ACCOUNT MONETAR' (- - - - ( R ev . 0 9/ 9 7 ) EXPENDI TURES

STATE PAC COMMI TTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEGI SLAT I VE ~CANDI DATES L I ST THE CANDI DATE I D ENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMN AND ' HE CHECKTHI S EOX I FPAC CHECK NUMBER FOR EACH EXPENDI TURE A L I ST OF I L NUMBERS I S AVAI LABLE FROMTHE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARDCOMMI TTEE NAME ( Mu s t b e same a s on St a t emen t o f Or g an i z a t i o n)

I CANDI DATE NAME ANDADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D+ s b u r s e r n e n t ) WAS MADE( MM/ ODNR) AND PACCHECK

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