FORINSTRUCTIONS,

SEEBACKOFFORM
DISCLOSURE
SUMMARYPAGE
Jgnuary1,2010,all statements and repoftsfiledby new ommltties' .f,{,fifiT#!l;.trr
Ailrr
r
stateoffice mustbe filed electronicallyand effectiveJaniary l, 2012,alt
andrepodsfrledbyall ammitteesforstafeoffie mustbe,t/rd
?0 | | JfifJ |9 PHtZ:
ZZ
May 1,2010,all statemenband reportsforStatepACsand State
Partiesmustbe ftledelectonically.

IMPORTANT:Indicateby# typeot commlttoe

you aroreportingfon ;"f;t
(Rev.1212009)
I o,,..o.u*,
| neeonr

11) LocalBallotlssue

Distric{(if Senateor House)

to posslble
LalergportsaresubJect dMl crimlnalpenaltes.Pursuanito lowa code sectlons68B.32ACO and 6EA.401(3),the candldate,for a
and lhe for any othertype of committee,is the indMdualresponslblefor fflingtmety and accuratereporls.

REPORT
4el'?-tr> | /1.t]
TELEPHONE DATESIGNED
r'lr ^ ^^1
rAMFfLfNGA Ce loLw A FoR(1)ELEcnoN
REpoRr /(2)NoN-ELEcnoN
vEAR.
,
(report
date) tndicateby# Lll
AMENDMENT DATED
To REPoRT LocalCommittees.enterDate of Election
Fr="*rF
El Cnecf if thls is final(terminaiion)
reporlandattachNoticeof Dissolution
FormDR-3. County& LocalCommlttees,
enterCountyin
(Youmustcontinueto file reportsuntlla DR-3is filed.) whichElectionis held

STATEMENT OF CASH ON HAND

CASHON HANDat the beginningof the repoiingperiod.(Totalof all tundsheldby the
committee.ThisamountMUSTbe the sameas the cashon handat the end
periodor mustbe zeroif thisis firstreportfrled.)...........................................
of thElastreporting $
ADDTOTALMONEYTAKENIN THISPERIOD
A: CashContributions
Schedule total(AttachScheduleA) ('alsoseeIn-kindbelow)..................
Schedule
F: LoansReceived total(AttachSchEduleF)...,............-,.
H: TotalSalesof Campaign
SchedulE (AttachSchedule
Property H)................
(ScheduleH aooliesto CandldatF'Gommtttees Onlv)
suB-ToTAL................
$
SUBTRACTTOTALMONEYSPENTTHISPERIOD
total(AttachScheduleB) ("also seedebtsand loansbelow)............
ScheduleB: Expenditures
ScheduleF: LoanRepaymentg total(AttachScheduleF)....................
period(iffinalreportbalancemusibe zero)...........................
CASHON HANDat theendof thisreporting $

CONSULTANT BREAKDOWN (ScheduleG Attached?) -YES )L*o

CANDIDATE COMMITTEESONLY:
VALUE OF CAMPAIGN PROPERW (From Schedule H - Attach Schedule H)
STATE COMMITTEEQ: Submit a reconciledcampaign accounl bank statement in January of each year.
,%
 FOR /NSIRUCI/ONS, SEEBACK OF FORM
SoHEDULE
I
- MONEYSPENTFROMCOMMITTEEACCOUNT
EXPENDITURES B I uonErnnv
(Rev.07/03)
| exeenorunes
gTATE PAC COMMITTEES:NOTE: FoR coNTRIBUTIoNs
MADETo STATEWDEoR LEGISIATIVE
CANDIDATES,LISTTHECANDIDATEIDENTTFICATION
NUMBERtNTHE DESIGNATED
COLUMNANDTHE
PACCHECKNUMBERFOREACHEXPENDITURE.A LISTOF ID NUMBERSIS AVAILABLEFROMTHE IOWA .I
cttc^rHrsBoxrF
ETHICS& CAMPAIGN DISCLOSURE
AMENDINGFORM
BOARD,

COMMITTEENAME (Musf be same as on Statementof Organization)

Oit 2s,\.8Tt Mu,rfu

UANUIUAI E NAMEAND ADDRESSTO WHOM PURPOSE AMUUNI
DATE ID NUMBER EXPENDITURE (DESCRTBE
TMNSACTTON) EXPENDED
EXPENDED (f applicable) (Di sbursement)WAS MADE
(MM/DD|rR) AND PAC
CHECK
NUMBER
tD#
IlbJl- l^dtx ste'
^ H ftds tt" lo - t3//.+
oi{o*erh's\"s-e
t0'll''DqcK#
A lh,.^,^ tta cnan?
l0'
zt/zi
l0 -
20/21
, ,lu':
tD#
lnr lu f r;nhr*i flyus , lc,lfwhra/,
to'lbD\ cK# " t13q E Oru,/ Ave lr{u ,'^rri n7, + t'nuuloye5g?0tt
bu h^oine;s,tn foZtt"
tD#
KYlt MtL , ^, rui ^t"*stmat d-
itiv P;""woodU 9w
Io'zo'01cK# Sbl[us h, ya'il t'Jot 402
fllho^" t A {ooo1
lD#

lo-ttl.01 cl(# fr,'; .+sw lwgtyurd-riJ t"s

#!:agoao't f e iorb*rs (-r <t-f {i'

t,4lr49
A|tv"t'q . tk
tD#
l0'7!' 0"1 cr(# w,pm'r*
Arc /TlrrApr lk 3n?l L W***
tD#
ct(#
rD#
cK#
10'#

ct(#
SUB-TOTAL s 1t+2,E9
TOTAL (lf last page of thls schedulQ $ zt42r9
THISBOXAPPLIESTO CANDIDATES'COMMITTEES
ONLY:
Purchasesof certalncampalgnpropertycostng $500 or more mustalso be inventoriedon ScheduleH, (Referto ScheduleH lnsfuctons.)

Expendituresto persons,/entltes
provldingcoNultlng,advertlslng,fund-ralslng,polling,managing,organizlngsoMces mustalso be detrailltemizedon
ScheduleG by the amount,purpose,and date of each type of expendituremadeby the person/entityon behalfof the candldate'scommittee.(Referto
ScheduleG instructionsand lowa Code68A.402(3)0).)
pagel"l

(for ScheduleB)