PA(;E 01

13194722309 5
10/2B/2004 15 :03

; li ISTRUCTIONS, SEE BACK OF FORM

,f-
DISCLOSURE SUMMARY PAGE
COM ITTEE NAME (,West e e e as of of Crg niralio

C
a
For OfJIcs Use Oniy 1

Comm . u
IMPORTANT: Indicste type of committee you are reporting for:
Indexed
( 1 )Statewiae/Legialetrve Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )CountytLocal Candidate Audited
( 5 )County PAC (n )Ballot lssuwFranchise Committee (7 )Countyy/City Central Committee
( S )Support Slang of Candidates Computer,
CANDIDATE COMMITTEES ONLY:
Candidate Name
a.1 1 14 S d-.r.

Office Sought

/O - .;$ - 0
DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK ANQ COMPLY THE FOLLOWING SENTENCE:
I AM FILING A l0 -- oZ.-L --0 4 REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR,
(report date) Indicate one
C]CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . Courtly 3 Local Committees, enter County In
which Election Is held
(You must continue to file reports until a Notice of Dissolution Is filed.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the total of all monles held
by the committee. This amount MUST be the same as the cash on hand at the end
of the last reporting period, or must be zero if this is first report tiled-) ., .. ... .... ... .. ..... ......... ..5 40e)
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) .. .. ..... , a a. o
Schedule F: Loans Received total (Attach Schedule F) .. .. ... .................. ...................... ....... .
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ....... ..... .. ................ ... .
(Sc, - hedule H applies to Cendidat~mlttees Only)
SUB-TOTAL......$ stb . a4 8
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) ... 3p 913A . (a 7
Schedule F: Loan Repayments total (Attach Schedule F) . .... .... ..... .. .. . .. .. .... .......... .. . ., .........
CASH ON HAND at the end of this reporting period (If final report, balance must
be zero) (Attach DR-3) ... ............ .. ..... . . .... .. ... . . . . . .. .. ... .. . . ....... .... .. ..... . . ..... .. ...... ... .. ..... ..... ...... ..$

"UNPAID BILLS (From Schedule D - Attach Schedule D) .. ...... . . .. .. ..... ...... ...... . .. .... ... ..... ....... ......... ._S
'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . .. ... . ... . . . . . . . . . ..., ... ..... ..., . . . . ... .... .$ l'f aJ O PL , O f.>

'OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . .. .. . . .. .. . . .. ... .. ... .. . . .. ., . .. .. ... ....... .....$ Oo no
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ ,
 5 PAGE 02
10/2812004 15 :03 13194722309

Fcr :nstructlerls, See Back of Form SCHEDULE

MCNE-Ap y
CCNTRIBUTICNS - MCNEY TAKEN IN (Rev. 06!97) RE%c :P,rS
(Including candidate's personal funds)
CHECK THIS eC:C !F
CCMMITTEE NAME (Must be same as on Statementof Organization) AMENDING FORM

STATE CANDIDATES NOTc IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (PoullcAL AC"1ON COMWTTE7, LIST TME PAC IDENTIFICATION
,yUMBE9 AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A UST OF ID NUMBERS 16 AVAILABLE F--ROM TWE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibds zte use of information copied from reports and statements for soiiciting conttibubom or
for any commercial purpose by any person other than statutory polMcal committees
.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -1 IF FAR

RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-

(MMIOOIYR) AND PAC CHECK (It applicable) RAISER
NUMBER IPlCOM E
to - 19 - a q I0# !o f ; .a 'TJa
P-0 . (3.. ~.n oti .A / a, o0o r~
C" ~ 3.9 3
ID# g 3 3g FA S- PAL F".,.,-,
IO-l9-0 CK# Z4,oo E- $44, ~ -{- /OO .oo
~r' 1 3 43~ ~ ..a_ .~a 0 3
IDf1
(vo..s(o Qw..I~-+.-.c Lc ...: l.a_
Xt-r f A SSa_1 a.J-. w-I .~ O O " C, C,
10 -1 5 -0 CK# e 8 a c. uw 4 A tid A ~. ...,..._~,
3 (o

/o -f 9 -d CK# 9c w~R .~.-,-~ S-.,=1v loo aSo , c, h

a a c4

7o 1 -4- L-0 , o a
CK#
~a 0 3L+a.., :. r 1'W . ~.n. ~. Ian- So3 oq - A490 I
I~
(0 0
i o -zo 'o o co 0a . a o
CK# 13 8 1
kY e -k--Z-A- 5131.1G__ 5b3aa-~
ID# 1~16ATEP~`
~~37
AJ, E. . Jo ,0 0
C" / -7 1
~aqo ;

la-a~-off CK# - ~o
4 3 ,4 .6
ID#
- f- `~ cK# ~A, ~. ~-
~>a_ 2 ~N\,e 2 ...`t, . Zn w, E u R 0

Io- (e-~`f CK# 0-99

SUB-TOTAL
t7~~ .o
TOTAL. rf last pa9's of fh1s
schedule)
' Disclosure law requires Candidate committees to dlsolose the relationship of any relative making a contribution to ilia
committee. Refatlonshlp must be shown to Iris third degree of consanguinity (blood relatives) and afftttity (relatives by
mania,ge) (See Page 2 of forma packet.) . If sumame of contributor is the same as cancUdate, but there is no Page --J_-of ;.-_
familial relationship, enter "not applicable' In the relationship column. (for Schedule A)
 5 PAGE 03
10f2e/2004 15 :03 13194722309

For ;ns'ructlons, See Back of Form SCHEDULE

MCNE-ARY
CcNTRISUr1CNS - MONEY TAKEN IN (Rev . 06!97) RECStFTS
(Inctudng candidate's personal funds)
C3 CHECK THIS BO)C IF
COMMITTEE MAME (Must be same as on Steremenr or Organizaflon) AMENCINC FORM
I

r
STATE CANDIDATES NOTE: IF A CONTRIB(InON IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMIXTTEY), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILaBL= r-RCM THE IOWA ErHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 888 .324(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contnibutiorw or
for any commerda1 purpose by any person other than statutory poBtical committees.
r
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT i 1F FCF
RECEIVED (if apptic able) TO CANDIDATE' RECEIVED FUNQ-
(MNWO/YR) AND PAC CHECK (If applicable) RAISER
NUMBER MCCME

)o-a(. -o y CK# 114 y 3ou. Z -A o~.oo .oa

o2~3g
I D#

CK#

I DIl '

CK#

IDS

_. C'1K9

ID#

CKA

ID#

CK#

I D>It

CKP

IEW '

CK#

1D#

CK#

ID#

CK#

SU&TOTAL ~"
$ otDO " vo
TOTAL rt last poge o/ this
schedule) $,34a), . dD
Disclosure law requires candidate commttiees to dlsdose the relationship of any mlative making a canulDcrtton to the
committee_ Relatlonshrp mrL;I be shown to the third degme of consanguinity (blood relatives) and affinity (relatives by
-Mage) (See ! Page 2 of forma packet)_ If sumame of Cohnibutor is the same as candidate, but there is no Pogo . o1 of
familial relationship, enter "not appllcabl®" in the relationship column. (for Schedule A)
 13194722309 5 PAGE 04
10f28120e4 15 : 03

FOR INSTRUCTIONS. SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev O"7) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRfBUT10NS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES . LIST THE CANDIDATE IDENTIFICAT70N NUMBER IN THE DESIGNATED COLUMN AND THE ~ CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

COMMITTEE NAME (Adust be same as on Statement of Orpanizatlort)

CANDIDATO NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE 10 NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if spokable) (Ofsbumerneraf) WAS MADE
(MMADO/YR) AND PAC
CHECK
NUMBER

)o -lg-C .7aoo 30 o.c~.., a Ads

CK# -C' o
.53 c)
ID# U

10 l 9 - a `~ CK# - 510 o r ru 1~ s' 13 o°L.o . 3 G,

o
_
ID# M PC. "
0000
lv - l 9 -v '/ CK# Po ~X oF
~D

ID#

~/ ~aa o 3, s,/- /004,9 7

cK# 70 ~,

ID#

CKS

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL
$ 38
(If last page of this schedule) $

THIS BOX APPLIES TO CANDIDATLS' COw1MITTEEa ONLY :

Purchases of certain campeign property costing 5500 or more must also be inventoried on Scnudule H. (Refer to Schedule H 4uatructlona,)

Expenaltures to peraons/entltles providing consulting, advertising, fund-raising, polling, rnlaragfog. organlrlng serv±t es must also be detail itemized on
Schedule G by the amount . purpose, and date of each ripe of experdliurs made by the pemonientity on behalf of the candldals'o commttlee. (Refer to
Scheduto G inetructlons and tows Code 56,6(3)(1) .)

- Page -_.a! of I

(For SChedlas B)
 P4GE 05
13194722309 5
10/28f2004 15 :03

FOR II4STRUCTjONS, SE= BACK OF FORM SCHEDULE

IN KIND
COwfTTEE DAMS ;Must be sear& as on Statement of Organimfion) (Rev. CONTRIBUTIONS

Cl CHECK THIS BOX IF

AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED "1 IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER ',
(MWDDfYR) OF CONTRIBUTOR ' (If applicable) DONTRIBUTICN VALUE CONTRIBUTION
S
t
x,
) b -,2J _ O lo
o o

G 3..1 E~s of s
1A." q ~_ ° `~' 3,00 0
l d -a.a -o `f " o-ts

S Yl'\O i c ."-.q- So 30

`Disclosure law requires candldWes to dteclose the relationship of any reWve making an In kind contribution to the Page __/ of ~ I
committee. Relationship must be shown bo the third degree at consanguinity (blood reiabves) and affinity (relatives (for Schedule E)
by marriage) . (Sae Page 2 of forms packet.) It surname of contributor is the same as caraldafs, but there is no
familial relationship, eater 'not applicable' In the relatior :ship column.
 -` j
SC14EDULE

COMMITTEE NAME(Musl ba sarrw os on Slaternent of 0rganaafion) F LOANS

(Rev, Odl88) RECEIVED
~A_,o
J i REPAID
1-

NOTE : Thus schedule reps money loaned to the comrniltes %filch Is deposited In the committae accounL E] CHECK THIS BOX (F
AMENDING3 FORM
TOTAL UNPAID LOANS FROM 1,621 REPORTING PERIOD I SO- ) e eo . e n

PART I - MONETARY LOANS RECEIVED I= REPORTING PERIOD PART II - MONETARY LOAN REPAYMENTS MADE gill REPORTINO PERIOD
(Oilgin&1 source of fawn, such as a bank, must de shown d a Wrd party is (Loans fbrgkon rnust bs rspartad on Schedttfe E - In-kind t;ortfrf6afio1lS .)
Involved. fncfude loans from candidate 3 pan onal funds.)
r
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT W
REGENED (Include Endorser's Name, If AppUexbie) TO CANDIIAM OF LOAN (1.KWDtYR) (include Endorsers Name, It Applicable) TO CANDIDATE` REPAID
MMID DIYR if Vcabfe' Il liable) _,
r.,
S
W
W
coo .

TOTAL (PART 1) $ ) Ooo .trc TOTAL CASK REPAYMENTS (PART ll)

From Schedule E -TOTAL LOANS FORGIVEN $

TOTAL OUTSTANDING LOANS END OF REPORT PERIOD

`Disclosure law nsqulras candidate wrrardtt.aes to dlscloea the raIAUorMbIp of any relative
making a cantribution to the oomm'Ifee . Reladonshlp axmf be shown to the third degree of
cons&Wu:ntty (blood raladves) and affinity (relaltves by marcta(1a)_ (See Page 2 of forms
packet .) It surnarne of contributor is the same as candidate . but there Is no famAlal
relaliauhip, enter "not appilcaNa ° In the relat!omNp column when it applies .
(for Schadula F)