FOR INSTRUCTIONS, SEE BACK OF FORM FORM DR-2 DISCLOSURE DISCLOSURE SUMMARY PAGE (Rev. 01/98) REPORT For Office Use Only | yan t15_ \* | COMMITTEE NAME (Must be spme as on Statement of Organization) f vem, gee ane indexes SI ates IMPORTANT: Indicate type of committee you are reporting for: [2 | Computer (1 Satovistogsaive Candate (2 Sttewee PAC (2) Pary (4 YCounyocl Canae {Saami ana estate Comics (7 suntv Corea Comune Sonn Sat Canaee Cot) Yagil Uslo4 ‘SIG tE OF \SURER (or person filing this report) ‘TELEPHONE DATE SIGNED Routine Penalties Due For Late Filed Reports Range from $20 to $800 ‘SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE: LAM EILING A__, Ta i 2, 2004 REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR, {report date) Indicate one LL CICHECK IF AMENDMENT TO REPORT DATED. Tocal Comvitoes, enter Dale of Elacton 1 Check this is nal termination) report and attach Notice of Dissolution Form DR-3, {County & Laval Commies, rer County in (You must continue to file reports until a Notice of Dissolution is filed.) re ‘STATEMENT OF CASH ON HAND CASH ON HAND at the beginning of the reporting period. (This isthe total Cf all monies held by the committee. This amount MUST be the sama 25th cash on hand athe end of he lest reporting period, (oF must be zero if this is first report fled). : ‘ADD TOTAL MONEY TAKEN IN THIS PERIOD ‘Schedule A: Cash Contributions total (Attach Schedule A) ‘Schedule F: Loans Received total (Attach Schedule F)... ‘Schedule H: Total Sales of Campaign Property (Attach Schedule H). ‘Sched \didates’ Committ ‘SUBTRACT TOTAL MONEY SPENT THIS PERIOD ‘Schedule B: Expenditures total (Attach Schedule B).. ‘Schedule F: Loan Repayments total (Attach Schedule F), CASH ON HAND at he end ofthis rportng ped (foal repo, balance must 'be zero) (Attach OR-3)... = S___ QO 12. UNPAID BILLS (From Schedule D - Attach Schedule 0). IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule &) OUTSTANDING LOANS (From Schedule F - Attach Schedule F)... CANDIDATE COMMITTEES ONLY: CONSULTANT BREAKDOWN (Schedule G Attached?) . YES __Nno VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) sFOR INSTRUCTIONS, SEE BACK OF FORM ‘SCHEDULE B MONETARY EXPENDITURES ~- MONEY SPENT FROM COMMITTEE ACCOUNT fesercann | exrenoinunes) STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MAOE TO STATEWIDE OR LEGISLATIVE CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE OCHECK THIS 80x IF PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF IO NUMBERS IS AVAILABLE FROM THE IOWA ~ AMENDING FORM ETHICS & CAMPAIGN DISCLOSURE BOARO. COMMITTEE NAME [Must bo Same 05 oy Sulggens of Oancator) ] Hearing Aid Specialist Blrtieal. Acton Committee. | Coe Se aera eg a | Sino (pesenee eioaAcTION) eee exrenbeo | apstase | Oxtueenenasvace | Binatone CHECK NUMBER oo id luetls Farao Bank a/t/oy |cx#AutO |rrasen@ity. TA | Mo. Servee Che |s 3.2/ luells Fargo Bank : Tsloy \cKeAuto | mpcon ehy.z9 soyos| 2 Service Chg Bal TOF DF ckit oF cK OF Ki [oF T | | ck# DF cK DF ck SUBTOTAL S TOTAL (if last page of this schedule) | § [HIS BOX APPLIES TO CANDIDATES COMMITTEES ONLY Purchases of certain campaign property costing $500 or mare must aso be inventoried on Schedule H. (Refer lo Schegule H instructions.) | Exponaiures to persons/enies providing consulting. adverising fnd-aising, poling, managing, organizing services must also be cota terized on Schedule G by the amount, pose, and date of each type of expenditure made by me personventty on behalf of te candidate's commtes. (Reet © | Senedule G instrctons and lowa Code 58.613) Page o_f (for Senedote 8)