FOR INSTRUCTIONS, 30 MCK eW FORM

DISCLOSURE SUMMARY PAGE

IWORTANT, Indleelo type of eommWes you an r6PWWW for:

(1 )tlbtawldwLapiIWdw Cr+dldm (2 )SIvI We PAC (s)"tate Pate (4 )CoumV/Local anaiaw

!~ ($ )County PAC (e )ascot IawetsnoWeo Co ra atbe (T )CoW+VICIV Gr+w comas
^(a )euooort elab 4f arm
CANDIDATE CO111111111111TT'!tp ONLY:
Candidate Nome Polhloel Pony
ALP
11 - ft t (if Sonata or House)

Late filed nports era subject to possible civil and criminal penalties.

end
SEE INSTRUCTION" ON /ACK AND COMFLET'E THE FOLLOWING SENTENCE :
I AM FILING A ga4' Go:r r REPORT FOR ANA ('1) IIAICTION U)NON-ELECTION YEAR .
(sport this)
Indfw one 0 tool Ca nrnfes. ~Date of Eledon
(3CHECK IF AMENDMENT TO REPORT DATED
entry in
1-1 Chock If Wits to ae°r°n k
fine %tsrmlnabon) report and s1fa0h Notion aN Olssokatlon Form DR- 4k
"d'lah

(You must ovAnue b So roporls urM a Notice of Dissolution is Aisd.) la

"TATEMENT OF CAIN ON HAND

CASH ON HAND of the bplnning of the reportkhg period. (This is the OW of all monios hold
by the committee. This amount MUST be tote wt» as ft ash on hand at ft and
of the lest reporbi period, orrnust bo arc it this le Arts report flfod.) .... ... .. ... .... ... ..... ..... . ... _
ADD TOTAL MONEY TAKEN IN THIS PEIUOD
$0»dula A: Cash Conlributiono IOW (A ch Schedule A) ('also as In-tlnd below) . ... .... . .
Schedule F: I-oano Reosiwd toss (Atdoh Schedule F) .. . . ..... .. .. . . .. ......... .. ....... ..... ... ...........
Schedule H: TWO Sales of Campaign Property (Attach Schedule H) ...... . . . ... .. . ... .. ... . ... . .. . .. .

StA-TOTAL ..»."
SUBTRACT TOTAL lIIIONny SPIZNT THIS IMRIOD
Schodu)o e: ExpondKures total (Attach Sohsdule e) ("oleo sae debts end loons below) ....
Schedule F: Loan Repoyrrenb WW (Atah Sohodule F) . .. .. ... .. .. . .... ..... ............ . . ... ...........
CASH ON HAND at the and of this reporting period (if final rspa L bshnoo must
be sego) (Attach OR-3) .. . .. .. . . . .. .......... . .. . ... .. .. . .. . . . .. . ..... .., .. . .. . . .. ... . . ..., ... . ... . .. ... ..... . . .. ...... ... S

"UNPAID VILA@ (From Schedule 0 -Atlach Schedule 0) .... . .... . .. . ... .. ... .. . .. ... ... ....I . .... ... . . .. . ............... lf
"IN KWD CONTROUTIONS (From Sdndule E - Atboh Schedule E) ..... . ....... ........ ... ..... ... ... , .... . ... . ,

a"
"WTSTANDM LOANS (From Sahodulo F - Afsch Schedule F) ........ .. . ... ... ..... ... .. . .. ... ..... ............ . f

r7y.,
A,

CON "ULTANT BROAKDOM1r1(aa+eoure o Aaeoned7) 1:jN0

VALUI OF CAWrAIQN PXOM!!TY (From schedule H -Atdoh Schedule H) t
 FOR WSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 0701)
MONETARY
EXPENDITURES

STATE PAC COWAITT1t1" I NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEG"TIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER !N THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE. A UST OF ID NUMBERS IB AVAILABLE FROM THE IOWA
0 CHECK THIS HOX IF
AMENDING FORM
ETHICS S CAMPAIGN DISCLOSURE BOARD.

COMIIIIARTEE NAME (Must be wares as on Statamont of OFgaWsatbn)

CANDIDATE NAME ANDADDRESS TO WHOM P 1."T E AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (H applicable) (AdaburaMent) WAS MADE
(MGNDIDIYR) AND PAC
CHECK
NUMBER
IDS
0 .
/
d CKS $ ~- Gt7

ID0 5Pelc4e_^ ~r 140,4> 5

e L~ r~
3/
d5`
CK# a f1 o i - ~,'-~ car ztn z .,. CvM n. '
IDIIk

CKS

IDO

CKS

ID*

CK*

1D#

CK#

CKO

IDS

CKB
.
urWITAL $
TOTAL (rrrace papa of di ra wow) a.
THIS SOX APPLIES TO CANDIDATES` COYAA111ITTEES ONLY :

Puromaaa of certain compelpn property oosllnp E600 or more must also be Inventoried on Sdwdule H. (ROW to Sdwduw H Insbudlons .)

Expenditures to pwoonWntlews provtdkv consulting, adver", kind-railft, podlnp, managing, orp&nW% services must also be debt Itemised on
Sdxrdule 0 by the amount. WPM, and data of each type of eapendNWr m1009 by 1M pw=Wentky on behalf of Ow cwWd8W1 COMMIltw. (Row to
Schedule 0 kutrdlons and lone Code SSA.BMV .) _ _

(for Sdedukr B)
 FORM (Rev. 07/03)
Notice of Dissolution
DR-~
NOTICE OF
DISSOLUTION
Mail to :
IECDB
510 East 12 °', Suite IA For Office Use Only
Des Moines, Iowa 50319
Comm. #
Indexed
APR 7 2005 Audited
Computer
Certified Date of Dissolution

COMMITTEE NAME

(U"r- S)~eo,~,er 'SC ~ 00~S

Official Name of Committee

O- Uc 6 .
Street

City, State, Zip Code

a G ,'- - (~p 3 -moo

Area Telephone
Code

WHEN TO FILE:
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following :

1. All debts, loans and obligations have been paid or transferred ;

2. All campaign funds have been spent;
3. All campaign property sold or transferred (candidates only) ; and
4. A final report disclosing all transactions closing the committee .

For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed.

6~~ zzz~,,~
Signature of Candidate or Treasurer (if candidate's committee)/Signature of Chair or Treasurer (if PAC)

FOR INSTRUCTIONS, SEE BACK OF FORM

This form is not applicable to statutory political committees.