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I
FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev . 12/2005) REPORT
File with :
Iowa Ethics and Campaign
Disclosure Board
510 E . 12'", Ste . 1A
Des Moines, Iowa 50319
Fax : 515-281-3701
Late reports are subject to possible civil and criminal penalties. Pursuant to Iowa Code section 68B.32A(7)
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is the
individual responsibjp for filing tirr ly and accurate reports .
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TELEPHONE DATE!SIGNED
IAMFILING A FINAL Tr QM(WA -T(f9N REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by #
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
'7 N oy y AA ( r, 2 le c2o 0 .
County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed.)
which Election is held
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Q CHECK THIS BOX IF
AMENDING FORM
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'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page of
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives ( or Schedule E)
by marriage) . (See Page 2 of forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .