FOR INSTRUCTIONS, SEE BACK OF ZM

DISCLOSURE SUMMARY PAGE

COMMITTEE NAME (Must be same as on Statement of Organization)

Vitamvas for Iowa House

IMPORTANT : Indicate type of committee you are reporting for :
( 1 )Statewidell-egislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( a )County
( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee

CANDIDATE COMMITTEES ONLY :

~" jS-off
=
TELEPHONE DATE SIGNED

Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A S'~~ SOD - REPORT FOR ANIA (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one

CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

[~ Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & 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 monies 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 filed .) . . . . . . . . . . . . . . . . . S

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A . Cash Contributions total (Attach Schedule A) ("also see in-kind below) . . . . . . . %U- 0 0
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . .$ - OU
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B Expenditures total (Attach Schedule B) ("also see debts and loans below) .
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 - ACach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . . .. .. . $

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . .. . . . .. . . .. . . . . $
""OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . .. .. . $

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $

For Instructions, See Back of Form SCHEDULE
Reset Form
CONTRIBUTIONS -- MONEY TAKEN IN
A I MONETARY
(Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Vitamvas for Iowa House

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person other than statutory politica~committees .

DATE PAC ID NUMBER NAME AN ADDRES OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR

RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
$ ~ ..
~'
3/6 CK#

ID#
U

CK#

ID# U " , DU
/
C K#
/_
y /,Z0
I D#

f 4/
I D#
vv
C K#

ID# v

CK#(, _ h,

ID#

CK#

I D#

C K#

ID #

I D# v

C K#

SUB-TOTAL

TOTAL (if last page of this schedule)

' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page -~ of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
`For Instructions, See Back of Form

CONTRIBUTIONS -- MONEY TAKEN IN

(Including candidate's personal funds)
HECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) ENDING FORM
Vitawvas for Iowa House

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION : Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting cortributions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~I IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED Ft:ND-
(MM/DDfyR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

l0# PO BoxA)98 .Silver City,

Y~ JA 51571
fI CK#

ID# v
2307 3 Avenue Council Bluffs, 1A 5153
CK# ~~' 9-3 V! ~
`7 /1

IO# 4414 Vale Circle Madison, 'sconsin 53711

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CK#

ID# 10011 Wildwood Way Villa Park, CA 92861

um~ta,I!
1
JD# 9111 Gracious End Court #101 o 4

'115- pV CK#
Jr1 ~~ , _::7 D,
JD# IFL-AFL-CIO
2000 Walker Street, Suite A C 'J I
CK# Des Moines, IA 50317-5201
i~
ID#

CK# i
i
' -_

i 1\1
CK#
-__
ID#
I AUG 2 6 2004 I
,

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

" Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
comrnittee . Relationship must . b e show to the third degree of consanguinity (blood relatives) and affinity (relatives by
. If surname of contributor is the same as candidate, but there Is no
marriage) Page _ of
familial relationship, enter "not applicable" in the relationship column (for Schedule A)