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I AM FILING A OC-Tf S lh, C1c :i .'ut REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .
(report date) Indicate by ft ,,
[] 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 DR-3 is filed.)
"'UNPAID BILLS (From Schedule D - Attach Schedule D) .. .. .. . .. .. ...... .. ....... .. .. .... . . ..... .. .. .. .. .. .. .. .. .. . .. .. . $
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . ... .. .. .. .... . . . ... ... .. .. .... .. . . .. ..... .. ... $ 22r gf~(:k 13y _
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SIGNATURE OF PERSON FILING REPORT TELEPHONE
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I AM FILING A C91 r -ZS ?c _REPORTFOR-(1)ELECTIO_
_ /(Z)NON-ELECTION YEAR .
(report date) lndjOWby
71 Check if this is final (termination) report and attach notice of .Dissolutim-Form DR-3, :
(You must continue to file reports until a DR-3 is filed .)
ounty & Local Committees, enter County in
hich Election is held
Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) . . . . . . . . . .
Schedule F : Loans Received total (Attach Schedule F) . . ., . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . ., ., . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
mmlttees On
SUB-TOTAL . . .. . $
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) . . . . . . . . . . . . . . . . . . . . . . . . : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
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familial relationship .enter"notapplicable"in the relationship column. b u t there i (for ScheduleA)
10/2/2004 20:45 5535333995 -JERI i:)JATSON PAGE 133/05
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CHECK THIS BOX IF
AMENDING FORM
J
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), UST THS 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: Section88B.32A(8), 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 political committees.
DATE PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDDfYR) AND PAC CHECK (if applicable)
NUMBER RAISER
INCOME
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Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Rslationsnlp must be shown to the third degree of consanguinity (blood relatives) and amity (relatives by
marriage) . If sumame of contributor is the same as candidate, but there is no Page
famillal relationship, enter'not applicable' in the relationship column . (for Schedule A)
1012712004 2
2 0 :45 5535333395 JERI WATSON FAGE 04!05
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COMMITTEE NAME (Must be same as on Statement of Organization)
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THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to personslentitien providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personlentity on behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code 68A .402(3)(i) .)
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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 (for Schedule E)
by marriage). (See Page 2 of forma packet .) If surname of contributor Is the same as candidate, but there Is no
familial relationship, enter "not applicable" in the relationship column .