You are on page 1of 3

OCT- 16-2005 11 :43 PEOPLES NATL HRNK 333EDWY

712 325 5141 P .02/04

I
FOR INSTRUCTIONS, SEE BACK OF FORM FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev .0712004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Offlse UsoOnly
040 -te a lga~~`r 11
Ta - Sc~~s. ...1 Comm . 4
Logged In
IMPORTANT : Indicate by # type of committee you are reparlJng;for . T
I I
(1 )StatewIdWLegfslallveIJudBe Standing for Retet lon Certdldatp ( 2 )State PAC ( 3 )Stets Party Scanned
( 4 )CountyCentral Committee ( 5 )Count to (q .. Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 8 )Cc I II '(.9 )A ' (10 )School Board, or Other PdMical Computer
Subdivision PAC (11 } Audited
CANDIDATE COMMITTEES" ..
Candidate Name '; ~olitlcel Party (d applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties.

->/z-3ed~-e- 3 3d, /p-/8- e,-C-


SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION 1(2 NON-ELECTION YEAR.


(report date) Indicate by #

Local Committees, enter Date of Election


[]CHECK 1F AMENDMENT TO REPORT DATED

County & Local Committees, enter County in


~] Check If this is final (termination) report end attach Notice of Dissolution Form DR-3. which Election Is held
(You must continue to file reports until a DR-3 is flied.)

STATEMENT OF CASH ON HAND


CASH ON HAND al the beginning of the reporting period . (Total of all funds 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.) ...................... ........ ... . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD &u
Schedule N.-'Cash Contributlops total (Attach Schedule A) ('also see in-kind below) .......... / 7v
Schedule F: Loans Received total (Attach Schedule F) ......... ...................... ............. ..... ......
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ........... .................. .....
(Schedule H applies to Candidates' Committee Only)
SUB-TOTAL ..... $ 3 z ;> -"
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 30
be zero) (Attach DR-3) .. . .. ... . .. . .. .. .... ... .. ...... .... ...... .... ........... ... .... ....... .... ....... .. ... ... . .......... ..... . $ 8
"UNPAID BILLS (From Schedule D -Attach Schedule D) ......... ........................................................$
'IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) ...................................... .........$ 6
"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) ........................... ....................... .$ 0-

U
CANDIDATE COMMITTEE$ ONLY;
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
OCT-19-2005 11 :43 PEOPLES NATL HANK 333HDWY
712 325 6141 P . 0 3/04

For Instructions, See Back of Form SCHEDULE


Q MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candkiate'a Personal funds)

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


a CHECK THIS BOX IF
AMENDING FORM

- / .Bvc-yr

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 political committees.

DATE PAC lD NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DC1rYR) ANO PAC CHECK (f applicable) RAISER
NUMBER _ INCOME

6 z ALX N. ,B .-_ Z
CK#
Cut..ne i /
I DO C. A

9 - 6- u-r cK# 7 ss I 7~-~ 6 ~, ._~


So
1D# j~c . .y/y /aTar ." e yTc

I D#
. .. v.r~ .-/~- .~/..1.

I D# ,'-
~

G CK# GG
/191

ID#

CK#

ID#

. CK#

ID#

CK#

CK#

ID#

CK#

SUB-TOTAL I $ o a
/,-",
TOTAL (if last page of this schedule)
I $I7U
' Disclosure law requires candidate committees to disclose the relationship of any relative making e 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)
OCT- 18-220 .5 1143 PEOPLES NATL BANK 333BDWY
712 325 5141 P . 0 4i04

FOR INSTRUCTIONS, SEE EACK OF FORM SCHEDULE

B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07103) EXPENDITURES

STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE


CHECK THIS BOX IF
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

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

/.~ a,,4 e t A r a .r ~[ ~O "r C. t ti- pn

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDO/YR) AND PAC
CHECK
NUMBER

0-0/w C

ID#

CK#

C K#

ID#

CK#

ID#

CK#

ID#
_ .
CK#

IN
CK#

)D#

CK#

SUB-TOTAL $ c~ cf y''r`
ys .
TOTAL (Iflast page of this schedule) $ I t.1 g-1

THIS BOX APPLIES TO CANDIDATES' COMMCrTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)

Expendtures to personslendtles providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detall 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 tows Code 68A.402(3)0).)

Page Z ~ of

(for Schedule B)

TOTAL P .04

You might also like