11/23/05 18 :22 FAX 1 515 266 1349 MILLER THE DRILLER Z001

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev. 0712D04) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
Martha Miller Campaign Comm . #
Logged In
IMPORTANT: Indicate by # type of committee you are reporting for : lW I
( 1 )Statewide/Leglsladve/Judge Standing for Retention Can ' 2 )State PAC (3 )Slate Party Scanned
(4 )County Central Committee (5 )County Candidat n ate ( 7 )School Board or Other Political Computer
Subdivision Candidate (8 )County PAC (9) ' ool aid or Other Political Subdivision PAC
11 ) Local Ballot Issue Audited - -

Late reports are subject to possible civil and Criminal penalties .

S1 Sa~G-aa ~ I (_.a3-05-
SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

-23-05
I AM FILING A -11
0
REPORT FOR (1) ELECTION 1(2)NON-ELECTION YEAR .
(report date) Indicate by #

Local Committees, enter Date of Election

'CHECK IF AMENDMENT TO REPORT DATED
11/8/05
heck if this is final (termination) report and attach Notice of Dissolution Form DR-3. County b Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed .) which Election is held
Polk

STATEMENT OF CASH ON HAND

CASH ON HAND at 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 32 .71
of the last reporting period or must be zero it this is first report filed .) . . . . . . . . . ., . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) . . . . . . . . . . . . . . . . . . 51 .29

Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . ., . . .. . . . . . . . . . ., . . . . .,
(Schedule H applies to Candidates' CommMees Only)
SUB-TOTAL . . . . . .. . . ..... . . ; 84 .00
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
84 .00
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
0.00
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

-UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . $ v .vv

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 101
"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . .$ 0.00
CONSULTANT BREAKDOWN (Schedule G Attached?) - YES J NO
CANDIDATE COMMITTEES ONLY :
0.00
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
STATE COMMITTEES . Submit a reconciled campaign account bank statement In January of each year.
11/23/05 - 18 :22 FAX 1 515 266 1349 MILLER THE DRILLER fa 003

For Instructions, See Back of Form SCHEDULE

A
CONTRIBUTIONS - MONEY TAKEN IN
(Including candidate's personal funds)
(Rev . 07/03) I MONETARY
RECEIPTS

0 CHECK THIS BOX IF

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

Martha Miller Campaign

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POUTICAL 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 ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Robert DeCook $25'00
11/4/05
CK# 1535 Springs Drive
Pleasant Hill . IA 50327
ID#
Martha Miller 26 .24
11/4/05 CarJ,oQa .
CK# 5230 E Oakwood Dr
Pleasant Hill . IA 50327
I D#
Horizon Federal Savings Bank ,05
11/7/05 1290 Copper Creek Dr, Pleasant Hill IA 50327
CK#
INTEREST RECEIVED ON CUCKING ACCT
ID#

C K#

ID#

CK#

I D#

CK#

ID#

CK#

I D#

CK#

ID#

CK#

ID#

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
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 1 1
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)
11/23/05 18 :22 FAX 1 515 266 1349 MILLER THE DRILLER 8 002

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 07103)
MONETARY
EXPENDITURES

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

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD,

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

Martha Miller Campaign

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DDIYR) AND PAC
CHECK
NUMBER
ID#
Bidwell Riverside Center Charitable Donation to close
11/10/05 1203 Hartford Ave committee bank account $ 84 .00
CK#
Des Moines, IA 50315

ID#

CK#

I D#

CK#

I D#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

ID#

C K#

SUB-TOTAL $ 84,00

TOTAL (if last page of this schedule) $ 84,00

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 persons/enfties 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 personlentily on behalf of the candidate's committee. (Refer to
Sch edule G instructions and Iowa Code 66A .402(3)(i) .)

(for Schedule B)