Professional Documents
Culture Documents
"UNPAID BILLS (From Schedule D - Attaih Schedule D) .... . . . . ., .., ..., ........, . ... . . . ., . ....., .. . .. .., ........., ........ . .. . ., . . ...$ 3.896 .94
'IN KIND CONTFIBUTIONS (From Schedule E - Attach Schedule E) . . .... . ..-1- . .... . . .... ........ . . . ... . . . . . .. . . ... . . ....... . .3 636_
.5_7
-OUTSTANDING LOANS (From Schedule F - Attach Schedule F) ... .. . ... . . . . .... . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . ... .. . . . . . . . . . . .s (L 00
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .
04i 121200G 16 : 13 .3 1319G532G31G FEDERATION SANK PAGE 0'2
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIvED FROM A STATE PAC (POLITICAL AC7ION 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 ": IF FOR
RECEIVED (If applicable) TO CANDIDATE , RECEIVED FUND-
(NIrv71DDiYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
nick Gallagher $250 .00
l7,-06
`~ # 672 260th
Washington . TA 52353
ID*
Janet Gallagher 250 . 00
~i l iiOC CK# 2672 2606
Washbigton, 1A 52353
ID#
Lorilec Mills 300 .00
2/22106 605 South kinxion Avc
CK#
Washington, [A 52353
I D#
Michael and Karen Van Osdol 300 .00
?-22!06 CK# 1 .314 Woodland Court
Washington [ :A 5235 ,
I D#
Eric Turner 100 .00
. ..106 CK# 906 South 10th Avenue
WashinZtnn .IA 52353
f D#
Shawn and Stephanie Ellingson 500,00
-2~,~0f 809 North 2nd Avenue
CK#
Washington . 1A 52353
ID#
42/06 Job)) and Karen Mocnck 500 .00
CK# 613 South Avenue D
Washington. 1A ./2353
ID#
Christina Buchholz 100 .00
2-w0( 2480 Hwy 92
CK#
Washington, IA 52353
I D#
CK#
I D#
CK#
SUB-TOTAL
' Disclosure law requires candidate committees to citsclase tf a relationship of Try ro(ative makings Contribution to the
committee. Roiationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by ) r)
marriage) . If cumamo of contributor is the same as candidate, but there I-. no Page _._l-_ .._
familial relationship . onter "not applicable" In the relationship column . (fpr Schedule /t)
04 :12!2005 05 :03 13195532'535 FEDERATION BANK PAGE 03
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACT1ON 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). Imva 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.
Oisrlosure law requires canoldate commlnees to disclose I .he relelionghip of any relative making i contribution to the
cornmltlee . Relallonahlp must be shown to the third degree of consanguinity (blood relatives) and afi)nity (relallves by 2
rnsrrlngej . If surname of contributor is the same as candidate, but there+ Is no Page r----- of '
fAmlnal relailonshlp, enter 'not applicable" in the relationship column . (for Schedule AT
04f1'2/'2t306 08 :0 .3 1 .31'3553'2536 FEDERATIOtl BANK PAGE 04
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM ASTATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER At"ID THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IO"VA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
CAUTION . Section 68B .32A(6), IOWA Code, prohibits the use of Information copied from reports and staloments for sollcifng contributions or
for any commercial purpose by any person other than statutory political commiltoes .
DATE PAC IO NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~i IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FIJND-
(f,dNt;AD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Ruthella English $200 .00
2!1''06 815 North Manon
C K#
I Washington, 1A 52353
ID#
Kevin E . Posekany 50,00
2r?4/0(
CK# 401 East 13th Street
Washin ton,IA 52353
I D#
2/2ff (lh
Doug Dunlap
200 .00
CK# 509 West Washington
Was hington, IA 52353,
ID#
Steven C . Olson 100 .00
3/1/06 CK# 270 Easz Trio Lane
Washington, TA 5'2353
1D#
Nancy Clawson 20.()Q
2/28!06 1000 West 5th
CK#
Washin ton,1A 52353
ID#
David )\tacos 500 .00
2'2e'06 622 Soutli 15th avenue
CK#
Washington, IA 52353
i ID#
John W Helscher, D .D .S . 500 .00
3~ l r'il( 205 South tbf.rion Avenue
CK4
Washington, TA 52353
ID#
David J . Schmitt 500 .00
3!1 :06 800 South 14th Avenue
CK#
Washington, IA 52353
I D#
Julie Groteivold
3/1/06 300,00
CK# 307 High Aven.uc East LJ
Oskaloosa .1A 52577
ID#
Rebecca Harman 1.00 .00
2!17x06 698 Perdock Coourt
00
Washington, IA 52353
SU&TOTAL
2,470 .00
TOTAL (if last page of this schedule)
S
' requires candidate committees to disclose the rNaltonshlp of any relative making a conlributfon to the
Olsclosure law
ccmmlttee . Rt~alionship must be shown to the third degree of ronpanquinity (blood relatives) and afffnity (relatives by 3 "'
man lago) If ^urname of contrlbulor Is the same as candidate, but there is no Page
famlllal rp0etionshlp . enter "not applicable" in the relationship column . (for Schedule A)
~aq '1 :'/2OFa6 08 : 03_-196532636 FEDERATION BANK PAGE Fay
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOY. 11=
COMMITTEE NAME (Must be same as on Stafement of Organization) AMENDING FORM
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDE14TIFICATION
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 solicdlng contributions or
far any commerdal purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED I (if applicable) TO CANDIDATE' RECEIVED FUND-
(PXMrDDiYR) AND PAC CHECK i (If applicable) RAISER
NUMBER 1NCOrdE
ID#
Sidney D . Manf-ull $500 .00
2/23106
CK# P .O . Box 86 ti
Washington, TA 52353
ID#
Dona)d Parterson )00 .00
2,'25!06 605 South 15th Avenue
CK#
Washin on, IA 52353
ID#
1:T . Winifrcd Marshall 2 000 .00
2124 ;06 1203 East Washington Street: '
CK#
Washington, TA 52353
IDt#
Tracy A . S(rabala
2Il ii06 10 .00
CK# 836 South Avenue 13
Virsshin on T.k 52353
ID#
VC ., Tnc . 300 .40
? :24/06
CK# 1405 Ridgevicw Court
Washington, 1 523533
ID#
` , `71 0 0 Jone< Funeral Home, Inc . 200 .00
CK# 116 East Main
Washington . TA 52353
I D#
Unitemized Contributions 103 .00
2/27106
CK#
L7
I I D#
Unitemized Contribition-c
3/2, 1 06 10.00
j CK#
ID#
CK#
IQ#
CK#
SUB-TOTAL
Disclosure law rnquiras cand)dste committees to disclose the relationship of any relative making a contribution to the
Cammillee. R8IAIIonShip must be shown to the third degrm nr cons anguinlty (blood relatives) and affinity (relatives by 4
marriegel . If surname of contributor is the sgrne as canaldata . OW thore Is no Page of
Tarnllial rolaaonsl))p, enter "not applicable' In the relationship column . (for SCh0CLlle A)
13195532535 FEDERATION BANK PAGE 06
04 :'12,'2005 0 ; :03
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FRCM A STATE PAC (POLITICAL ACTION COMMITTEE). LIST THE PAC !DFNTIFICATIOI!
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
D!SCLOSUHE BOARD.
CAUTION : Secdon 686 .32A6), 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 .
DF1TE PAC ID Nt)MBER NAME AND ADDRESS OF CONTRIBUTOR RELA71ONSHIP AMOUNT r: IF FOR
;if applirAhle'I TO CANDIDATE' RECEIVED Fj^: ; .
!f.It":~r'D~:'lR1 4r"Ip -f ;(.', rl-1_CK, (if fippli~ahla, ti'A15=I~
ra i~ Nl BE n. I t-IC r~
,;,.. t
ID#
Shelly L . Hofrman $100 .(H)
.',.'(11/06 CK# 1105 North ylarion Avenue;
Washington, IA 52353
I D4
Edward A . Brown 500 .00 I
2 !24/0!, 2714 250th Strect
cKu
Wa~hinpron .IA 52353
I Dil
J- ran, :iti I b
.,"11,4-on 1 .0( .(!
s !U1/(G f 1 .11 E .ua
CK# n Korea
ID#
Donald 13 «'ells 101) .0()
:~UIiUG 27()! 285th Street
CK#
ID#
CK :.
John Garter I 500.(10
# 113t)'> \bl,!1 .1tll :tnfJ I_ Ou1T I
IDS'
L)niterni7rtd Contributions 31,00
t I)i, _ _. 1 .' fill
C'.KX
~. .'.1i11<I
fJiCm( .:l
2()0,011
CK9 001 kVest NI .tin Srreel
ID# I
Debbie S . Orris 150 UU
3/0 9/06 S11 South 2nd A-e
C K#
Washington, IA 52353 j
Sue-TOTAL
' ~Disclosure 13w requires canakJate commfetoes to dkeocc the relatlhnshrp of any mtapve ma" a contribullon to the
cors+miUee Relationship mu .jl be shown to the thircl degree of conninguinfy (blood rrraliveb) and affinky (fetativos try 5 ."
i .7rrIz0E'I 11 Surname of contributor is the sam2 as canUldate, nut Ihem is no Pa9C". ___-__ Of --
f"n,llial relationsnip . enter 'not applicable" in the relationship column. (for Suheaule A.)
1319G592G3G FEDEPATION EANK PAGE 07
134i_2120P3G 0h :03
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 DCSIf=NATED COLUMN, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
UISCI.n: r)FE BOARD .
CAUTION: Section 68[3.32A(6) . Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
for any commercial purpose by anyperson other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT I d IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND .
(k"IIti4!DD/)'RI AND PAC CHECK (if appllcablc) RAISER
NUMBER INi.~I,-IE
ID#
Horak Tnsurlncc $500 .0(1
- , JO, ,Oct 115 Fast Washington
CK#
Washington . TA 52353
ID#
Donald Klinc 300 .00
3:22;'05 CK# 909 South 12th Ave
Washington, TA 52353
I D#
Marianne and Jim Hanshaw 250.00
3!$i0G CK# 1 I I West IOth Street
WashiirEton,1A 52353
SID#
Don Sobaski 1$0.00
3/22/06 CK# 3245 Dogwood Ave
Bri jhton 1A 52540
I Dit.
klichael Moors 250 .00
3'24'06 CK# 1301. East 1V+i.shinrnon Street
Washington. IA 52353
I D4
Judith Driscoll 500,(,10
3:22/06 617 West Washington Blvd
CK4
Washington, TA 52353
ID~i
Cathy Rich 50.00
3128!05 P.O. Box 214
CK#
Drighton, TA 52540
I D#
Lauren and David Powcrs
3( .:9i06 7 00 .00
CK# 714 N 2nd Avc
Washington, 1A 52353
ID#
Shane Ehrcsrnan 200 .00
3;'29/06 CK# 315 Wcst 3rd Street
1
WaOin?tnn, IA >235'
ID#
Uniternized Contributions
413!06 20.00
CK#
SUB-TOTAL
255000
,,
' t?Isclosure 1 .3,u requires candldat0 committees to disclose the relationship of any relative msklng a conBibution to the
commtuee Relationship must be shown to the th1M degree of consanguinity (blood relatives) and efTnity (relatives by
marriaga) Ir surname of contributor is the acme es condidote, but Iherc 13 no Page ( of
familial relationship, enter "not applicable' In the relationship column . (for Schedule A)
PAGE 13°
04/12 ;2001, I3° :03 13195532536 FEDERATION BANK
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE). LIST THE PAC IDENTIFICATIOri
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPa1GN
DISCLOSURE BOARD.
CAUTION: Sertion 68B.32A(6), Iowa Code, prohlblis the use of information copied from reports and statements for sollGtlng 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 " IF FOR
RECEIVED (if appllrable) TO CANDIDATE' RECEIVED FUND-
(MM/DD!YR) AND PAC CHECK (If applicable) RAISER.
NUMBED, INCOME
ID#
Vernon Hoskinson 850,00
4!2/06
CK# 1302 Last Washington St
Washington, Irk 52353
J D#
Lcisha A.T-inge
4i5%06 1.50 .00
CK# 902 South Iowa Ave
Washington . IA 52353
ID#
N .P .K .K . Pork, L,C,
4!6106 500.00
CK# 1806 250th Street
Washington, IA 52353
ID#
CK#
ID#
CK#i
014
CK#
ID#
CK#
ID#
CK#
_ _
ID#
CK#
I DA
CK#
I
I
SUB-TOTAL
' OIA ;lasure taw requires candidate Commlrlees to disclose the reiatlonshlp of any relative making a contribution to the
commitleo Relatlanship must be shown to the third degree r,-f consanguinity (blood rela0vee) and afhy (relsllvee by 7
rnarrlage) . If wmame of contributor is the same as candidate, but there Is no Paso _______
famlual relarlonsnlp, enter - not applicable" In the rolauonsnlp column . (for SChe4Ul8 A)
A4/ 1'2/'2P30h 08 : e3 13195532535 FEDERATION BANK PAGE 09
.: .
FOR INSTRUCTIONS, SEE BACK OF FORM QI717," ;
SCHEDULE
CK#
ID#
CK#
Purchases of certain campaign property costing m500 or more must 11so be inventoried on Schedule H. (Refer to Schedule H Instructions .)
Expenditures to porsons/entities providing consulting, advorlising. 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 person/entity on behalf of the candidate's committee (Refer to
Schedule G instructions and lok+ia Code 68A.402(3)(i),)
I
Page of _-_-
I
FOR INSTRUCTIONS, SEE HACK OF FORM SCHEDULE
D INCURRED
COMMITTEE NAME (A9ust bo rime as on Ststemenr of Organization) (Rev, 08198) INDEBTEDNESS
Xsshington Good To Grcat
Q CHECK THIS BOX
IF AMENDING
NOTE : Debts previously reported that remain unpaid must be Included on this
FORM
Schedule . as well as any new obligations incurred in this period .
SUB-TOTAL $
3,896 .94
'If actual figure Is unknown, show "estimated" beside the figure . Page I of 1
0)
(for Schedule
schedule)
'Disclosure law requires candidates to disclose the relationship of any relative making an In kind contribution to the Page 1 or 1
commitlgo. Relationship must ba shown to the rh;M degree or conranguinlty (blood relatives) And afnlty tr®lariwac (for Schedulo El
by marriage) . (Soe Page 2 of forms packet .) It surname of contributor is the same as candidate, but thorn is no
ramiliel relationship, enter 'not applicablo" in the relationship column .