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Generated On: 12/29/2008 12:15:03 PM

DR-2 Disclosure Summary Page DR-2


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 11/1/2008 11:16:32 AM

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date 12/29/2008

Report Date: 2008 Candidate Name: Jenson, Douglas W

Treasurer
Last Name: jenson First Name: Lora MI:
Address: 35256 200th Avenue
City: Forest City State: IA Zip Code: 50436 Phone: 641-581-5102
E-Mail:

Chairperson

Statement of Cash On Hand


Cash on Hand at Start of Period $29.10
Schedule A: Cash Contributions Total $2,435.00
Schedule F1: Loans Received Total $0.00
Schedule H2: Campaign Property Sales $0.00
Sub-Total $2,464.10

Schedule B: Expenditure Total $2,464.10


Schedule F2: Cash Loan Repayments $0.00
Cash on Hand at End of Period $0.00

Additional Assets and Liabilities


Loans in Place at Start of Period $0.00
Schedule D: Unpaid Bills $0.00
Schedule E: In-Kind Contributions $418.46
Schedule F2: Forgiven Loans $0.00
Schedule F2: Outstanding Loans $0.00
Schedule G: Consultant Breakdown No
Schedule H1: Campaign Property Value $0.00

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1
Generated On: 12/29/2008 12:15:09 PM

Schedule A: Contributions Sch-A


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser


Date Committee ID Candidate Amount
Check # albertson, dave
10/18/2008 44262 150th None $100.00
leland, IA 50453
campaign contribution
Check # bartelson, joann
10/18/2008 449 w. halverson st. None $25.00
forest city, IA 50436
campaign contribution
Check # benson, james
10/18/2008 35261 180th Ave None $100.00
forest city, IA 50436
campaign contribution
Check # jenson, Lora
10/18/2008 35256 200th Avenue Spouse $100.00
Forest City, IA 50436
campaign contribution
Check # jenson, Lora
10/18/2008 cash 35256 200th Avenue Spouse $0.00
Forest City, IA 50436
campaign contribution
Check # lewis, riley
10/18/2008 34938 145th ave None $100.00
forest city, IA 50436
campaign contribution
Check # newman, june
10/18/2008 PO Box 408 None $125.00
forest city, IA 50436
campaign contribution
Check # schulz, kelly
10/18/2008 605 hwy 9 e None $200.00
forest city, IA 59436
campaign contribution
Check # steffens, dave
10/18/2008 206 n. 1st ave. e None $250.00
lake mills, IA 50450
campaign contribution

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 3
Generated On: 12/29/2008 12:15:09 PM

Schedule A: Contributions Sch-A


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser


Date Committee ID Candidate Amount
Check # Urbatsch, Harley
10/18/2008 35421 190th Ave None $15.00
forest city, IA 50436
campaign contribution
Check # wilson, george
10/18/2008 246 w. "c" st None $10.00
forest city, IA 59436
campaign contribution
Check # winkleman, dwight
10/18/2008 42942 50th ave None $100.00
buffalo center, IA 50424
campaign contribution
Check # Wooge Farms
10/18/2008 34930 110th ave None $500.00
forest city, IA 50436
campaign contribution
Check # benson, dale
11/1/2008 19730 355th st None $100.00
forest city, IA 50436
campaign contribution
Check # boock, gail
11/1/2008 635 sunset ct. None $20.00
forest city, IA 50436
campaign contribution
Check # cordes, caroline
11/1/2008 945 west "i" st None $25.00
forest city, IA 50436
campaign contribution
Check # cordes, al
11/1/2008 945 west "I" st None $300.00
forest city, IA 50436
campaign contribution
Check # hepperly, michelle
11/1/2008 264 4th ave None $20.00
thompson, IA 50478-5037
campaign contribution

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 2 of 3
Generated On: 12/29/2008 12:15:09 PM

Schedule A: Contributions Sch-A


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser


Date Committee ID Candidate Amount
Check # jenson, Lora
11/1/2008 cash 35256 200th Avenue Spouse $0.00
Forest City, IA 50436
campaign contribution
Check # tegland, vicki
11/1/2008 36240 20th ave None $20.00
forest city, IA 50436
campaign contribution
Check # bartleson, joanne
12/12/2008 449 halverson st None $25.00
forest city, IA 50436
contribution
Check # carlson, byron
12/12/2008 34201 230th None $100.00
forest city, IA 50436
campaign contribution
Check # drabik, claudia
12/12/2008 898 Westwind Dr Sister-in-law $100.00
Little Canada, MN 55109
campaign contribution
Check # lillquist, mike & steve
12/12/2008 845 S Golf Course Road None $0.00
Forest city, IA 50436
campaign contribution
Check # lillquist, mike & steve
12/12/2008 845 S Golf Course Road None $100.00
Forest city, IA 50436
campaign contribution

Total Regular Contributions $2,435.00


Total Fundraiser Contributions $0.00
Grand Total All Contributions $2,435.00

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 3 of 3
Generated On: 12/29/2008 12:15:11 PM

Schedule B: Expenditures Sch-B


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Expenditure Expenditure Expenditure Name & Address Purpose Expenditure


Date Committee ID Amount
Check # fareway foods Miscellaneous or
11/10/2008 Unitemized 910 hwy 18 w $17.73
Unitemized
clearlake, IA 50428
food for victory party
Check # clear lake schools
11/12/2008 2533 901 s 14th st Other Expenditure $166.13
clearlake, IA 50428
food for victory party
Check # wal-mart
11/12/2008 2531 4151 4th st sw Other Expenditure $19.21
mason city, IA 50401
food for victory party
Check # buffalo center tribune
12/26/2008 2535 124 n. main st Advertising $131.67
buffalo center, IA 50424
newspaper ads
Check # globe gazette
12/26/2008 2529 300 washingon ave n. Advertising $25.00
mason city, IA 50401
newspaper ad
Check # lake mills graphic
12/26/2008 2534 204 n. mill Advertising $92.70
lake mills, IA 50450
newspaper ads
Check # State of Iowa
12/26/2008 2537 510 East 12th St Civil Penalty, Hearing Costs $150.00
Des Moines, IA 50319
penalty for filing reports late
Check # thompson courier & rake register
12/26/2008 2536 th Advertising $61.50
thompson, IA 50478
newspaper ads
Check # Jenson, Douglas W
12/29/2008 2538 35256 200th Avenue Other Expenditure $1,800.16
Forest City, IA 50436
partial payment of debt

Total Amount $2,464.10

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1
Generated On: 12/29/2008 12:15:12 PM

Schedule D: Incurred Indebtedness Sch-D


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Balance Owed at
Date Name and Address of Person to Whom Debt Description of Goods or Services Close of
Incurred or Obligation is Owed Provided or Purchased Reporting
Period*
1/17/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 payment for web-site
6/21/2008 Jenson, Douglas W Campaign Merchandise $0.00
35256 200th Avenue
Forest City, IA 50436 ordered merchandise on-line paid
with credit card
8/15/2008 Jenson, Douglas W Advertising $0.00
35256 200th Avenue
Forest City, IA 50436 newspaper ads
9/14/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 paint
9/15/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 paint
9/15/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436
9/15/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436
9/20/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 fence posts
9/20/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 tootsie rolls
9/24/2008 Jenson, Douglas W Printing & Reproduction $0.00
35256 200th Avenue
Forest City, IA 50436 printing brochures
9/28/2008 Jenson, Douglas W Other Expenditure $0.00
35256 200th Avenue
Forest City, IA 50436 fence posts
10/8/2008 Jenson, Douglas W Advertising $0.00
35256 200th Avenue
Forest City, IA 50436 KIOW radio advertising

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 2
Generated On: 12/29/2008 12:15:12 PM

Schedule D: Incurred Indebtedness Sch-D


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Balance Owed at
Date Name and Address of Person to Whom Debt Description of Goods or Services Close of
Incurred or Obligation is Owed Provided or Purchased Reporting
Period*
10/21/2008 Jenson, Douglas W Advertising $0.00
35256 200th Avenue
Forest City, IA 50436 KBEW- radio advertising
10/21/2008 Jenson, Douglas W Advertising $0.00
35256 200th Avenue
Forest City, IA 50436 KIOW- radio advertising
10/24/2008 Jenson, Douglas W Advertising $0.00
35256 200th Avenue
Forest City, IA 50436 KIOW- radio advertising
10/29/2008 north iowa media group Advertising $0.00
po box 271
mason city, IA 50402 newspaper ad
11/12/2008 north iowa media group Advertising $0.00
po box 271
mason city, IA 50402 newspaper ad

Total Balance Owed at Close of $0.00


Reporting Period

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 2 of 2
Generated On: 12/29/2008 12:15:12 PM

Schedule E: In Kind Contributions Sch-E


Doug Jenson For Sheriff Status: Amended
Committee Type: County Candidate - Sheriff Statutory Due Date 1/19/2009

County: Winnebago Adjusted Due Date

District: 0 Filed Date 12/29/2008

Committee Code: 18320 Postmark Date

Political Party: Republican Amendment Date

Date Name & Address of Relationship to Description of in Estimated Fair "X" for
Contributor Candidate *(if Kind Market Value Fund-
applicable) Contribution Raiser
10/20/2008 wooge, stephanie None Advertising $40.00
34930 110th ave
forest city, IA 50436 window advertising
12/29/2008 Jenson, Douglas W Self Debt Forgiven $378.46
35256 200th Avenue
Forest City, IA 50436 not enough money
left in account-
partial payment

Total Estimated Fair


$418.46
Market Value

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1

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