Professional Documents
Culture Documents
For Instructions, See Back of Form Be Same As T"ar I: Disclosure
For Instructions, See Back of Form Be Same As T"ar I: Disclosure
For Instructions, See Back of Form Be Same As T"ar I: Disclosure
Check if this is final (termination) report and atta o u ton orm DR-3. County S 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) .. ... ..... ... .. . .. ...... . . .. ... . .. . .... ........ $ 32-592 .11
-OUTSTANDING LOANS (From Schedule F-Attach Schedule F). ........ ........ ....................... .......... .$
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES 176/ NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
STATE CANDIDATES NOTE_ IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PACCHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF 10 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 IDNUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Iowa Democratic Party - Senate Truman Fund
10/18/04 5661 Fleur Dr 63,000 .00
CK# 6441
Des Moines, lit 50321
ID# 6046
Justice for All
10/18/04 CK# 218 6th Ave Suite 526 `,000'00
3909 Des Moines, IA 50309-4091 1 =
ID#
6070 Iowa Law PAC
10/18/04 500.00
CK# 521 East Locust St. FL 3rd
3117 Des Moines IA 50309-1939
ID#
Heather Bombei
10/18/04 18824 Zephyr Ave 100.00
CK#
Delta, IA 52550
t0#
Janene Chan Powers
10/18/04 1456 W Byron St 50,00
CK#
Chicago, IL 60613-2828
ID#
Unitemized Contributions
10/18/04 185.00
CK#
ID#
Julie Grotewold
10/18/04 807 Hig1T Ave E 100.00
CK#
Oskaloosa, IA 52577
ID#
Donald K Campbell
10/18/04 CK# 1609 S Park Ave 35 .00
Oskaloosa, IA 52577
ID#
Neat Hadden
10/18/04 CK# 807 Woodland Rd 50.00
Oskaloo 1A 52577
ID#
6294 Iowa City Carpenters PAC
10/20/04 CK# 705 S Clinton St 200.00
1173 Iowa City, 1A 52240
SUB-TOTAL
' Disclosure law requires candidate committees to disclose the relationship of any relative making a oonlnbufm to the
committee. Relationship must be shown to the third degree of consanguinity (bl)od relatives) and affinity (relatives by
marriage)
of . If surname of contributor is the same as candidate, but there is no Page -
1
__
- 7
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
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 ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(M"I") AND PAC CHECK Ctf applicable) RAISER
NUMBER INCOME
ID# 6046
Justice for All PAC
10/20/04 218 6th Ave Ste 526 $ 2,500.00
CK# 3923
Des Moines, IA 50309
ID#
Wapello County Democratic Central Committee
10/20104 200'00
CK#
0887 Ottumwa, IA 52501
ID#
Sandra D Sanders
10/20/04 CK# 2382 Plymouth Ave 50 .00
Oskaloosa, IA 52577
ID#
Marie Ware
10/20/04 CK# 216 Terrace Dr 50 .00
Oskaloosa, IA 52577
lD#
David Foubert
10/20/04 2150 310th St 100.00
CK#
North English, IA 52316
ID#
Iowa Democratic Party - State Account
10/21104 CK# 5661 Fleur Dr 28,500 .00
1784,9 Des .Moines, IA 50321
ID#
Harold Heslinga
10/21/04 50 .00
CK#
Oskaloosa, IA 52577
ID#
Larry Anderson
10/21/04 214 Caldwell Place 50 .00
CK#
Oskaloosa, IA 52577
ID#
Mike Vore
10121/04 CK# 2411 McMullin Dr 300.00
Oskaloos iA 52577
ID#
Pat Burke
10/21/04 CK# 1301 Edmunds-on Dr 100.00
Oskaloosa, IA 52577
SUB-TOTAL
" 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 2
marriage) . If sumame of contributor is the same as candidate, but there is no Page --- of -
familial relationship, enter "not applicable" in the relationship oolumn . (for Schedule A)
a
(Including candidates personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must he same as on Statement of Organization) AMENDING FORM
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 ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
(MM/DDfYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
William VanDevender
10/21/04 1006 Maywood Dr $ 35 .00
CK#
Oskaloosa, IA 52577
ID#
Dara Dickey
100 .00
10/21104 CK# 302 N .9th
Oskaloosa,IA 52577
ID#
Ted Overbergen
40.00
10/21/04 CK#
Oskaloosa, TA 52577
ID#
Matthew Moore
10/21/04 118 North Market St 100 .00
CK#
Oskaloosk, IA 52577
ID#
Mary E Rielly
10121/04 2008 South I ith St Mother 100 .00
CK#
Oskaloosa, IA 52577
ID#
Robert Lynn
IO/2IJ04 1106 Fox Run Dr 50.00
CK#
Oskaloosa, IA 52577
ID#
Gary Walker
10/21 l04 100 .00
CK# 1282 C Ave E
Oskaloosa,IA 52577
IQ#
Max Shields
10121/04 1806 S I Ith St 40 .00
CK#
Oskaloosa, lA 52577
ID#
John Pothoven
10/21/04 CK# 3 Park Place 250.00
Oskaloosa 1A 52577
ID#
Nancy Spry
10121/04 CK# 4081stAveE 50 .00
Oskaloosa, lA 52577
SUB-TOTAL
' 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 3 "1
marriage) . If sumarne of contributor is the same as candidate, but there is no Page _ of __
familial relationship, enter "not eppticable' in the relationship column . (for Schedule A)
0
(Including candidate's personal (unds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
Rielly for Senate
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 ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND}
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
David Ahmad
10/21 /04 CK# PO Box 65 $ 100.00
Oskaloosa, IA 52577
ID#
Unitemized Contributions
10/21/04 330 .00
CK#
ID#
Theresa Grahek
10/21104 50 .00
CK# 1605 A Ave E
Oskaloo IA 52577
ID#
Lori Oaks
10/21/04 CK# 1909 Edmundson Dr 50 .00
Oskaloosa, IA 52577
ID#
Linda Yates
10/21/04 203 N West St 200.00
CK#
SigotnTley, IA 52591
I DN Brandon Stone
10/21/04 113 I/2 Higb Ave W 40 .00
CK#
Oskaloosa, IA 52577
lp#
Danielle Rouw
10/21/04 100.00
CK# 310 Soutb 9th St
Oskaloosa, IA 52577
ID#
James Zimmerman
10/21/04_ CK# 110 High Ave W Suite 3A 100.00
Oskaloosa, IA 52577
ID# a
Unitemized Contributions
10/22/04 CK# 162.00
ID#
Arlene Wiedmann
10/22/04 312 Keomah Village 40 .00
CK#
Oskaloosa, IA 52577
SUB-TOTAL
' 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 e 4 '7
marriage) . If sumarne 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)
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 ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATIE` RECEIVED FUND-
(MWDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOM
ID#
William Y Benson, Jr
10/22/04 2685 Jewel/ Ave $ 50,00
CK#
Oskaloosa, 1A 52577
El
ID#
Michelle Pierson
10/22104 2295 independence Ave 50 .00
CK#
Oskaloosa, IA 52577
ID#
Mahaska County Democrats
10122104 300.00
CK#
193 Oskaloosa, IA 52577
ID#
Tom Fitzgerald
10122/44 658 45th St 175.00
CK#
Des Moines, IA 50312
ID#
Unitemized Contributions
10/22/04 135.00
CK#
ID#
Mary Ruffridge
10/22/04 204 15th Ave E 100.00
CK#
Oskaloosa, TA 52577
IDit
Unitemized Contributions
10/26/04 150.00
CK#
ID#
Joseph Ryan
10/26/04 50'00
CK# 301 4th Ave E
Oskaloosa,1A 52577
ID#
Mary A Patterson
10/26/04 CK# 104 W Glendale Rd 75.00
Oskaloos lA 52577
1D#
Richard L Bamard
10/26/04 1101 N 1st St. 50 .00
CK#
Oskaloosa,lA 52577
SUB-TOTAL 1,135.00
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 thethird degree of consanguinity (blood relatives) and affinity (relatives by 5
marriage)- tf sumam of contributor Is the same as candidate, but there is no Page -T- of
familial relationship, enter"not applicable in the relationship column . (for Schedule A)
0
(Including cand'idate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
Rielly for Senate
STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM ASTATE 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 copled from reports and statements for soliciting contributions or
for anycommercial purpose by any person other than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Barbara Anne Aszman Stone
10/26/04 1216 Elm St $ 50.00
CK#
Grinnell, IA 50112
ID#
Jack Lidbetter
10/26/04 CK4 W3534 Wildwood Dr 500.00
Lake Geneva, WI 53147
ID#
Jerome TNusbaum
10/26/04 CK# 510 Park Ave Dr 100 .00
New Sharon, IA 50207
ID#
Randal L Pleima
10/26/04 CK# 211 N 9th St 50.00
Oskaloosa, IA 52577
ID#
Paul S Foster
10/26/04 602 N 9th St 100.00
CK#
Oskaloosa, IA 52577
I 8026 I.B .E.W. Educational Committee
10/26/04 CK# 1125 15th St NW 5,000.00
07952 Washington DC 20005
ID# 6070
Iowa LdwPAC
10/26/04 CK# 521 E Locust St, F1 3rd 1,000.00
3171 Des Moines, IA 50309
ID#
ip`4 `744 Sac & Fox Tribe of the Mississippi in lows
10/26/04 CK# 072960 349 Meskwaki Road 3,000.00
Tania, IA 52339 9634
ID#
(P I jq Iron Workers Local #67 PAC
10/26/04 CK# 1501 E Aurora Ave 1,000.00
575 Des Moines IA 50313
ID#
6113 AFSCME/TOWA Council 61 - People
10/26/04 CK# 4320 NW 2nd Ave 500.00
003034 Des Moines, TA 50313
SUB-TOTAL
Disclosure law requires candidate committees to disclose the relationship of any relative making a oontribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 6
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)
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), lorea 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 IDNUM13ER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUNL-
(MMlDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Daryl Beall
10/26/04 200.00
CK# 1928 N 22nd St
Fort Dodge, TA 50501
ID#
CK#
ID#
CK#
ID#
CK#
l D#
CK#
ID#
CK#
tD#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL 200.00
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shorn to the third degree of consanguinity (blood relatives) and affinity !relatives by 7 7
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)
D
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN ANDTHE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to personslentities 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) .)
(for Schedule B)
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 07103) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN ANDTHE D CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.
ID#
IviidWestOne Bank & Trust Wire fee for media buys
10/21/04 124 South Ist St 16.05
CK# Vdire ir:c
Oskaloosa, IA 52577
ID#
C .B . Liquor Refreshments for workers - People to
10/21/04 1202 A Ave E People mailing 52.95
CK# 1055
Oskaloosa,1A 52577
ID#
Fareway Refreshments for workers - People to
10/21/04
CK# 1056 311 3rd Ave W People mailing 19 .07
Oskaloosa,IA 52577
ID#
Josh Heggen Reimburse for decorations for
10/21/04 926 Main St campaign event paid to Bates 31 .80
CK# 1057 Grinnell, IA 50112 Flowers 1012 Broad St Grinnell, TA
ID#
VOID
10/21104
CK# 1058
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H_ (Refer to Schedule H instructions.)
Expenditures to personslenttt'res 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 person/entity on behalf of the candidate's committee. (Refer to
Schedule G Instructions and Iowa Code 68AA02(3)(i) .)
Page _
2
---of- 3
(for Schedule B)
ID#
VOID
10,122/04
CK# 1061
ID# -
VOID
10/22/04
CK# 1062
CK#
ID#
CK#
SUB-TOTAL $ 526.68
TOTAL (iflast page of this schedule) $ 107,850.14
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to persons/entities 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)_)
(for Schedule B)
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page I of 2
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 forms packet .) If surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .
71
SUB-TOTAL
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page 2 of 2
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 fortes packet_) If surname of contributor is the same as candidate, but there is no
familial relationship, enter 'not applicable' in the relationship column .