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9-Leofl: Disclosure Summary Page: Dr-2
9-Leofl: Disclosure Summary Page: Dr-2
19 2004 06 :04PM P2
Use one
For Office
WISE VOTERS
Coax:r. ~
IMPORTANT: Indicate by # type of committee you aye reporting for.L1 .71 Logged .
I )swewmenww"vet,l~e s~s a;8 i- Rat-116- can"Mt t z jialQ, AA,c t a >stms P
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidatu ( 7 )School Board or Other Scanned
Political Subdivision Candidate (8 )County PAC (9 )City PAC (10 )School Board or Other Political Computer
SWdlrision PAC ( f 7 ) Local Saffof Issue
CANDIDATE COMMITTEES ONLY: Audited
October 19 2004 :? .
JAM FILING,A RFPO FOR (9) ELECTION Jf2)NON ELECTION YEAR,
`(report date ' ~OD~e Indicate by #
C.
1
[]CHECK IF AMENDMENT TO REPOR~ DATE ___ a Local Committees, enter Date of Election
© Check if this is final (termination) report And of Dissolution Form DR-3 . County & Local Committees, enter County In
(You must continue to file reports uli is filed.) which Elution is heJA
"UNPAID BILLS (From Schedule D - Attach Schedule D) . .. . .. ... ..... ..... .. ... ... .. . .. ... .......... .. ._ . ... ... .. ....... $
`IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .... ..... ... .. ... .......... ..... ..... ... .. ... .. $ 156.11
-WJTSTANDWO LOANS (D=ram SDhadLV& F -Attach Salhe~ F) . ._ . . ... .. .. . . . .. .. . .. . .. .. . .. . . . .. ._ . .. . . . .. . . . . . . .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :04PM P3
STATE CANDIDATES NOTE . IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN Tt1E DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
OtSCLOSME SOAR0.
CAUTION: Section 68B.32A(5), 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 REIIATIONSH)P AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
fMM/DD/YR) AND PAC CHECK (ifapplicable) RAISER
NUMBER INCOME
ID#
Lavme W . Schmeder
7131 x04 $ 25 .00
CK# 3208 SW 34th Street
Des Mcdnes,1A 5(-12.1
Ib#
Michael 1?. Medved
2530 73rd Street 375 .00
CK#
Urbandale IA 50322
IDp
6060 IA Committee on Political Education
OK# 2000 Walker, Suite A 200.00
2299 3es Moines .IA, .50317
JD#
6116 Political Action - Iowa Dealers
P.O. Box 65840 150.00
CK#
1' 299 West Des Moines IA 50265
Iixe
AQtohsea my"s
2530 73rd Street 375.00
CK#
Urbandale,TA 50322
ID#
Charles S. Mitchell
50.00
8/'151!04 CK# 126 Concert
Keokuk,1A 52632
Pfizer PAC-State
235 East 42nd Street
100.00
t
14'74 New York, NY 10017
ID#
Arthur and Catherine Sellers
20 .00
CK# 7 Greenbrier Court
KCokttk;1A 52632
ID#
Stan Waldron
814 Main Street 25 .00
CK#
Keokuk IA 5 632
l /2--
49 7 ,Z Plumbers and Pipe Floes, Local 125
1839 16th A.veaue SW 1000_00
CK#
1101 Cedar Rapids, IA. 52404-1755
SUB-T07At ( $ 2320 .00
- Disclosure lawrequirescandidate committees to disclose the relationship of arty relative making a contilbutlon to the
committee. ReMonshlp must be shown to thethird 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
fWAfl te*ton", attitW "t\Ot appkabW lt\ tt\a Mlatwt\chvp calumt\. (OT Sd~ftdule A1
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :05PM P4
STATE CANDIDATES NOTE- IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHI=CK NUMBER IN THE DESIGNATED COLUMN, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
OISCJLOtillf?F 80ARD .
CAUTION: Section 68S.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 11) NUMBER NAME AND ADDRESS OF CONTRl%1TOR RELATIONSHIP AMOUNT d IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
I D#
StephenR. BsClnman
823/04 416 Avenue F $ 25 .00
CK#
Fr- Madiscm, JA .52627
ID#
Arch Logan
1013 Avenue F 25 .OU
CK#
Ft . Madison, 1A 52627
ID#
James Sodey
CK# BluckhawkHeights 25 .00
Ft Madison 1A 52627
)Lw
Gcorgc Wright
2821 River Hills Road 30 .00
CK#
Ft . Madison IA 52627
IDtt
Ernr»cn W BUDOC
108 High Street 30.00
CK#
Keokuk,IA 52632
ID#
Cheryl Liles
717 Avenue E 30.01)
CK#
Ft. Madison, 1A 52627
L-j
11)#
Michael Phelan
#3 Bluff Park, P.O . Box 353 50 .00
CK#
Montrose, IA 52639
ID#
~~ Justice for All PAC
218 6th Avetme, Ste. 526 250.00
CK# 3850
Drs Moues, LA Sd309-4041
IDN
Charles Scoville
100.00
CK# 603 Avenue F
Ft. Madison IA 52627
IDtk
Gary Hoyer
619 Tenth $cruel, P .O-Rox 586 1.50 .00
CK#
Ft. Madison, 1A 5 2627
S11B-TOTAL
any
I Disclosure law reguiree candidate committees to disclose the relationship of relative making a contribution to the
committee. Relationship must be shown to the third dogma of consanguinity (bluod relatives) and affinity (relatives by
;- of //
marriage), If surname of contributor is the same as candidate, but there is no Page .
tto~kal mtaaor`shtp, enter -not applicable" in tt*celatiat shlP . (!or Wv-CI&Aft A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct. 19 2004 06 :05PM P5
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DMCLOSURr BOARD.
CAUTION: Section B8B.32A(B), 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 CONTRIBUTTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
fMM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
IDN
Cynthia Shxiver
8/27/04 2022 Grand Avenue $ 100.00
CK#
Keokuk, TA 5263,2
lD#
James
CK# 500 Griffin Bldg-, 319 7th Street 250.00
Des Moines, lA 50309
IQ#
Paulee Lipsntan
CK# 2880 Grand Avenme, #106 50 .00
Des Moines IA 50312
' Disclosure law requires candidate committees to disclose the relationship of arty relative making e contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and af nlty (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page 3 of
familial mtatwshlls, ~'not appUcabw in tttie retatant Mp Oakum. (tot Sdrvedu(e Ai
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :06PM P6
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS REC61vED 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
MSCl03Ul?E EOARO.
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
forany commercial purpose by any person otherthan statutory political committees.
DATE PAC 1D NUMBER NAME AND ADDRESS OF CONrRMUTOR RELATIOTISHIP AMOUNrf d IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YII) AND PAC CHECK lit applicable) RAISER
NUMBER INCOME
11?tx 6404
Iowa Retail f AC
8/27)04 2175 NW 86th Street, Ste. 14 $ 100.00
CK# 9017
Clive,1A 5025
IQ#
Steven Ackerzon
1634 NW 131st Street lOt)-Op
CK#
Clive,IA 50325
ID#
6237 ABATEPAC
CK# 3118 Eastctn AvonueR3E 100.00
1.634 Cedar Ra ids IA 52402
9659 Federation of IA Insurers PAC
P0$ox 1756 500.00
CK#
" 1291 Des Moines IA 50306-1756
ID#
LindaNoJsvw
231 Midland Drive 200 .00
CIC#
Council Bluffs, IA. 5150:1
ID# 6069 __
IIPAC
904 Watnut_ Spite (01 .100 DO
CK# 2203
Des Moines, 1A 50309-3503
6118 Iowa Optometric Association
1454 30th Street, Ste 204 200.00
r-K# ZI02
West Des Moines, IA 50266
IDN
Janet Fife-Lafrenz
1122 Grand Avenue 50 .00
CK#
Koviaok,1A 52632
ID#
Thomas lochum
1137 36th 500.00
CK#
Des Moines lA 5031.1
ID#
Microsoft Corporation PAC'
16011 NE 36th Way, Box 97417 500_00
CK#
4541 Redmond, WA 98073-9717
SUa-rorAL
Disclosure lawrequires candidate committees to disclose the relefonah(p of any relative maldrkt a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood Tetauves) and amn;Ur (TelatNes by
marriage) . 9surname of contributor is the same as candidate, but there is no Page ~~ of r
tamwat MISAWship, entes'not applicable" it\ the selatlm" cuWmn . SEor Schedule 0
.)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :06PM P7
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
Di9CLOBIIRE 80ARD.
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 10 NUMBI=R 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# 8 179
MCIIOWA PAC
S/27/04 707 17th Street, Suite 3600 $ 100.00
CK# 1363
Denver, CO EW-023436
[DO
6052 Independent Insurance Agents of Iowa PAC
4000 Westown Parkway, Ste 200 10V.W
CK#
2794 West Des Moines, IA 50265
IDIN
6498 Wel1PAC
CK# 636 Grand Aventita, Stations 13 500.00
1243 Des Moines IA 50309
)D# 6058 Iowa Chiropractic Society
CK# 1605 N. Ankeny Blvd_, Suite 100 150.00
2449 Anken ,IA 50021-4159
IDf1
6429 HanryswayPAC
2415 Ingersoll Avenue 1000 .00
CK# 1878
Des Moines, IA. 50312-).620
ID#
6067 Iowa Health PAC
6750 Wcstown Parkway #160 1061.00
CK#
3154 West .Des Moines, .IA 50266
1D#
Miles Brewcr
9/3/04 3469 236th Avenue 20 .00
CK#
Keokuk,IA 52632
ID#
David Palmer
50.00
CK# ,213 SW Flynn Drivc
Aakxay, Irt. 54021
Il7tt
Anne Pedersen
506 33rd Street 25 .00
CK#
Ft . Madison IA 526,27
ID#
PRINPAC
111 High Sate, 250_00
1324 Des Moines, IA 50392
SUB-TOTAL 1$ 2295 .00
Disclosure law requires candidate committees to disclose the relationship of arw relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and ariinlty (relatives by
. tf surname of contributoris the same as candidate, but there is no
marriage) Page . o
y- of
(atevdiat relationettip, es Aw -notapptice4te in tt% MteeW5t%ip Column . tSch"Wta A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :07PM P8
I
For Instructions, See Back of Form SCHEDULE
:' Rcscf',Fgi'.i
CONTRIBUTIONS -- MONEY TAKEN IN
A MONETARY
(Rev. 07103) RECEIPTS
(Including candidate's Dersonal funds)
WISE VOTERS
STATE CANDIDATES NOTE_ IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE). LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECKNUMBER IN THE DESIGNATED COLUMN. A Ll,,T OF ID NUMBERS IS AVAILABLE FROM THt3 IOWA ETHICS ANDCAMPAIGN
OtSCWSUliS 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 1D NUMBER NAME AND ADDRESS OF CONTRIBUTOR RElAT1oNsNw AMOUNT J IF FOR
RECEIVED (ifapplicable) TO CANDIDATE' RECEIVED FUND-
(MM1DD1YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
L-j
Unitemizcd cash cvr)rr1buiion
20 .00
CK#
10#
Jim Vandenberg
2404 Carbide Lane 35.OD
CK#
Keokuk,IA 52632
lnik
Joseph Crozier
100 .00
CXP 17 Crreenvicw Tcrracc
Donncllson, IA 52625
DO ,
John Kuster
100 .00
CK# 2418 Silverwood Lane
Fa&ficld, IR 52556
ID#
Edward Marsot
1002 N. 13th Street 250.00
CK#
Keokuk IA 52632
IQft
Stephen Wixom
12 Navahv Drive 50-0
CK#
Keokuk,TA 52632
SUS-TOTAL
- Disclosure law requires candidate committees to disclose the relationship of my relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage), H surname of contributor is the same as candidate, but there is no Page of I
Amw m(attortshtp, enter "not app((cab(e" to the mlat(msttip cc,(Mn . {toe SCJIted+ste A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :07PM P9
0
Jlncludirtig candidate's personal funds)
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
Dtt3CLUSUFIE BOARD.
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of inforTnaflon copied from reports and statements for soliciting contributions or
forany commercial purpose by any person otherthan statutory political Committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
jMM/DD/YR) AND PAC CHECK (Ifapplicable) RAISER
NUMBER INCOME
Ib#
Rose Marie Katie
9/15/04 404 Orleans Avenue $ 25 .00
CK#
Keokuk JA 52&'1,2
ID#
John Lee
#10 Carriage Greens 11)0 .00
CK#
Kcokuk,IA 52632
ID#
William Vorhies
402 Hawthorne QLace 25,00
CK#
Keokuk IA 52632
ID:#
KcancthMcsscr
CK# 1624 Morgan 75 .00
Keokuk,IA 52632
lb#
Patrark HDean
928 Timea 100.00
CK#
Keokuk,IA 52632
ID#
Mary Jo Hendrickson
1704 Grand Avcnuc 25.00
CK#
Keokuk, IA 5 2632
L-j
11~#
W . Tyler Logan
1229 Grand Avenue 200 .00
Keokuk,IA 52632
Il3tt
Emma Lee Lahmeyer
226 Fulton Street 100 .00
CK#
KcokT&, in 52632
ID#
Deverie Kiedaisch
1025 Grand Avenue 50 .00
CK#
Keokuk Lk 52632
ID#
R. L. Taylor
No . 2 Park Place 50,00
C1(9t
Keokuk,IA 52632
SUB-TOTAL
- Disclosure law requires candidate committees to disclose the relationship of arty relative making a contribution to the
commhtee. Relationship m%W be shown to the third degree of consanguinity (Mood relatives) and affrnlty (relatives by
marriage) . If surname of contributor Is the same as candidate, but there is no Page -~ of
familial reWionshi9, er\ter `twt appkabla- i% the MWXoaship column . ft SO-dolt A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :08PM P10
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
WSCLO"F ROARO .
CAUTION: Section 688.32A(6), Iowa Code, prohibits the use of Information copied from reports and statements for soliciting contributions or
for any commercial purpose by any person otherthan statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RPLATIONSHIP AMOUNT q IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if Applicable) RAISER
NUMBER INCOME
ID#
Thomas Scabdld
9/15/04 226 Morgarr $ 50 .00
CK#
Keok* JA 52632
ID#
Donald Steingcabcr
2123 Crestwood Lane 25 .00
CK#
Keokuk,IA 52632
ID#
Marjorie Roost
1910 otand AvcnuG 25 .00
CK*
Keokuk lA 52632
Jt~
Susan Dunek
100.00
CK# 2411 Grand Avenuc
Keokuk,TA 52632
ID#
Rayrwrrd G"ke
1905 Grand Avenue 25.00
Co
Keokuk,1A 52632
ID#
Edward Bazow
1706 Parkvicw Heights 35.00
CK#
Keokuk,IA 52632
IDII: 8026
MEW Education Committ4c
9/27/04 1125 15th Strcet, NW 100.00
CKO ~743Z
Washington, DC 20005
IDtf
Craig1Neilsen
8620 Titleist Circle 200.00
CK#
Las Vcgas, N'ti' 84117
ID#315 Iowa F.O.R,E.
250.00
CK# 8525 Doug)as Avenuc, Suitc 48
1921 Des Moines, 1A 50322
ID#
Scott Piper
5 Pask Placc ),00.00
CK#
Keokuk, I A 5 263 2
StM>hTOTAL
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 I I
.
familial relstiansWep, enter 'cwt apiftzbW isttve catatt&mNp column. (tot 8cheduie A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :09PM P11
WISE VOTERS
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
Wsr-LoSURE SOAM .
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 ADARE$S OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
IMMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# 6087
Iowa industry PAC
9/27/04 2987 100th Strcct $ 200.00
CK# 1357
Urbandale,1A 5022 55ill
II?#
Citizens for Preservation o (Racing
CK# 1 Prairie Meadows Drive 250.00
07
Altoona, IA 50009
L
ID#
Richard Bcaird
1108 Gzand Avenue 25 .00
CK#
Keokuk TA 52632
11'3#
Cecilia Tomlonovic
CK# 1245 40th Street 25 .00
Dcs Moines IA 50311
ID#
Lilnv ;A2Wlaus
3091 175th Avenuc 50_00
CK#
Argyle, IA 52619
ID#
J A. Rovane
P.O. Box 611 SD.~
CK#
Keoktk IA 52632
1D# 315
Munipac
250 .00 J
9/30/04 ~ 1735 NE 70th Strcct
1017 Ankeny,IA 50021-9353
ID# 6084
aA Statc UAV - PAC ConnnAtee
2700 S . Rivcr Rd ., Ste. 200 250.00
CK# 760
Des Plainer, rI. 60018
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
marriage) . If surname of contributor is the same as candidate, but there Is no Page of !
famit(at relatlamhlp, emar "not appbcab(e 4S rte t+Matlons* column 0- educe Al
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :09PN P12
WISE VOTERS
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 TH610WA ETHICS AND CAMPAIGN
DlBCLOSURE f3QARD .
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
forany 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-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
IDf 6099
M~crc-di% Cosporztiou for Better Govennnent
1017/04 1716 Locust Street $ 300.00
CK# 1003
Des Moines, L3 S0-109
ID#
6086 ISEA-PAC
777 3rd Street 500.00
CK#
13230 Des Moines, IA 50309
ID#
6073 Iowa Medical PAC
CK# 1W1 Gralnd Avenue 100 .00
767 West Des Moines IA 50265-3$02
)14
6237 ABATEPAC
CK# 3118 EasternAvenue, NE 250.00
1694 Cedar Raids, IA 52402
1D# 6042
Gmcem PAC.
2540106th Street, Suite 102 250.00
CK#
1145 Des Moines, IA 50322
ID# 6077
Iowa Pharmacy PAC
ICiI'[3IC14 CK# 6'SIsDouglas,Suice16 100.00
1748 Des Moines, IA 50322
)D# 6001
Allied Group, Inc-
500.00
Gt.# 701 5th Avenue
2236 Dos Moines, 1A 50391-2000
ID#
Gerald Schleier
50 .00
CK# 1408 Grand Avenue
Kcoirak,1A 52632
6125 Iowa Realtors PAC
CK# 1370 NW 114 th Street, Ste 100
2000 .00
002379 Cive 1.A, $0325
1130
6058 Iowa Chiropractic Society
1605 N . Atilceny Blvd., Suite 100 150.00
C)C#
2474 Ankeny, IA 50021-4159
SUB-TOTAL
4200 .00
Disclosure law requires candidateoommlttees to disclose the relatlonshtp of al ly relative maldrtq a contrIbution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by /n
marriage) . If sumame of contributor Is the same as candidate, butthere Is no Page .- of
tarttiltat relatiartt3hip, erAer'!wt applicaw in clue retafwnsNp Gotua t%. (far SCt1eCtUl®A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :10PM P13
I
For Instructions, See Back of Form SCHEDULE
~R69d06iin;;
CONTRIBUTIONS -. MONEY TAKEN IN
A MONETARY
(Rev. 07/03) RECEIPTS
tlncludlny candidate's personal funds)
CHECKTHIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
WISE VOTERS
STATE CANDIDATES NOTE- IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS 13 AVAILABLE FROM THE IOWA ETHIC$ AND CAMPAIGN
Ot6CLOSLAE 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 oommittees .
DATE PAC 1D NUMBER NAME AND ADDRESS OF CONTRTgUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I 00 6063
Iowa ~W Association PAC
10/13/04 505 SthAvenue, Sute 333 $ 50 .00
CK# 1771
Des Maine YA 50309-2379
ID#
Keokuk Savings Beak
10/14/04 Keokuk, IA 52632 (not a contribution, interest 8 .27
CK#
on checking account)
ID#
CK#
113#
CK#
ID#
CK# L--j
ID#
CK#
ID#
GCiet
ID#
CK#
ID# I i
CK# LM-
L~ I
ID#
C1C#
I
SUtf-TOiAIL
I
Disclosure law requires candidate committees to disclose the relationship of ally relative making a contribution to the
committee_ Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (MtatiVor by
marriage), If surname of contributor is the same as candidate, but there is no Page - of I
tamale( mtafveat tap, wAe< "not aWkabbei M the mtat(on~ cab~, (tor Schedule A)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :10PM P14
WISE VOTEFIS
tt7
rter Printing Campaign cards
8/2/04 739 Bast Grand Avenue 519 .40
CK#
es Moines, IA 50316
XV
boy Day Media Campaign ad
8/5/04 CK# 01 Blondeau 150 .00
okuk, TA 52632
I D#
aokuk Pasaxto6rer Barlkrare (~T61Q6'r. .
8/12/04 14 S . 2nd 61 .26
CK#
ololh LA. 52632
ID#
,cFarland-Swan Printer ink cartridge
8/27/04 25 S_ 5th 32 .09
CK# rnkuk, IA 52632
Purchases of certain campaign property costing $500 or more must also be Inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenfueetoperrantfentitvat providrg Comut" aduehte 9. fund-mgnn%, Pz". mmag", orMr%ztrrg tervices mint atso be detail Itemized On
Schedule G by the amount, purpose, and date of eseth 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) .)
Pose I of ---4
tray Sdredule 8)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :11PM P15
Purchases of certain campaign property costing $600 or more must also be Inventoried on Schedule H, (Refer to Schedule H instructions .)
.&utf to pe%ontJ®rtWes pl`ovvd" avn°.utt0 g, pdve~t"vdtvg . fund-TsAwNs . l~~, mer s9t~9 . e%%wa%K-,9 sw^cas must also be dfAail itemized ov\
Exper
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entlty on behalf of the candidate's committee, (Refer to
Schedule G Instructions and Iowa Code 68A_402(3)(i).)
(for Sdedmk 8)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :11PM P16
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H Instructlow)
Ex9endtWes to perfarwAeMitlas Wrw4dEn9 ootv.AANV, UdWMS0g, %rA raWt, VDIW 51, MW%agf, O9Z'AYf r'esv`ces mull atso be detail itemized M
Schedule G by the amount, purpose, and date of each type of expenditure made by the personlentily on behalf of the candidate's eommittas. (Refer to
.~ Schedule G instructions and Iowa Code 68A.402(3)(q,)
Page 3 of
(far S+-1d&.A- 8)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct. 19 2004 06 :12PM P17
H
(Rev.07/03,) EXPENDITURES
STATE PAC COMMITTEES : NOTE_ FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS s CAMPAIGN DISCLOSURE BOARD.
JD*
dio Station KDMG-FM Campaign radio ads
10/12/04 CK# 850 Mt . Pleasant Street 1232 .00
urlington, 1A 526(11
IDO i
Ratio Station KQ-92 Campaign raatio acs
10/12/04 CK# 2850 Mt . Pleasant Street 1099 .56
Burlil .gton, IA 52601
ID#
amt Campaign relepfwree
10/13/04 0'W 4th Street, Floor One 6.07
CK#
t, Paul, MN 55102
ID#
CK#
Purchases of certain campaign property costing (',500 or more must also be inventoried on Schedule H . (Refer to Schedule H Instructions .)
Expe%Ndttu-s to parsot~slet~titiet3 providing castwlti~g, sdveXt%W -.%, (anti-cela .kV, Polttc%, man89a~8, OjKgW%jZk%9 sep tceS muwt e1%o be 4etail itemized o~
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 68A.402(3)(I) .)
of Page 4 4
(iror SdwderL H)
FROM : JERRY KEARNS PHONE NO . : 319 524 3756 Oct . 19 2004 06 :12PM P19
; ;; Rescf,F ;ru v;
I,nI
El
SIRi TOTAL
156.11
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page 1 of 1
committee. Relationship must be shown to the third degree of consanguirdty (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,
FOR INSTRUCr7ONS, SEE SACK OF FORM
SCHEDULE
H
I
0)
THIS PORM IS USED BY CANDIDATES" COMMITTEES ONLY CAMPAIGN
(Rev. 071U3) PROPERTY
M ATTACH SCHECU6E H TO
COIYIMITiTEE fiAlilE (Mvst be ssmeias on S+a1tement of Organizafion)
EACH REPORT ; MAKING
Wiw Voters CHANGES AS RE0U1REG.
m
v Q CHECK THISBOX 11:
m
m AMENDING FORM
PART I - ONGOING INVENTORY OF CAMPAIGN PROPERTY PART II - SALES OR TRANSFERS OF CAMPAIGN PROPERTY"
m
Date ~urohased
(Schedule 9) Purchase Current
Narne and Address of Purchaser0otre9 Description otProperlY, Said? Sole valu! of
Of Dale Received Description of Property Price or Est. Value- al Fair Dale
U
Market This (pdIAiDDIYR) YIN Floe Donation
O (Schedule E) Value Men
MM)DDJYR wired' Re on
Computes
0127`04 1591 .68 1391,613
M
V
N
In
Ql
O
Z
W
Z
O
0_
U
Z
Q TOTAL$ S _____T$
Y TOTAL VALUE GA&APAjGd.1 PROPERTY THIS REPORT
(TRANSFER TO SUMMARY PAGE) $
1391 .68 e31,
*" PROPERTY SALES 8 TRANSFERS TOTAL
(TRANSFER To SUMA"Y PAGE) $