FOR INSTRUCTIONS, SEE BACK OF FORM FORM

I
Rcsct Farm
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization (Rev . 07/2004) REPORT

4- 11
Comm . #
IMPORTANT: Indicate by #type of committee you are reporting for : 16 1 Logged In
( 1 )Statewide/Legislative/Judge St a etenfon Candidate ( 2 )State PAC ( 3 )State Party Scanned
(4 )County Central Committee (5 ( ) ) ur )School Board or Other
Political Subdivision Candidate 8 ou ~( I c I7Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Audited

itical Party (if applicable)

Late reports are subject to
possible civil and criminal
penalties .

-5z~s - 6?J 7- .) 2op

TELEPHONE

final report
I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by # 12

Local Committees, enter Date of Election

FICHECK IF AMENDMENT TO REPORT DATED
August 19, 2003
County & Local Committees, enter County in
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
which Election is held
(You must continue to file reports until a DR-3 is filed.) Delaware

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
25 .44
of the last reporting period or must be zero if 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) . . . . . . . . . . 0
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . ..$ 2 5 .44
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . . 25 .44
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (if final report balance must
0
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

**UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 0

*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$ 0
**OUTSTANDING LOANS (From Schedule F -Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 0

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
 FOR INSTRUCTIONS, SEE BACK OF FORM Reset Foil" SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

B MONETARY
(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 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 .

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

cc,t C C(117
CANDIDATE
_a~,
-4 ~- VIA 1 lUe>- l
NAME AND ADDRESS TO WHOM
C-t01 i, ZC~
~ .a V? .
PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID# Greater Delaware County Foundation Donation to the Fine Arts Fund for
07/06/2004 217 N. Franklin Street future construction of an auditorium . 25,44
CK# Manchester, Iowa 52057 $

1D#

CK#

I D#

CK#

1D#

CK#

I D#

CK#

1D#

CK#

I D#

CK#

ID#

CK#

SUB-TOTAL $ 25 .44
TOTAL (if last page of this schedule) $ 25,44

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/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 person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)
I 1
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(for Schedule B)