PUG-26-2004 16 :34 HOYER LAID 1 319 372 7776 P .

02'04
FOR INSTRUCTIONS . SEE BACK OF FORM FORM I I
DISCLOSURE SUMMARY PAGE DR-2
ininlnaM~Mn i

DISCLOSURE
(Rev. 0712004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For OfficeUse Only
Catfish Bend Casinos, L.C. Committee Comm . #
IMPORTANT : Indicate by 0 type of committee you are reporting for Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties.

SIGNATU F PERSON FILING REPORT TELEPHONE

day prior to clcction (8/26/04)

I AM FILING A 50' REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by # 0
Local Committees, enter Date of Election
CICHECK IF AMENDMENT TO REPORT DATED

0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a DR-3 is filed .)

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
0.00
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-land below) . .... .. .. . 50 .000 .00
Schedule F : Loans Received total (Attach Schedule F) .. .. .. .. . . .. .. ....... ..... .... .. .. ...... .. .. .. .... .. .. .
Schedule H. Total Sales of Campaign Property (Attach Schedule H) . .. .. .... .. .......... ....... . . .. ..
(Schedule H applies to Candidates' Com_mitltges Only)
SUB-TOTAL ..... $ 50,000.00
SUBTRACT TOTAL (MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below) ... . 50,000 .00
Schedule F: Loan Repayments total (Attach Schedule F) .. .... .. .. .. .. .. .. .. .. .... .. . . .... ........ .. ... .....
CASH ON HAND at the end of this reporting period (If final report balance must
0.00
be zero) (Attach DR-3) . . . .. . . ... . ..... .. ... ... .. ... . . .. .. .. ... .. . ....... .. .. ...... .. .. .. .... .... .. .. ..... . ., .. ... .., .. ... .. .. .., $

"UNPAID BILLS (From Schedule D-Attach Schedule D) . ...... .. .. .. .... ........ ..... ...., ... .. .. . .. ... .. ........ ...... .$ 0 .00
'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .. .. .. .. .. .. .. .. .... .. ........ .. .. .. .. . . . ... .. . $
"OUTSTANDING LOANS (From Schedule F -Attach Schedule F) .. .... .. .. .. .... .. .. .. .... .. ... . .... ......... .... . . S
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
 AUG-26-2004 16 :34HOYER LAIC 1 319 372 7776 P .03i04
For Instructions, See Back of Form SCHEDULE 1

CONTRIBUTIONS -- MONEY TAKEN IN

X'~-f;IN . t '2
A
(Rev . 07/03)
I MONETARY
RECEIPTS
(Including candidate's personal funds)
® CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Catfish Bend Casinos, L.C. Committee

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 then etatutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~i IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (ff applicable) RAISER
NUMBER INCOME
ID#
Catfish Bend Casino, L .C. - out of general funds
07/09/04 $20,000 .00
CK# 1367 P .O. Box 471 N/A
Fort Madison, IA 52627
I D#
Catfish Bend Casino, L .C. - out of general funds
8/13104 P .O. Box 471 N/A 30,000.00
CK#
1379 Fort Madison, 1A 52627
ID#

CK#

I D#

CK#

ID#

CK#

ID*

C K#

10*

CK#

ID#

CK#

ID#

CK#

I D#

CK#

SUB-TOTAL

TOTAL (if test page of this schedule)

50,000 .00
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationshlp must be shown to the third degree of consanguinity (blood relatives) and afnlty (relatives by I I
marriage) . If surname of contributor is the same as candidate, but there is no Page of _
famlllal relationship, enter "not applicable" in the relationship column. (for Schedule A)
 AUG-26-2004 16 :34 HOVER LAW 1 319 372 7776 P .04i04

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

B I 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 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)

Catfish Bend Casinos, L.C. Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DDNR) AND PAC
CHECK
NUMBER
ID#
Washington County Citizens for Good To fund referendum ballot issues
07/09/04 Jobs Committee, 206 S. Iowa Ave. $ 20,000 .00
CK# 1367 Washington, IA 52353
ID#
Washington County Citizens for Good To fund referendum ballot issues
08/13/04 CK#1379 Jobs Committee, 206 S. Iowa Ave . 30,000.00
ashingtoa, IA 52353
1D#

C K#

1D#

CK#

ID*

CK#

ID#

CK#

1D#

CK#

ID#

CK#

SUB-TOTAL $

TOTAL (if last page of this schedule) $ 50,000 .00

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property costing $500 or more must also be inventoried an 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 6eA,402(3)(i) .)

(for Schedule Bl
TOTAL P .04