12 /07 /2'nn4 14 ~ .~ FAQ.

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FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev, 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Offic Uae Only

Friends of Northwest Iowa Community College Comm a .21 ,2-1 11

IMPORTANT: Indicate by 11 type of committee you are reporting for : Logged In /"
( 1 )Statewide/LeglslativeiJudge Stsnding 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 ( 9 )County PAC ( 9 )City PAC ( 1o )SOpol Board or Other Political Computer "J"91
Subdivislon PAC ( 11 )_Local Bail_oHssilb .. , . .., -._ _ Audited
CANDIDATE COMMITTEES ONLY : `
Candidate Name P Iitical Party (if applicable)
JEG J D 200q ' Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties .

I_2_-7-00-
DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .

(report date) Indicate by # a

Local Committees, enter Date of Election

®CHECK IF AMENDMENT TO REPORT DATED September 29 , 2004
September 14, 2004
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 .)

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
of the last reporting period or must be zero if this is first report flied .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 3,396-30
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) . ., . . . . . . . 0 .00
Schedule F : Loans Received total (Attach Schedule F) . . .  . . . . . . . . . . . . . . .  ., . . . . . . . . . . . ., ., ., . . ., . . . . . . . . 0 .00
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 .00
(Schedule H applies to Candidates' Committees Only)

SUB-TOTAL . . . . . $ 3,396-30
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below)  . . 3,336 . 30
Schedule F : Loan Repayments total (Attach Schedule F) . . . . .  . .  . . . . . . . . . . ., .  , . . . . . . . . . ., . .  . ., . . 0 .00
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 60 .00

"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . .  , . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00

'IN KIND CONTRIBUTIONS (Front Schedule E - Attach Schedule E) . ., . . . . . . . . . . ., .  . ., . . . . . . . . . . ., . .  . . . . . . . . S 0 .00
'"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . . . . . . .  ., . . . . . . . . . . . . . . ., . ., . . . . . . . . . . . . . . . .$ 0 .00
CANDIDATE COMMITTEES ONL :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) S
D YES D NO
12/n7/20o4 1a 23 F0,: 712 324 4126 tic ; 0p3,'nr)

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT

B I MONETARY
(Rev . 07103) EXPENDITURES
STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
0 CHECK THIS BOX IF
AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Friends of Northwest Iowa Community College

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
(if applicable) (Disbursement) WAS MADE
AND PAC
CHECK
NUMBER
South O'Brien News ChAi'ge to insert levy--
14,4 East Broadway vote inserts with local
P .O . Box 637
Paullina, IA 51046 papers .

Sanborn Pioneer
121 Main Street
P .O . Box 120
Sanborn, IA 51248
Marcus News Charge to insert levy
401 Main Street
P .O . Box 445 vote inserts with local
Marcus, IA 51035 papers .

Northwest Iowa Community Office supplies (labels

College
603 West Park Street and envelopes) and
Sheldon, IA 51201 printing of levy posters-

TOTAL (!f last page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property coating $500 or more must also be Inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entilies 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 mode by the person/entity on behalf of the candidate's committee (Refer to
Schedule G Instructions and Iowa Code OBA.a02(3)(i) )

Page 1 of 2

(for Schedule B)
12/87,2004 14 23 FAY. 712 324 4136 1 ,1 CC 004 ` f108

FOR INSTRUCTIONS, SEE BACK OF FORM I SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev . 07/03)
MONETARY
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 THISBOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Friends of Northwest* .Iowa Community College
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DDfYR) AND PAC
CHECK
NUMBER
ID# Pluim Publishing, Inc . Charge to insert levy
113 Central Ave- :, :S_E . vote inserts with local
9-28-04 CK# 1018 Orange City, IA 51041 papers . $ 220 :85'
ID# Northwest Iowa Community Printing .
College
CK# 1019 603 West Park Street
9-28-04 "32 :82
Sheldon, IA 51201
ID# Kathy Brock Mileage .
617 6th Avenue
9-28-04 CK# 1020 Sheldon, IA 51201 121.87
ID# Northwest Iowa Community Wages and fringe benefits
College
9-28-04 CK# 1021 603 West Park Street 1,612 :22
Sheldon, IA 51201
ID# Northwest Iowa Community Postage .
College
9-28-04 CK# 1022 603 West Park Street 8 .58
Sheldon, IA 51201
ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $
1,996 .34
TOTAL (If last page of this schedule) $
3,336-301

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property coating SS00 or more must also be Inventoried on Schedule H. (Refer to Schedule H Instructions .)

Expenditures to pensonslentilies 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 an d Iowa Code SaA.402(3)(I),)

Page 2 of 2

(for Scnadulc B)