DEC-20-2004 03 :06 PM KOLLERP_.COMPANY,LLP 131965Z6745 P .

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/a
FOR INSTRUCTIONS, SEE BACK OF FORM FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 07/2004) REPORT
COMMITTEE NAME (Must be some as on Statement of Organization)
For OHlce Use Qnly
Washington County Citiz ens For Go od Jobs Committee Comm . p 12112-71
IMPORTANT. Indicate by lf type of committee you are reporting fore Logged In
( 1 )Stetewde/Legl9latlve/Judge Standing for Retention Candidate ( 2 )Stets PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( B )County Candidate ( 8 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate (8 )County PAC ( 9 )City PAC ( 10 )School Board Or Other Political Computer ~Z
Subdivision PAC ( 11 ) Local Ballot Issue Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if applicable)
UEC Late reports are subject to
d possible civil and criminal
Office Sought District (If Senate or House) penalties .

44

3/9 6~ -6SGl 2 zo 0
91 NATURE OF P ON FILING REPORT TELEPHONE DATE SIGNED

January 19, 2005

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

Local Committees, enter Date of Election

OCHECK IF AMENDMENT TO REPORT DATED
08131 /04

Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County 8 Local Committees, enter County In
which Election is held
(You must continue to file reports until a DR-3 is filed,) Washington

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 .) .. . . . . ., . ., . . . . . . . . . . . .  .  . . . . . .5 27,893 .17

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A : Cash Contributions total (Attach Schedule A) ('also see In-kind below) . . . .  . . .,
Schedule F : Loans Received total (Attach Schedule F) . . . . ., . . . .  , . . . . . ., . . . . . . . . . . . .  .  ., . . . .  , .  .  ,
Schedule H : Total Sales of Campaign Property (Attach Schedule H) .  . . . . ., . . . ., . .  . .  , . .  .
1162' Co
SUB-TOTAL . . ., .$ 27,893 .17
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (*'also see debts and loans below) . ., . 27, 893 .1 7 .
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5 . ..~._. .__..._. ..~.

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

'IN KIND CONTRIBUTIONS (From Schedule E -Attach Scnedulo E) . . . . . . ., . . .  .  . . . . . ., ., . . . . . .  , . .  , ., . . . .S
"OUTSTANDING LOANS (From Schedule F -Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S
CANDIQATES
. OMM1TTE
_ ,FI, B ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) - YES i NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) S
DEC-20-2004 03 :06 PM 13196536745
KOLLER&COMPANY,LLP
P .03

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

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 IOENTIFICATION 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 a CAMPAIGN DISCLOSURE BOARD.

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

Washington County Citizens For Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) I EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDO/YR) AND PAC
CHECK
NUMBER
ID#
Washington State Bank Stop Payment Fee Reversed
10.131/04 PO Box 311 $ -20 .00
CK#
Washington, IA 52353

ID#
'oiler & Company, L L .P . Professional Fee
11-'10104 06 S . Iowa Ave 1,297 .40
CK#1176
ashington, IA 52353

ID#
Wash County Casino Resort, LLC Reimburse money from Contributor
11122 :04 O Box 1234 Catfish Bend Casino dba Washington 26,615 77
CK#1177 linton, IA 52733 County Casino Resort LLC

IN

C K#

IN

C K#

Ill

C K#

ID#

C K#

CK#

SUB-TOTAL / $

TOTAL (!f last page of this schedule) $ 27, 893 .17

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 personslentilles providing consulting, advertiolng, fund-raising, polling, managing, organlzlng services must al9o be detail Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the per3onlentity on behalf of the candidate's committee (Refer to
Schedule 0 in structions and lows Code t3BA,a02( 3)(I ) -

Page 1 -------- of

(for Schedule B)