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Disclosure Summary Page DR-2: Kids at Heart Committee
Disclosure Summary Page DR-2: Kids at Heart Committee
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
215 .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-kind below) . . . . . . . . . . 1770 .00
Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . . $ 1985 .00
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . . 427 .00
CASH ON HAND at the end of this reporting period (if final report balance must
1558 .00
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
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 than statutory political committees .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT V IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
Ramona and Cy Nelson
01/19/2005 505 Leif Erikson Dr $50.00
CK#
Decorah, IA 52101
I D#
Steven and Dena Chambliss
01/20/2005 1671 Augusta Rd 75 .00
CK#
Decorah, IA 52 101
I D#
undesignated
01/20/2005 5.00
CK#
I D#
Hacker Nelson and Co .
01/20/2005 123 W Water St 300.00
CK#
Decorah, IA 52101
ID#
Mark and Vicki Donhowe, 731 Ridge Rd .,
100 .00
01/24/2005 CK# Decorah, IA 52 101
I D#
Brian and Kathy Petersburg, 2253 Madison Rd.,
01/24/2005 Decorah, IA 52101 50 .00
CK#
I D#
A&J Petersburg Agency, 106 College Dr.,
01/24/2005 Decorah, IA 52101 250.00
CK#
ID#
Loren and Sue Kiel, 610 Stanwood Dr., Decorah,
01/26/2005 1A 52101 50 .00
CK#
ID#
Ron and Bobbi Lenninger, 2816 US Hwy 52,
100 .00
01/26/2005 CK# Decorah, 1A 52101
I D#
Bob and Beth Cowie, 1103 Skyline Dr ., Decorah,
01/27/2005 CK# IA 52101 25 .00
SUB-TOTAL
' 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 1 2
marriage) . If surname of contributor is the same as candidate, but there is no Page ________ of ____-_
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form
I
SCHEDULE
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 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
ID#
C .R . and Karen Wyse
01/27/2005 706 Valley View Dr $25 .00
CK#
Decorah, IA 52101
I D#
Erdman Engineering, P .C .
01/29/2005 708 Commerce Dr 100.00
CK#
Decorah, IA 52 101
I D#
Weis Buick, Pontiac, GMC, Inc .
01/29/2005 131 College Dr 25 .00
CK#
Decorah, IA 52101
ID#
Rick and Lori Burras
02/01/2005 CK# 2271 Madison Rd 25 .00
Decorah, IA 52 101
I D#
El
James and Susan Haemker
02/01/2005 705 Franklin St 25 .00
CK#
Decorah, IA 52101
I D#
E:1
Kenton and Lois Finanger
02/01/2005 718 Ridge Rd 15 .00
CK#
Decorah,IA 52101
I D#
E]
Emerson, Inc .
02/02/2005 915 Short St 100 .00
CK#
Decorah, IA 52 101
ID#
Dr. Meehan, Leeper and Schwartz, 805
02/02/2005 Montgomery St ., Decorah, IA 52 101 300.00
CK#
I D#
Chiropractic Offices, 300 E Water St ., Decorah, IA
02/03/2005 CK# 52101 100.00
I D#
Northeast Security Bank, North Carpenter, Sumner,
02/08/2005 CK# IA 50674 50 .00
SUB-TOTAL
* 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 2 2
marriage) . If surname of contributor is the same as candidate, but there is no Page -----__ of --------
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE
I D#
CK#
ID#
C K#
1D#
CK#
ID#
CK#
ID#
C K#
ID#
CK#
I D#
CK#
SUB-TOTAL $ 427,00
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) .)
1 1
Page ___-_____ of ----------
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN-KIND
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev. 06/97)1 CONTRIBUTIONS
Kids at Heart Committee
71 CHECK THIS BOX IF
AMENDING FORM
F 1
Decorah Bank and Trust Co . Billboard Ad 450.00
02/01/2005 115 Washington St placed on -
Decorah, IA 52101 Montonmerv qt
F 1-
F 1-
F1 -
F 1-
F1 -
F 1 -
F 1 -
F1 -
F 1-
'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 consanguinity (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 .