APR-1 .3-'?0-15 08 :-- 7 I A ETHICS CAMPAIGN D I SCLO 15152213701 P .

03

FOR WS rPUCTICNS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE
(Rev. 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Orgenitedorl)
For Office Use Ooh
Comm . #
IMPORTANT : Indicate by # type of committee you are reporting for. Loggrad In _ -
( 1 )StatewirtFdLegls1ative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )Stale Party Scanned
( 4 )County Central Carnrnitlee ( 5 )County Carl ( d )City Candidate (7 )School Board or Other
~1
r
Poltical SubdVision Cardldaty 8 ) ::Iiy PAC ( 10 )School Board or Other Political
(8 )County PAC ( Computer
subdlvl8lon PAC ( t t ) LOCai B&I1ot ISehs Audited
a

I CANDIDATE COMMITTEES ONLY :

Candidate Name Political Party (if applicable)
I-ate reports are subject to
possible civil and criminal
Office Sought District (if Senate cr House) penalties.

$iGNATURE OF PERSON FILING REPORT

I AM FILING A _ _ _ -! REPORT FOR (1) ELECTION I(LNON-ELECTION YEAR .

(report date) Indicate by # 0

Local Committees, enter Date of Election

i7I CHECK IF AMENDMENT TO REPORT DATED

County d Local Comndttesa . meter

County in
[! Cheek if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
which Election Is held
(You must aonfnue 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 1s first report filed .) . . . . . .. . .. . . . . . . . . . . . . . . . . . . . .. . . . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
0111,

Schedule A: Cash Contributions total (Attach Schedule A) ("also see in-kind below) . ....... 5
Schedule F : Loans Received total (Attach Schedule F) _ . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . _ . . . . . . . . . . .
Schedule I-i : Total Sales at Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . .
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL ... .. $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD 5 101)
Schedule S : Cxpenditures total (Attach Schedule B) (`also see debts an loans below) . . . . ci ca,
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . ,_
CASH ON HAND at the and Of this reporting period (if final report balance must
be zero) (Attach OR-3) . . . . . .,. . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . $

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

*IN KIND GONTRIBUTIONS (From Schedule E -Attach Schedule E) . . . . . . . . --- -------- --1 .111-11111
"OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . $
CANDIt3A1'E COMMITTEESONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
 For Instructions, See Back of Form Reset Form ; SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 071G3) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Kids First 2005 Bond Issue

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 CAAAPAIGN
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 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD1YR) AND PAC CHECK (ff applicable) RAISER
NUMBER INCOME
Ip#
Unitemized Contributions
3.116/2005 200.00
CK#

ID#
Pratner
3/28/2005 25 .00
CK# 101 it) . Cltn4on
ID#
Kivcttc
3/2812005 - 50 .00
CK# 1403 Hu- i E(oq G . Jtnm s'l

ID# ~ . YVo1kCh
3 1 2812005 CK# 200 .00
` -2810 Qd G, (met h
ID#
Unitr:m>.zed Contnbutions
3128/2005 CK# 70 .00

I D#
Unitcmized Contributions
4/1/2005 CK# 307 .00

ID#
$jelland Plumbing
4i151?o05 100.00
__
CK# 21500
aln 3L) .D1 Man RCS- M 4:~S hr-( Howh,
ID#
Citizens Savings Bank
4/1512005 CK# 958002 LeGrand, IA 50 142 200.00

ID#
Alan Meyer C-3c kf1r1Q.q ., _rA
4/15/2005 CK# 50,00
3157
ID*
Robert Thomas
4/15/2005 CK# 50 .00
1377 2543 7IVrhVtrt;" e r__ Rol MCi VS`I,1 11 -loc-Un

SUB-TOTAL

TOTAL (if last page of this schedule)

' Disciosure law requires candidate committees to disclose the relationship of any relative making e contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood !Natives) and afflnlty (relatives by 1
marriage) If surname of contributor Is the some as candidate, but there is no 2
Page ____ of -
familial relationship, enter "not applicable" In the relationship column . (for Schedule A)
 For instructions, See Back of Form
I
SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Kids First 2005 Bond Issue

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 lo NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 668.32A(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 polltlcal committees .

DATE PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT d IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Citizens Savings Bank
S Gilman, IA 50106 150.00
/I CK# 44538
/0 J
ID#
Clcmons Chcvrolet
513112005 Marshalltown, IA 50158 150.00
CK#

ID#

CK#

I D# -

C K#
_ ID#

CK#

__
ID#

CKO

ID#

CK#

ID# -

CK#

ID# -
i
CK#

I D#

CK#

SUB-TOTAL

TOTAL (If last page of this schedule)

' Disclosure law requires candidate committees to disclose the relationship of sny relative making e contribution to the
commltlee . Relationship must be shown+ to the third degree of conssnguln)ty (blood ralatIvae)
end affinity (relatives by 2
marriage) If surname of contributor is the same as candidate, but there is no 2
Page ____ of
familial relationship, enter 'not applicable' In the relationship column .
(for Schedule A)
 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 CHECK THIS BOX IF
THE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND
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)

Kids First 2005 Bond Issue

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIODfYR) AND PAC
CHECK
NUMBER
ID#
Minute Man Copying
313012005 $ 177,62
CK# 001
lot s. ~
S+
S+ +Ma~
11D# Todd & Mindy Finders Copying, signs
4t14r2005 546 .77
CK# 002

ID# Minute Man Copying

412012005 82 .39
CK# 003

ID#
Steve Edwards Copying/Signs
4/2012005
CK# 004 X21 9 2i(i!v AvP 498 .00
M(4 , 5h0(< -fD
ID#
Mindy & Todd Finders Copying & Website costs
513012005 247 .17
CK# 005

ID#

CK#

ID# --

CK#
__
ID#

CK#

SUB-TOTAL $
TOTAL (if fast page of this schedule) $ 1,551 .95

THIS BOX APPLIES TO CANDIDATES' COMMITTEES

ONLY :
Purchases of certain campaign property costing 5500 or more must
also be inventoried on Schedule H . (Refer to Schedule H Instrualons .)
Expenditures to personsientities 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 personientily on behalf of the candidate's committee . (Refer to
Schedule G instrumions and Iowa Code 68A.d02(3)(i).)

(for Schedule B)