Download as pdf or txt
Download as pdf or txt
You are on page 1of 12

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

Reset Form
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization)
(Rev. 07/2004) 1 REPORT

For Office Use Only

a.1,17we- ~ AL ---% Comm . # - -~


P bmmAe=
IMPORTANT : Indica e by # 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 .

5/Szy17LVSZ7 ~7 s ~o
SIG A RE OF PERSON FILIb G REPOR TELEPHONE DATE SIGNED

I AM FILING A 5 l~ 20o L-i REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .


(report date) Indicate by # 0

IF AMENDMENT TO REPORT DATED -ZO Local Committees, enter Date of Election

County & Local Committees, enter County in


k 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 filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

ADD TOTAL MONEY TAKEN IN THIS PERIOD


Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . . . Z 5 0 ri
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C) ' 0

Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L-) .O U


(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . . $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . .
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U " O
CASH ON HAND at the end of this reporting period (if final report balance must -~
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ '2- 1 J U
**UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0, DO
**OUTSTANDING LOANS (From Schedule F -Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 06/97) RECEIPTS

a CHECK THIS BOX IF


(Including candidate's personal funds)

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

Deere & Company Political Action Committee - Iowa (Deere PAC - Iowa)

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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
Wells Fargo Bank Iowa, N.A ., PO Box 837
1/1/2004 ID#
Des Moines, Iowa 50304
thru Offsets to operating expenditures -
$7 .42
5/14/2004 CK#
(Refunds, Rebates, etc .) - Refund for bank fees

ID# Deere & Company Political Action Committee


3/3/2004 $25,000.00
1 John Deere Place
CK# Moline, Illinois 61265

SUB-TOTAL
$25,007.42

TOTAL (if last page of this schedule) $14.84


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
marriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no Page 1 of 1
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM
SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT


B MONETARY
(Rev. 09/97) EXPENDITURES
STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE INDENTIFICATION 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)


Deere & Company Political Action Committee - Iowa (Deere PAC - Iowa)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
AND PAC
(MM/DD/YR)
CHECK
NUMBER

ID# Wells Fargo Bank Iowa, N.A. Bank Charges


1/30/2004 $2 .12
P.O. Box 837
CK# Des Moines, IA 50304

ID# Wells Fargo Bank Iowa, N.A . Bank Charges


1/30/2004 P .O. Box 837 $5 .30
CK# Des Moines, IA 50304

ID# Ward for Senate Contribution to non-federal


1/30/2004 1500 1545 Glen Oaks Drive candidate for Pat Ward (IA-30-R) $750 .00
CK# West Des Moines, IA 50266
2150
ID# Wells Fargo Bank Iowa, N.A . Bank Charges
2/27/2004 P.O. Box 837 $2 .12
CK# Des Moines, IA 50304

ID# Wells Fargo Bank Iowa, N.A . Bank Charges


2/27/2004 P.O . Box 837 $5 .30
CK# Des Moines, IA 50304

ID# Wells Fargo Bank Iowa, N.A . Bank Charges


3/31/2004 $2 .12
P.O . Box 837
CK# Des Moines, IA 50304

ID# Wells Fargo Bank Iowa, N.A . Bank Charges


3/31/2004 P.O . Box 837 $5 .30
CK# Des Moines, IA 50304

SUB-TOTAL
$772 .26
TOTAL (if last page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

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 56 .6(3)(i) .)

Page 1 of 2

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT


B MONETARY
(Rev. 09/97) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE INDENTIFICATION 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)


Deere & Company Political Action Committee - Iowa (Deere PAC - Iowa)

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
AND PAC
(MM/DD/YR) CHECK
NUMBER

ID# Wells Fargo Bank Iowa, N.A. Bank Charges


3/31/2004 P .O . Box 837 $2 .12
CK# Des Moines, IA 50304

ID# Wells Fargo Bank Iowa, N.A . Bank Charges


4/30/2004 P .O . Box 837 $2.12
CK# Des Moines, IA 50304

SUB-TOTAL $4 .24
TOTAL (if last page of this schedule) $776 .50

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

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 56 .6(3)(i).)

Page 2 of 2

(for Schedule B)

You might also like