l+U!NA Eii-'.

ICS ANO CAMAIGN DISCLOSURE SCARD Farm

5' 4 EkST LOCUST, SUITE_ 104 f V-.'RIF!ED STATczAE`lT
REGISTRAT7CN
DES WINES, IA 5,0309-1s1 :2 ! 'Cut-jf--Stam Czmmittees;
(Rev. i/CQ)
VERIFIED STATEE EN T REGISTRATION i
For ofc- use oniv
ti.
(Gut-cf-State Committee) i
Comm.
Indexed _
C0MMITT=
.+j :f1OT ORGANI= IN IOWA 'O C^uiAFLE-E IN CLP--JGTE
SEND ORIGINAL COPY TO 1r?E SCARD ANID Audited _
ONE CDFY_WW: TEACH CONTRISUTCN TO i'HE iOWA CCMMlTT.
CheCted .
. Rs1=ASE Rlr
t.R TO 0 E7I =J INS LCTCNS ON 3ACK OF =QRM .
Computer
CDMk r"EE NAME
Offtcai Name of Out-of-State Committee (Do not abbreviate =mmidee name. Write expianatren must be oravided far Aaenym.)
MZT.LWMICHT LOCAL UNION 2158 Pac #8048
Mailing Address
2'707 62ND STREET COURT
City, State, Zip Code Area Coda telephone NQ
BETTENDORF, IA 52722 L5&!--J 332 - 2158

TREASURER OTHER OFF CcR8 (Attac!i second page if needed)

Name of Treasurer Name of C.~airperson
KARL KOST STUART ME SMER
Mailing Address
2707 62ND STREET COURT 2707 62ND STREET COURT
City, Slate. Zip Ccde Telephone Cav, State, ZIp Code Telephone
BETTENDORF
56-3)332-21 . IA 52722 t 6 3)332-215 BtTTENDORF, IA 52722 8
IOWA RESIDENT AGENT
of Iowa Resident Agent PARENT ENZTI"'f, AFRLJATE, SPONSOR OF COMMnT1
".+ (Use separate page if needed to list more than one entity)
Name oiloar Resident
KARL KOSTyped j MILLWRIGHT LOCAL UNION 2158
mail, ~_Address
1:738 210TH STREET 2707 62ND STREET~nCOURT
Caty, State, ZIo Cede Telephone
CT,ARFNCE, IA 52216 563 452-355 aty,S ,'o Code
C- BETTENDORF IA ~ 22

PURPOSE OF COMMITTEE-
LABOR OR TO SUPPORT CANDIDATES FAVORABLE TO ORGANIZED LABOR

IOWA COMMITTEE RECEVING CONTRIBUTION

STATE OR FEDERAL JURISDICTIChl WNE.RE CaUMrTTE`
IS REGMTEr'2ED OR OPERATES
Nick Maybanks NnY' ETWft Attorney i
Narne of Junsdicton M iAddress
ILLINOIS STATE BOARD OF ELECTIONS 203 Fifth Street0 14~ Coralvill, IA- 5 ~ 241
iWailin Address If In Kind ConMhutlan, Oescibe
7 / 1 / 05
t
1020 S SPRING- STREET
City, State, Zip Code Telephone Amount ~ I
SPRINGFIELD, IL 61087 2t 17) 7_82-414 300 .00 !I

VERIFIED STATEMENT OF COMMM7EE:

i KARL swear KOST hat the ccntnbudon reported soave is accurate. I further swear +trot ;tie information aoout this out-of-
siate =mmeee is =necz ono ac==e to the bear army ~mwiedge. 1 attest `hat the revcrm filed ;i7 the navned;wi-dicden cnmpty with requmwnents ahieh are
>ubstanaaily siiniiar'o icwa Ccde sewn w_&, atc uding the disclosure cf all c-ntrzcutlcns received and atl expendffums made. 1further attest teat the =-cntribubon
'eportea above was mace ;torn an acc--unt which aces .et accept ccnbrmutions kom crrpcradcns ar otherprahibred ccntnbumrs under Iowa Code ae=on 56. 151
'understand zhat,owa ccrmnitees are prohibited from accapting can=uwns from our-of--,,7,=e c,.min ite~s unless a :signed odgmai or this form has been fed with
fie laws -hits and Camaaign Cisaosure Sd car ore thtrtl
cu-o-Sae cam1M&Ws i registered and fng fW1 disc6wure reports ;n lcwa
TREASURER 7-1-0-S
(Cray Signature of Treasurer or Caairpemorr) rr~c,As
1,r ., TUCYM. DVORAK
ubscnted and s4vcm before me tis. L-4af' day of -(a&j . 2~ ar _ xe Comm Numbw70S1 02
y m on tw
Ay icmry ccmtnisslon expires °°' Sepllembw 14,
Notary Fubiic