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FOR INSTRUCTIONS, SEF.

BACK OF FORM

DISCLOSURE SUMMARY PAGE

COMMITTEE NAME (Must be same as on Statement of Org


VERIZON IOWA STATE GOOD GOVERNMENT CLUB

IMPORTANT: Indicate type of committee you are reporting for:


(1) Statewide/Legislative Candidate (2) Statewide PAC (3) State Party (4) County/Local Candidate
(5) County PAC (6) Ballot Issue/Franchise Committee (7) County/City Central Committee
(8) Suppoft Slate of Candidates

J~Z
~
SIGNATUP47M TREASURER (or person filing this report)
w TELEPHONE DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

I AM FILING A OCT 19, 2004 REPORT FOR AN/A (1) ELECTION / (2) NON-ELECTION YEAR .
(report date) Indicate one e
CIA IF AMENDMENT TO REPORT DATED OCT 19, 2004 Local Committees, enter Date of Election

heck if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
(You must continue to file reports until a Notice of Dissolution is filed .) which election is held

STATEMENT OF CASH ON HAND


CASH ON HAND at the beginning of the reporting period . (This is the total
of all monies 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 the first report filed .) . . . . . . ... . . . . . .. . . . . .. . . . . . . . . . . . . . .. . . . . .... . . . . . ... . . . . . .. . . . . $ 5,851 .41
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) . . .. . . . . . . .. . . . . . .. . . . . . ... . . . . .... . . . . . . . . . . 3,692 .68
Schedule F: Loans Received total (Attach Schedule F) . . . . .. . . . . . ... . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . . . . . . .. 0 .00
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . .... . . . . . . . . . . . . . .. . . . . .. . . . . . . 0 .00
(Schedule H applies to Candidates' Committees only )
SUB-TOTAL . . ...... $ 3,692 .68
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ... . . . . .. . . . . . .. . . . . . . .. . . . . ... . . . . . . . . . . . . . ... . . . . .. . . 3,550 .00
Schedule F: Loan Repayments total (Attach Schedule F) .. . . . . . .. . . . . .... . . . . . . . . . . . . . .. . . . . .. . . . . . . . . . . 0 .00
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . ... . . . . . .... . . . . . . .. . . . . . . . . . . . . . .. . . . . ... . . . . .. . . . . . . . .. . . . .... . . . . . . . . . . . . . .. . . . . . . . . . . . . . . $ 5,994 .09

UNPAID BILLS (From Schedule D - Attach Schedule D) . .. . . . . .... . . . . . . . . . . . ... . . . . . .. . . . . . . .. . . . . . .... . . . . .. . . . . . . $ 0 .00
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . .. . . . . . . .. . . . . . .. . . . . . . .. . . . . . . .. . . . . . . . . . $ 0 .00
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . .. . . . . . ... . . . . . . . . . . . .... . . . . .... . . . . . . . . . . . . . .. $ 0 .00
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) . . . . . . . .. . . . . . .. . . . . . . .. . . . . . . .. $ 0 .00
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

.~X CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 1 IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Uhitemized Receipt 1 .00


CK#

08/06/04 In# Uhitemized Receipt 1 .00


CK#

08/20/04 ID# Uhi temized Receipt 1 .00


CK#

09/03/04 ID# Uhi temized Receipt 1 .00


CK#

09/17/04 ID# Uhitemized Receipt 1 .00


CK#

10/01/04 ID# Uhitemized Receipt 1 .00


CK#

07/23/04 ID# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

08/06/04 ID# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

08/20/04 ID# Anderson 5 .00


1654Fisher Av
CK# New Sharon, la 50207

09/03/04 ID# D . Anderson 5 .00


R1654 Fisher Ave
CK# New Sharon, Ia 50207

SUB-TOTAL I$ 26 .00
TOTAL (if last page of this schedule) 1$
*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 relative) and affinity (relatives 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 .
Page 1 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

MX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# RodneyD . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

10/01/04 ID# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

07/23/04 m# Michelle R . Barman 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

08/06/04 ID# Michelle R . Barntmm 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

08/20/04 ID# Michelle R . Barman 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

09/03/04 ID# Michelle R . Barntmr< 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

09/17/04 ID# Michelle R . Barman 2 .50


1515 Reed St
CK# Grinnell, Ia 50112 '

10/01/04 ID# Michelle R . Barnum 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

07/23/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, la 50207

08/06/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, Ia 50207
I I I I I I I

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 2 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

b6/97)
F
(including candidate's personal funds) (Rev . RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, la 50207

09/03/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, la 50207

09/17/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, Ia 50207

10/01/04 ID# Ronald D . Brawn 2 .50


PO Box 226
CK# New Sharon, Ia 50207

07/23/04 ID# Unitemized Receipt 1 .00


CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Uniteaaized Receipt 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)

`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 relative) and affinity (relatives 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 .
Page 3 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

RX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 f IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Cheryl A . Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

08/06/04 ID# Cheryl A . Christinson 2 .50


1428 Reed Street
CK# Grinnell, la 50112

08/20/04 m# Cheryl A . Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

09/03/04 ID# Cheryl A . Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

09/17/04 ID# Cheryl A . Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

10/01/04 ID# Cheryl A. Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

07/23/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinnell, Ia 50112

08/06/04 ID# Cynthia S . Cloyed 5 .00


1121 Prince Street
CK# Grinnell, Ia 50112

08/20/04 ID# Cynthia S . Cloyed 5 .00


1121 Prince Street
CK# Grinnell, la 50112

09/03/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 4 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
09/17/04 ID# Cynthia S . Cloyed 5 .00
1 21 Prince Street
CK# Grinnell, Ia 50112

10/01/04 ID# Cynthia S . Cloyed 5 .00


11-21 Prince Street
CK# Grinnell, Ia 50112

07/23/04 ID# Uniteaized Receipt 2 .50


CK#

08/06/04 ID# Unitemized Receipt 2 .50


CK#

08/20/04 ID# Unitemized Receipt 2 .50


CK#

09/03/04 ID# Unitenized Receipt 2 .50


CK#

09/17/04 ID# Unitemized Receipt 2 .50


CK#

10/01/04 ID# Unitamized Receipt 2 .50


CK#

07/23/04 m# Jay M. Ctnings 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

08/06/04 ID# Jay M. C3m~nings


CK#
1408 Old 6 d
Malcom, la 50157
2 .50

SUB-TOTAL 1$ 30 .00

TOTAL (if last page of this schedule) J $

"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 relative) and affinity (relatives 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 .
Page 5 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


M CHECK THIS BOX IF
AMENDING FORM
VERIZON IOWA STATE GOOD GOVERNMENT CLUB
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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
08/20/04 ID# Jay M . ~mmins 2 .50
1408 Old 6 Rd-.
CK# Malcom, Ia 50157

09/03/04 ID# Jay M . Cu maings 2 .50


1408 Old 6 Rd .
CK# Malcom, la 50157

09/17/04 ID# Jay M . C L;mmrinrgs 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

10/01/04 ID# Jay M . Cummings 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

07/23/04 ID# Unitemized Receipt 1 .50


CK#

08/06/04 ID# Unitemized Receipt 1 .50


CK#

08/20/04 ID# Unitemized Receipt 1 .50


CK#

09/03/04 ID# Unitemized Receipt 1 .50


CK#

09/17/04 ID# Unitemized Receipt 1 .50


CK#

10/01/04 ID# Unitemized Receipt 1 .50


CK# '

SUB-TOTAL IS 19 .00
TOTAL (if last page of this schedule) 1$
*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 relative) and affinity (relatives 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 .
Page 6 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

COMMITTEE NAME (Must be same as on Statement of Organization) 0 CHECK THIS BOX IF


AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

07/23/04 ID# Anal Devilder 2 .36


1414 350th Ave
CRC# Brooklyn, Ia 52211

08/06/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

08/20/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

09/03/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

09/17/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

07/23/04 ID# Unitemized Receipt 1 .00


CK#

08/06/04 ID# Unitemized Receipt 1 .00


CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 m# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

SUB-TOTAL I$ 16 .80
TOTAL (if last page of this schedule) 1 $ '
*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 relative) and affinity (relatives 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 .
Page 7 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
VERIZON IOWA STATE GOOD GOVERNMENT CLUB
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 THHE 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
A/
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
10/01/04 ID# Unitemized Receipt 1 .00
CK#

07/23/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, la 50112

08/06/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

08/20/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

09/03/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

09/17/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

10/01/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

07/23/04 ID# Romaine K. Fenner 5 .00


4234 20th street
CSC# Grinnell, la 50112

08/06/04 ID# Rrmaino K, Fenner 5 .00


4234 20th Street
CK# Grinnell, Ia 50112

08/20/04 ID# Romaine K. Fenner 5 .00


4234 20th Street
CK# Grinnell, Ia 50112

SUB-TOTAL 1$ 40 .00

TOTAL (if last page of this schedule) 1 $


*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 relative) and affinity Irelatives 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 .
Page 8 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

nX CHECK THIS BOX IF


COMMITTEE NAME /Must be same as on Statement of Organization/ ' AMENDING FORM
VERIZON IOWA STATE GOOD GOVERNMENT CLUB
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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
09/03/04 ID# Rrmwinp K . Fenner 5 .00
4234 20th Street
CK# Grinnell, Is. 50112

09/17/04 ID# Rcma ne K . Fenner 5 .00


4234 20th street
C3C# Grinnell, Ia 50112

10/01/04 ID# Rc aine K . Farmer 5 .00


4234 20th street
CK# Grinnell, la 50112

07/23/04 ID# Unitemized Receipt 1 .00


CSC#

08/06/04 ID# Unitemized Receipt 1 .00


CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


C3C#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

10/01/04 ID# Unitemized Receipt 1 .00


CK#

07/23/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, la 50265

SUB-TOTAL IS 33 .50

TOTAL (if last page of this schedule) 1 $


*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 relative) and affinity (relatives 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 .
Page 9 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


R CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# John S . Flannery 12 .50


1024 21st '
C3C# W . Des Moines, Ia 50265

08/20/04 ID# John S . Flannery 12 .50


1024 21st
CSC# W . Des Moines, Ia 50265

09/03/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moues, Is 50265

09/17/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

10/01/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Is. 50265

07/23/04 m# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Is. 50112

08/06/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, la 50112

08/20/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Ia 50112

09/03/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, la 50112

09/17/04 ID# Patricia A. Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 10 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

10/01/04 ID# Patricia A. Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, la 50112

07/23/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

08/06/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

08/20/04 ID# Ellen T. Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

09/03/04 ID# Ellen T. Graff 4 .00


700 Garfield St
CK# Tama, la 52339

09/17/04 ID# Ellen T. Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

10/01/04 ID# Ellen T. Graff 4 .00


700 Garfield St
CK# Tama, la 52339 '

07/23/04 ID# Andrew J. Grosenbach 5.00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

08/06/04 ID# Andrew J. Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

08/20/04 ID# Andrew J. Grosenbach 5 .00


1116 Reed St Ap t 101
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page . 11 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/03/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Ap t 101
CK# Grinnell, Ia 50112

09/17/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

10/01/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

07/23/04 m# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, la 50157

08/06/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

08/20/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

09/03/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Male=, Ia 50157

09/17/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

10/01/04 m# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

07/23/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page_ 12 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688 .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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, la 50135

08/20/04 m# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

09/03/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135 ,

09/17/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

10/01/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 13 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
VERIZON IOWA STATE GOOD GOVERNMENT CLUB
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 THHE 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
10/01/04 ID# Unitemized Receipt 1 .00
C3C#

07/23/04 ID# Ann M . Ranssen 6 .00


PO Box 246
CK# Kellogg, Ia 50135

08/06/04 ID# Ann M . Hanssen 6 .00


PO Box 246
CK# Kellogg, Ia 50135

08/20/04 ID# Ana M . Hanssen 6 .00


PO Box 246 '
CK# Kellogg, Ia 50135

09/03/04 ID# Ana M . Hanssen 6 .00


PO Box 246
CK# Kellogg, la 50135

09/17/04 ID# Ann M . Hanssen 6 .00


PO Box 246
C2C# Kellogg, la 50135

10/01/04 ID# Ana M . Hanssen 6 .00


PO Box 246
CK# Kellogg, Ia 50135

07/23/04 ID# Unitemized Receipt 2 .50


CK#

08/06/04 ID# Unitemized Receipt 2 .50


C2C#

08/20/04 ID# Unitemized Receipt 2 .50


CK#

SUB-TOTAL IS 44 .50
TOTAL (if last page of this schedule) 1$
'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 relative) and affinity (relatives 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 .
Page 14 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


.0 CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Unitemized Receipt 2 .50

CK#

10/01/04 ID# Unitemized Receipt 2 .50

CC#

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CC#

09/17/04 ID# Unitemized Receipt 2 .50


CC#

10/01/04 ID# Unitemized Receipt 2 .50

CC#

07/23/04 ID# Unitemized Receipt 1 .00


CK#
I I I I I I I

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 15 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)

MX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND
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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Uni temized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#
! I I I j ~ I
SUB-TOTAL
TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 16 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)
CHECK THIS BOX IF
AMENDING FORM
COMMITTEE NAME (Must be same as on Statement of Organization)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


PAC IDENTIFICATION
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE
ETHICS AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
DISCLOSURE BOARD.
for soliciting contributions or
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements
for any commercial purpose by any person other than statutory political committees .

PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR


DATE
(if applicable) TO CANDIDATE* RECEIVED FUND-
RECEIVED
(if applicable) RAISER
(MM/DD/YR) AND PAC CHECK
INCOME
NUMBER

ID# Unitemized Receipt 1 .00


10/01/04

CK#

ID# Peggy A . Jantzen 2 .50


07/23/04
522 9th Avenue
CK# Grinnell, Ia 50112

08/06/04 ID# Peggy A . Jantzen 2 .50


522 9113 Avenue
CK# Grinnell, la 50112

08/20/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, Ia 50112

09/03/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, la. 50112

09/17/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, Ia 50112

10/01/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, la. 50112

07/23/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, Ia 50112

08/06/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, Ia 50112

08/20/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# I Grinnell, Ia 50112

TOTAL (if last page of this schedule)

"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 relative) and affinity (relatives 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 .
Page 17 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

.~ CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/03/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, Ia 50112

09/17/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, la 50112

10/01/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, la 50112

07/23/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

08/06/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, la. 50112

08/20/04 ID# Pmnela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

09/03/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Is 50112

09/17/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, la 50112

10/01/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 18 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

rX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemmized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

C3C#

07/23/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, la 52211

08/06/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, la. 52211

08/20/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, la. 52211

09/03/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

09/17/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 19 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

MX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

10/01/04 ID# Kimberly K . Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 m# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# uhitemized Receipt 1 .00

CK#

07/23/04 ID# Sharon L . Krtmm 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

08/06/04 ID# Sharon L . Kxlamn 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

08/20/04 m# Sharon L . Krtmm 2 .50


15415 N 75th Ave E
CK# Grinnell, la 50112

TOTAL (if last page of this schedule)


"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 relative) and affinity (relatives 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 .
Page 20 of 44

(for Schedule A)
SCHEDULE
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

nX CHECK THIS BOX IF


(Must be same as on Statement of Organization) AMENDING FORM
COMMITTEE NAME
VERIZON IOWA STATE GOOD GOVERNMENT CLUB
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
THE IOWA ETHICS AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM
DISCLOSURE BOARD .
contributions or
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting
for any commercial purpose by any person other than statutory political committees .

NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR


DATE PAC ID NUMBER
TO CANDIDATE* RECEIVED FUND-
RECEIVED (if applicable)
(if applicable) RAISER
(MM/DD/YR) AND PAC CHECK
NUMBER INCOME

09/03/04 ID# Sharon L . Krman 2 .50


15415 N 75th Ave E
CK# Grinnell, la 50112

09/17/04 ID# Sharon L . Kx1af 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

10/01/04 ID# Sharon L . Krtnnn 2 .50


15415 N 75th Ave E
cK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK# '

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, la 50112

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 21 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

EX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 m# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Ia 50112

08/20/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, la 50112

09/03/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grim 11, Ia 50112

09/17/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, la 50112

10/01/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Is 50112

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Y Unitemized Receipt 2 .50

CK#

10/01/04 ID# Unite:aized Receipt 2 .50


CK#

07/23/04 ID# Susan J . Mc Cain 2 .50


CK#
4370
a
63 Box
h 5015'7
Malcom, gI 8

08/06/04 ID# Susan J . Mc Cain 2 .50


4370 63 Box
CK# Malcom, Is 5015'7 8

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 22 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


n CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Haas 8
CK# Malccm, la 50157

09/03/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcam, Ia 50157

09/17/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcam, la 50157

10/01/04 m# Susan J . Mc rain 2 .50


4370 Highway 63, Box 8
CK# Malcam, Ia 50157

07/23/04 m# Uniteoized Receipt 1 .00

CK#

08/06/04 ID# Uniteaized Receipt 1 .00

CK#

08/20/04 ID# Uniteoized Receipt 1 .00

CK#

09/03/04 ID# Uniteaized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Uniteaized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 23 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 m# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Unitemized Receipt 2 .50

CK#

10/01/04 ID# Unitemized Receipt 2 .50

C3C# '

07/23/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
C3C# Grinnell, la 50112

08/06/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 24 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

I
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 %f IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Rhonda R. Mayes 5 .00


302 2nd Ave
CK# Grim 11, Ia 50112

09/03/04 ID# Rhonda R. Mayes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

09/17/04 ID# Rhonda R. Mayes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

10/01/04 ID# Rhonda R . Moyes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 2 .50


CK#

08/06/04 ID# Unitemized Receipt 2 .50


CK#

08/20/04 ID# Unitaaized Receipt 2 .50


CK#

09/03/04 ID# Unitemized Receipt 2 .50


CK#

09/17/04 m# Unitemized Receipt 2 .50


CK#

10/01/04 ID# Unitemized Receipt 2 .50


CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 25 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

.~ CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Rebecca L . Northcutt 2 .50


705 E Flood St Box 819
CK# Montezuma, Ia 50171

08/06/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, Ia 50171

08/20/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, la 50171

09/03/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, la 50171

09/17/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, Ia 50171

10/01/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, la 50171

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Uniteaized Receipt 1 .00

CK#

08/20/04 ID# UnitetLized Receipt 1 .00

CK#

09/03/04 ID# Uniteaized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 26 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitettized Receipt 2 .50

CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Unitemized Receipt 2 .50

CK#

10/01/04 ID# Uniteaized Receipt 2 .50

CK#

07/23/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

08/06/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, TSc 76092

TOTAL (iflast page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 27 of 44

(for Schedule A)
For Instructions. See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev .'06/97) RECEIPTS

EX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 -I IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CC# South Lake, TSc 76092

09/03/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

09/17/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

10/01/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

07/23/04 ID# Linda M . Peace 5 .00


1108 Summer St
CEC# Grinnell, la. 50112

08/06/04 ID# Linda M . Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

08/20/04 ID# Linda M . Pease 5 .00


1108 summer St
CK# Grinnell, Ia 50112

09/03/04 ID# Linda M . Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

09/17/04 ID# Linda M . Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

10/01/04 ID# Linda M . Peace 5 .00


1108 Summer St
CK# I Grinnell, Ia 50112

TOTAL (if last page of this schedule)

`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 relative) and affinity Irelatives 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 .
Page 28 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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
41
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place
Ct# Grim 11, Ia 50112

08/06/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

08/20/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place '
CK# Grinnell, Ia 50112

09/03/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

09/17/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, la 50112

10/01/04 ID# Jmnes R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

07/23/04 ID# Jan K . Pope 5 .00


603 Van Horne Cir
CK# Grinnell, Ia 50112

08/06/04 ID# Jan K . Pope 5 .00


603 Van Borne Cir
CK# Grinnell, Ia 50112

08/20/04 ID# Jan K . Pope 5 .00


603 Van Home Cir
CK# Grinnell, Ia 50112

09/03/04 ID# Jan K . Pope 5 .00


603 Van Horne Cir
CK# Grim 11, la 50112

TOTAL (if last page of this schedule)


"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 relative) and affinity (relatives 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 .
Page 29 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

M CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 -I IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Jan K . Gape 5 .00


603 Van Home Cir
CK# Grinnell, la. 50112

10/01/04 ID# Jan K . Pope 5 .00


603 Van Horne Cir
CK# Grinnell, Ia 50112

07/23/04 ID# Unitmized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 In# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 30 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

.~ CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Uni temized Receipt 1 .00


CK#

10/01/04 ID# Unitemized Receipt 1 .00


CK#

07/23/04 ID# Unitemized Receipt 1 .00


CK#

08/06/04 ID# Unitemized Receipt 1 .00


CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 m# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

10/01/04 ID# Unitemized Receipt 1 .00


CK#

SUB-TOTAL I$ 10 .00

TOTAL (if last page of this schedule) 1$


*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 relative) and affinity Irelatives 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 .
Page 31 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

RX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

08/06/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

08/20/04 m# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

09/03/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

09/17/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

10/01/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, la. 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page -32 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


M CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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-
AND PAC CHECK (if applicable) RAISER
(MM/DD/YR)
NUMBER INCOME

09/17/04 m# Unitemized Receipt 1 .00


CK#

10/01/04 m# Unitemized Receipt 1 .00


CK# '

07/23/04 m# Unitemized Receipt 2 .50


CK#

08/06/04 m# Unitemized Receipt 2 .50


CK#

08/20/04 m# Unitemized Receipt 2 .50


CK#

09/03/04 m# Unitemized Receipt 2 .50


CK#

09/17/04 m# Unitemized Receipt 2 .50


CK#

10/01/04 m# Unitemized Receipt 2 .50


CK#

07/23/04 m# Unitemized Receipt 1.25


CK#

08/06/04 m# Unitemized Receipt 1 .25


CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 33 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)

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


M CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS
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 -I IF


FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Uniteaized Receipt 1 .25

CK#

09/03/04 ID# Uniteoized Receipt 1 .25

CK#

09/17/04 ID# Uniteaized Receipt 1 .25

CK#

10/01/04 ID# Uniteaized Receipt 1 .25

CK#

07/23/04 ID# Michele L. Sisson 3 .00


1421 4th Ave
CK# Gri-ell, Ia 50112

08/06/04 ID# Michele L. Sisson 3 .00


1421 4th Ave
CK# Grinnell, la 50112

08/20/04 In# Michele L. Sisson 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

09/03/04 ID# Michele L . Sisson 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

09/17/04 m# Michele L. Sisson 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

10/01/04 ID# Michele L. Sisson 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112
I I I I I ~ I

TOTAL (if last page of this schedule)

"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 relative) and affinity (relatives 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 .
Page 34 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Unitemized Receipt 2 .50


CK#

08/06/04 ID# Unitemized Receipt 2 .50


CK#

08/20/04 ID# Unitemized Receipt 2 .50


CK#

09/03/04 m# Unitemized Receipt 2 .50


CK#

09/17/04 ID# Unitemized Receipt 2 .50


CK#

10/01/04 ID# Unitemized Receipt 2 .50


CK#

07/23/04 ID# Kathy V. Stanek 2 .50


PO Boot 926
CK# Grim 11, Ia 50112

08/06/04 ID# Kathy V. Stanek 2 .50


PO Box 926
CK# Grinnell, Ia 50112

08/20/04 ID# Kathy V. Stanek 2 .50


PO Box 926
CK# Grinnell, la 50112

09/03/04 ID# Kathy V. Stanek 2 .50


PO Box 926
CK# I Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 35 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

F
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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
v1

RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-


(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Kathy V . Stanek 2 .50


PO Box 926
CK# Grime11, Ia 50112

10/01/04 ID# Kathy V . Stanek 2 .50


PO Boat 926
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CZ#

08/20/04 m# Uniteaized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitenized Receipt 1 .00

CK#

10/01/04 ID# Uniteaized Receipt 1 .00

Cat#

07/23/04 ID# Unitemized Receipt 2 .50

Cat#

08/06/04 ID# Unitemized Receipt 2 .50

CZ#

TOTAL (if last page of this schedule)

*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 Iblood relative) and affinity (relatives 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 .
Page 36 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FX CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Uniteaized Receipt 2 .50

CK#

09/17/04 ID# Unitemdzed Receipt 2 .50

CK#

10/01/04 ID# Uniteaized Receipt 2 .50

CK#

07/23/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CC# Montem-, is 50171

08/06/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Molnteztana, Ia 50171 .

08/20/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CC# Monteztmla, Ia 50171

09/03/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Montezuma, Ia 50171

09/17/04 ID# Marcia Tannin 2 .50


5027 Hwy 63
CC# Monteztmia, Ia 50171

10/01/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CC# Monteztmla, Ia 50171
1 I I I I I I

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 37 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FRI CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

08/06/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

08/20/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

09/03/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, la 50251

09/17/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

10/01/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

07/23/04 ID# Unitemized Receipt 1 .00

CK# .

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 m# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page _ 38 - of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

.~ CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, la 50153

08/06/04 m# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, Ia 50153

08/20/04 ID# Marlis R . Van Zante 2 .50


E 14017 Hwy F-62 E '
CK# Lynnville, Ia 50153

t 09/03/04 ID# Marlis R . Van Zante 2 .50


14017 Ewy F-62 E
CK# Lynnville, la 50153

09/17/04 m# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, Ia 50153

10/01/04 ID# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, Ia 50153

07/23/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, Ia 50112

08/06/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# I Grinnell, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 39 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

~X CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, Ia 50112

09/03/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, Ia 50112

09/17/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E '
CK# Grinnell, Is. 50112

10/01/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, la 50112

07/27/04 ID# Verizon Good Government Club - TS[ 1,250 .00


816 Congress Ave ., Suite 1500
CK# Austin, T5c 78701

10/12/04 ID# Verizon Good Government Club - TX 1,250 .00


816 Suite 1500
C3C# Austin x78701

07/23/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

08/06/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
C3C# Montezuma, Ia 50171

08/20/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

i 09/03/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
C3C# Montezuma, la 50171
I I I I I I
SUB-TOTAL IS . 2, 527 .92
4k
TOTAL (if last page of this schedule) J $
*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 relative) and affinity
(relatives 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 .
Page 40 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/17/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

10/01/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

07/23/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Is. 50112

08/06/04 ID# David L . Weaver 2 .50


179 Walnut Road '
CK# Grinnell, Is 50112

08/20/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

09/03/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

09/17/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

10/01/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

07/23/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Is, 50112

08/06/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Is. 50112
1 i I I I I I

TOTAL (if last page of this schedule)


`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 relative) and affinity (relatives 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 .
Page 41 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 %I IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, la 50112

09/03/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, la. 50112

09/17/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, la, 50112

10/01/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 m# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

10/01/04 ID# Unitemized Receipt 1 .00


CK# '

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 42 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)
EX CHECK THIS BOX IF
AMENDING FORM
COMMITTEE NAME (Must be same as on Statement of Organization)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

ID# Linda J . Winchell 2 .50


08/06/04
315 2nd Avenue
CK# Grinnell, Ia 50112

08/20/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

09/03/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

09/17/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

10/01/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, la 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 m# Unitemized Receipt 1 .00

~# I 1 1

TOTAL (if last page of this schedule)

"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 relative) and affinity (relatives 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 .
Page 43 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS

0
(including candidate's personal funds)

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
AND PAC CHECK (if applicable) RAISER
(MM/DD/YR)
NUMBER INCOME

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitenized Receipt 1 .00

CK#

1 I I ~ l i '

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 44 of 44

(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


0 CHECK THIS BOX IF
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
AMENDING FORM
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
ETHICS & CAMPAIGN DISCLOSURE BOARD .

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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
DATE
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER

09/14/04 1DI# . BcVle PtialicService 0audssim 500.00


11420 S. 11th Street Gmeral 2004/ne
a0# (Outs, 1~E 68508 Political 0altribut m
00125
niitumasd acpec>Iditme 500.00-
09/14/04
a0#

09/17/04 7be axxau Oosmtbee state x~n~i, .


Gialimal 2004/ia
Afi, ,eJ~P 200 .00
DMV c1113M1i
a0# 244 400 Fblitiaaa 033tdbut im
00128 'ill , La 50112

08/26/04 ID* Daunt for souse State Hwse,/legislablaelrep 50 .00


2+IqrIc Detvitt Glaleral 2004/id74
a0# 611 W AsWaA (731-ributim
00123 IIertiamda, is 50125

09/14/04 ZD* Demdm fm State Swats Q3MILtbee State 9arlate 50 .00


3113 KiMW Aal=>le ameral 2004/ia
Q0 Des Moines, La 50309 wi ;ti aal . 033bib rim
001.26

09/17/04 Ffaise frr Samte State senate 200.00


6038 MFYaise Galielisl 2004/sci50
a0# Rt. 1 PdL t ical O>ritributim
00134 Ft. M3dism, Ia 52621

09/17/04 1 1D1# FYirarls for Dix St~be Aawa/hegislat3r%/rW 500.00


P O Hosc 220 Galetral 2004/ia
C# iShe11 Rod, Ia 50670 PbUtLa il 033t ribl_=alt
00137

09/14/04 31* Gerald Vap-puta7ic swim a=dsakmer Bilbi ;~ Seirvice OomdsWam 500 .00
1200 Nxth Street coal 2004/m
a0# rhyd'a , AE 68508 Political. Omitributim
00124
SUB-TOTAL 1$ 1,500.00

TOTAL (if last page of this schedule) 1 $

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 .613)(i) .)

Page 1 of 4

(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 IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE El 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)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER

09/14/04 II# Lhibmdzed bme 500 .00-

Qd1

09/17/04 lDll Gipp frr ative Wmattee State 13ouse/legislattaq/xep 200 .00
586 IC3jck Gipp Gaul 2004/~a031
Po1itiMl 033trib, rim
00133 Peaciiwh, Ia 52101

09/17/04 Citizens £cc Gk=Bta State 200 .00


Grcnstal General 2004/ia-
220 Hea31ett A9e Ad i tycal Ctntxibatirn
00132 Ooixmil Shams, Ia 51903

08/26/04 3D# Hser fxr State Aepreestative State Ha ;ISQ/lrecpslatua'e/xv 50 .00


Geri Ply Gwecal 2004/ii
r3K1 ~213 7th street N4 C brAxibitirn
00121 IAltooaa, Ia 50009

10/04/04 lawn Dwmxatic Petty State Poli tarwl Patty 500 .00
9098 345 Vidt Mer Posy Gaul 2004/ia
Qdk DEB M3dnes, Ia 50310 Palitdrcal rtmtxib,tim
00138

09/17/04 lD* INVrem for State Senate 200 .00


Stewext lversm G~a~~u~~l~,2~004/ia005
3020 Dow- LVill isren Itad Political ' stir
00130 Dons, Ia 50071

10/].1/04 113 ~Jar~2'~s Ommi ttee State xep 200.00


1808 58th Street Gaiecal 2004/ia
West Des Mod nes, la 52339 Palitical a2itrib,tim
00139

09/17/04 Kdbbde ficrr Sate State Senate 200 .00


P O Hcx 190 Gexal 2004/srp14
PJmletdag, Ia 50536 Polit ical Ortxibutim
00129

SUB-TOTAL 1$ 1,050 .00

TOTAL (if last page of this schedule) 1 $

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 4

(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 IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 0 CHECK THIS BOX IF
AMENDING FORM
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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


VERIZON IOWA STATE GOOD GOVERNMENT CLUB
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
08/26/04 11* Iradv &r hula Se~+te State Sscate 50 .00
Garral 2004/ia
PO Box 563 f}0l3tribut rn
00122 IA 52302
08/18/04 Godttee to ElectN3tt Mo[by State 9eoate 100 .00
M3ttbew MoOpy Gwaal 2004/sMl
4720 Pbodiand Ave . Political Cfontributim
00120 Des Modnes, Ia 50320
07/27/04 1 11I# Mlapty ficc Starve RP.Iressutative State HnuaaitlaJxfl-An rel/zW 100.00
Patrick MmTW Gweaal 2004/ii=
CIO/ 153 N Groadviety Ave. Clontribkim
00]18 uue, 7a 52001
l
09/17/04 Peluez for State PePreseodative 50 .00
114 First Am. E Gaul 2004/ii
CdcaLoosa, la 50635 Pta1itiodl 033Lxiibutim
00136
07/z7/o4 31* Paul Bell for State R4:1reealitative State T3L71 /leg+'alat,m.~ZW 100 .00
611 E. 17th St. N. General 2004/ia
Q0 Newt= la 50208 Cta3trib tim
00119
09/17/04 Putney for Serrate State 100 .00
Jdaz Pubiey Geueaal 2004/sd20
QKI 1365 170th Street Political a32 --rbutim
00135 GIz daodc, Ia 50635
09/17/04 1D# ,lieu., Patty of lom state Political Party 500.00
521 E. locust street Gaul 2004/ia
Qc# Des Nbdnes, Ia 50309 Political Omrikutim
00131
09/14/04 II* And Johnson Public Service Cbmdesian. 100 .00
1200 North Street Gecral 200
;//e
C10k Cahe, NB 68508 Political Coritrbutim
00127
SUB-TOTAL IS 1,100 .00
TOTAL (if last page of this schedule) 1 $

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 3 of 4
(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 IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
D CHECK THIS BOX IF
AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


CANDIDATE NAME AND ADDRESS TO WHOM
ID NUMBER EXPENDITURE
(if applicable) (Disbursement) WAS MADE
AND PAC
CHECK
NUMBER

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)(1) .)

Page 4 of

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM FORM
DR -2 DISCLOSURE
DISCLOSURE SUMMARY PAGE (Rev . 01/98) REPORT

COMMITTEE NAME (Must be same as on Statement of Organization) Comm . #


VERIZON IOWA STATE GOOD GOVERNMENT CLUB Indexed
Audited
IMPORTANT : Indicate type of committee you are reporting for : Computer
(1) Statewide/Legislative Candidate (2) Statewide PAC (3) State Party (4) County/Local Candidate
(5) County PAC (6) Ballot Issue/Franchise Committee (7) County/City Central Committee
(8) Support Slate of Candidates

iD -/?-D4/
SIGNATURE TREASURER (or person filing this report) TELEPHONE DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

I AM FILING A OCT 19, 2004 - REPORT FOR AN/A (1) ELECTION / (2) NON-ELECTION YEAR .
(report date) Indicate one e
CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

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

STATEMENT OF CASH ON HAND


CASH ON HAND at the beginning of the reporting period . (This is the total -
of all monies 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 the first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5,851 .41
ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A : Cash Contributions total (Attach Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,442 .68


Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 .00

Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 .0 0

(Schedule H applies to Candidates' Committees only)


- SUB-TOTAL . . . . . . . . $ 2,442 .68
SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B : Expenditures total (Attach Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,650 .00


Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 .00

CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3,644 .09

UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00

IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00

OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00


For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688 .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 %I IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00


CK#
s

08/20/04 ID# - Uniteaized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK# -

10/01/04 m# Unitemized Receipt 1 .00

CK#

07/23/04 m# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, la 50207

08/06/04 ID# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

08/20/04 ID# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, la 50207

09/03/04 m# Rodney D . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, la 50207

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 1 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : . IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
ETHICS AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
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 .

" NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT dIF FOR


` rATE - -- PAC ID NUMBER
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# RodneyD. Anderson - 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207

10/01/04 ID# RodneyD . Anderson 5 .00


1654 Fisher Ave
CK# New Sharon, Ia 50207
a

07/23/04 ID# - Michelle R. B rnum 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

08/06/04 ID# Michelle R. Barntmi 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

08/20/04 ID# Michelle R.' Barnurm 2 .50


1515 Reed St
CK# Grinnell, Ia 50112 -

09/03/04 ID# Michelle R. Barntmt 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

09/17/04 ID# Michelle R . Barntmt 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

10/01/04 ID# Michelle R. Barnum 2 .50


1515 Reed St
CK# Grinnell, Ia 50112

07/23/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, Ia 50207

08/06/04 ID# Ronald D. Brawn 2 .50


PO Box 226
Cat# New Sharon, Ia 50207

SUB-TOTAL

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 2 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS
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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Ronald D . Broom 2 .50


PO Boot 226
CK# New Sharon, Ia 50207

09/03/04 ID# Ronald D . Broom 2 .50


PO Boot 226
CK# New Sharon, Ia 50207
a

09/17/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, la 50207

10/01/04 ID# Ronald D . Brown 2 .50


PO Box 226
CK# New Sharon, Ia 50207

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitelaized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitenized Receipt 1 .00

CK#

10/01/04 ID# Uniteaized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 3 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 dIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Cheryl A. Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

08/06/04 ID# Cheryl A . Christinsom 2 .50


1428 Reed Street
CK# Grim 11, Ia 50112 s

08/20/04 ID# Cheryl A. Christine+ 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

09/03/04 ID# Cheryl A. Christinson 2 " 50


1428 Reed Street
CK# Grim 11, Ia 50112

09/17/04 ID# Cheryl A. Christ" n n 2 .50


1428 Reed Street _
CK# Grinnell, Ia 50112

10/01/04 ID# Cheryl A. Christinson 2 .50


1428 Reed Street
CK# Grinnell, Ia 50112

07/23/04 ID# Cynthia S . Cloyed 5 .00


1121 Prince Street
CK# Grinaell, la 50112

08/06/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Stmt
CK# Grinnell, Ia 50112

08/20/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinaell, Ia 50112

09/03/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinnell, la 50112

TOTAL (if fast page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 4 of - 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinnell, Ia 50112

10/01/04 ID# Cynthia S . Cloyed 5 .00


1221 Prince Street
CK# Grinnell, Ia 50112

07/23/04 ID# Unitetiized Receipt 2 .50

CK#

08/06/04 ID# Uniteaized Receipt 2 .50

CK#

08/20/04 ID# Uniteaized.Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Unitenized Receipt 2 .50

CK#

10/01/04 ID# Uniteaized Receipt 2 .50


CK#

07/23/04 ID# Jay M . Ctmmings 2 .50


1408 Old 6 Rd .
CC# Malcom, Ia 50157

08/06/04 ID# Jay M . Comings 2 .50


1408 Old 6 Rd .
CK# Malcom, la 50157

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 5 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FI CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 I IF FOR
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Joy M . semings 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

09/03/04 ID# Joy M . inrna 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

09/17/04 ID# Jay M . ings 2 .50


1408 Old 6 Rd .
C:K# Malcom, Ia 50157

10/01/04 ID# Joy M . ings 2 .50


1408 Old 6 Rd .
CK# Malcom, Ia 50157

07/23/04 ID# Unitemized Receipt 1 .50

Cat#

08/06/04 ID# Unitemized Receipt 1 .50

Cst#

08/20/04 ID# Unitemized Receipt 1 .50

CK#

09/03/04 ID# Unitemized Receipt - 1 .50

CK#

09/17/04 ID# Unitemized Receipt 1 .50

Cat#

x
10/01/04 ID# Unitemized Receipt 1 .50

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 6 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FI CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

08/06/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211 z

08/20/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

09/03/04 ID# Anna Devilder 2 .36


1414 350th Ave
CK# Brooklyn, Ia 52211

09/17/04 ID# Anna Devilder 2 .36


1414 350th Ave -
CK# Brooklyn, Ia 52211

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 Wood relative) and affinity (relatives 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 .
Page 7 of - - 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

10/01/04 m# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

08/06/04 ID# Susan M. Edelen 4 .00


3630 90th St
Cat# Grinnell, Ia 50112

08/20/04 ID# Susan M. Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

09/03/04 ID# Susan M . Edelen 4 .00


3630 90th St -
CK# Grinnell, Ia 50112

09/17/04 ID# Susan M . Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

10/01/04 ID# Susan M . Edelen 4 .00


3630 90th St
CK# Grinnell, Ia 50112

07/23/04 ID# Rr.~RBinp K . Fenner ,. 5 .00


4234 20th street
CK# Grim 11, Ia 50112

08/06/04 ID# Rr maine K . Fenner 5 .00


4234 20th Street
CK# Grinnell, Ia 50112

08/20/04 ID# Rcmainsa K . Fenner 5 .00


4234 20th street
Cat# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

"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 relative) and affinity (relatives 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 .
Page 8 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/03/04 ID# Romaine K . Fenner 5 .00


4234 20th Street
CK# Grinnell, Ia 50112

09/17/04 ID# Rcmainp K . Fenner 5 .00


4234 20th street
C(# Grinnell, Ia 50112

10/01/04 ID# Rcmainp K . Fenner 5 .00


4234 20th street
CK# Grinaell, Ia 50112

07/23/04 ID# Unitmized Receipt 1 .00


CK#

08/06/04 ID# Unitmlized Receipt 1 .00


CC#

08/20/04 ID# Unitemized Receipt 1 .00


C(#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 In# Unitemized Receipt 1 .00


CK#

10/01/04 ID# Unitemized Receipt 1 .00


C(#

07/23/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

SUB-TOTAL 1$ 33 .50
TOTAL (if last page of this schedule) 1$
'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 relative) and affinity (relatives 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 .
Page 9 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

08/20/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

09/03/04 ID# John S . Flannexy 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

09/17/04 ID# John S . Flannery 12 .50


1024 21st
CK# W . Des Moines, Ia 50265

10/01/04 ID# John S . Flannery 12 .50


1024 21st -
CK# W . Des Moines, Ia 50265

07/23/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grim 11, Ia 50112

08/06/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Ia 50112

08/20/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Ia 50112

09/03/04 ID# Patricia A. Gosselink 2 .50


15346 S 84th Ave E
CK# Grinnell, Ia 50112

09/17/04 ID# Patricia A . Gosselink 2 .50


15346 S 84th Ave E
CK# Grim 11, Ia 50112

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives by
marriage) (See Page 2 of forms packetl . If surname of contributor is the same as candidate, but there is no
familial relationship, enter 'not applicable' in the relationship column .
Page 10 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

10/01/04 ID# Patricia A. Gosselink 2 .50


15346 S 84th Ave E
CK# Gr nne ll, la 50112

07/23/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tana, Ia 52339 a

08/06/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, la 52339

08/20/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

09/03/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

09/17/04 m# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, Ia 52339

10/01/04 ID# Ellen T . Graff 4 .00


700 Garfield St
CK# Tama, la 52339

07/23/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

08/06/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, Ia 50112

08/20/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed St Apt 101
CK# Grinnell, la 5a112

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 11 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(Rev . 06/97) RECEIPTS


(including candidate's personal funds)
CHECK THIS BOX IF
(Must be same as on Statement of Organization) AMENDING FORM
COMMITTEE NAME

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
THE IOWA ETHICS AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM
DISCLOSURE BOARD .

CAUTION: Section 688.32A(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 J IF FOR
(if applicable) TO CANDIDATE" RECEIVED FUND-
RECEIVED
AND PAC CHECK (if applicable) RAISER
(MM/DD/YR)
NUMBER INCOME

09/03/04 ID# Andrew J . Grosenbach 5 .00


1116 Reed t 101
CK# Grinnell, Ia
St 12 N1
09/17/04 ID# Andrew J . Grosenbach 5 .00
1116 Reed Apt 101
CK# Grinnell, la
St 5K112 x

10/01/04 ID# Andrew J . Grosenbach . 5 .00


1116 Reed Apt 101
CK# Ia 5112
Grinnell, St

07/23/04 ID# Jennifer Gu nderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

08/06/04 ID# Jennifer Gunderson 2 .50


409 Clay St "
CK# Malcom, Ia 50157

08/20/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

09/03/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

09/17/04 ID# Jennifer Gunderson - 2 .50


409 Clay St
CK# Malcom, Ia 50157

10/01/04 ID# Jennifer Gunderson 2 .50


409 Clay St
CK# Malcom, Ia 50157

07/23/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 12 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(Rev . 06/97) RECEIPTS
(including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
ETHICS AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg , Ia 50135

08/20/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135 s

09/03/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

09/17/04 ID# Traci A . Guthrie 8 .00


121 Adair St
CK# Kellogg, Ia 50135

10/01/04 ID# Traci A . Guthrie 8 .00


121 Adair St -
CK# Kellogg, Ia 50135

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Uni temized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 13 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Ann M . Ranssen 6 .00


PO Box 246
CK# Kellogg, Ia 50135 a

08/06/04 ID# Ann M . Ran ssen 6 .00


PO Boat 246
CK# Kellogg, Ia 50135

08/20/04 m# Ana M . Ran ssen 6 .00


PO Bcac 246
CK# Kellogg, Ia 50135

09/03/04 ID# Ann M . Ranssen 6 .00


PO Box 246
CK# Kellogg, la 50135

09/17/04 ID# Ann M . Manssen 6 .00


PO Bcx 246
CK# Kellogg, Ia 50135

10/01/04 ID# Ann M . Hanssen 6 .00


PO Box 246
CK# Kellogg, Ia 50135

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Uaitemized Receipt 2 .50

CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 14 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/03/04 m# Unitenized Receipt 2 .50

CK#

09/17/04 m# Unitemized Receipt 2 .50

CK#

10/01/04 m# Unitemized Receipt 2 .50

CK#

07/23/04 m# Unitemized Receipt 2 .50

CK#

08/06/04 m# Unitemized Receipt 2 .50

CK#

08/20/04 m# Unitemized Receipt 2 .50

CK#

09/03/04 m# Unitemized Receipt 2 .50

CK#

09/17/04 m# Unitemized Receipt - 2 .50

CK#

10/01/04 m# Unitemized Receipt 2 .50

CK#

07/23/04 m# Unitemized Receipt 1 .00

CK#

SUB-TOTAL IS 23 .50

TOTAL (if last page of this schedule) 1$ -

'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 relative) and affinity (relatives 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 .
Page 15 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 11F FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 m# Unitemized Receipt 1 .00


CK#

08/20/04 m# Uniteaized Receipt 1 .00


CK#

09/03/04 m# Uniteaized Receipt 1 .00


CK#

09/17/04 m# Uniteaized Receipt 1 .00


CK#

10/01/04 m# Unitemized Receipt 1 .00


CK#

07/23/04 m# Uniteaized Receipt 1 .00


CK#

08/06/04 m# Uniteaized Receipt 1 .00


CK#

08/20/04 m# Uniteaized Receipt 1 .00


CK#

09/03/04 m# Uniteaized Receipt 1 .00


CK#

09/17/04 m# Uniteaized Receipt 1.00


CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives by
marriage) (See Page 2 of forms packetl . If surname of contributor is the same as candidate, but there is no
familial relationship, enter 'not applicable' in the relationship column .
Page 16 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(Rev . 06/97) RECEIPTS
(including candidate's personal funds)
CHECK THIS BOX IF
AMENDING FORM
COMMITTEE NAME (Must be same as on Statement of Organization)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


PAC IDENTIFICATION
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE
AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS
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 %f IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

10/01/04 ID# IInitemized Receipt 1 .00

CK#

07/23/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, Ia 50112 a

08/06/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grim 11, Ia 50112

08/20/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, la. 50112

09/03/04 ID# Peggyr A . Jantzen 2 .50


522 9th Avenue
C3C# Grinnell, Ia 50112

09/17/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinaell, Ia 50112

10/01/04 ID# Peggy A . Jantzen 2 .50


522 9th Avenue
CK# Grinnell, Ia 50112

07/23/04 ID# Diane J . Keenan , 2 .50


1228 West St
C3C# Grinnell, Ia 50112

08/06/04 ID# Diane J . Kee^a n 2 .50


1228 West St
CK# Grinnell, Ia 50112

08/20/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grim 11, Ia 50112

SUB-TOTAL $ 23 .50 1
TOTAL (if last page of this schedule) 1$
'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 relative) and affinity (relatives 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 .
Page 17 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
09/03/04 ID# Diane J . Keenan 2 .50
1228 West St
CK# Grinnell, Ia 50112

09/17/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, Ia 50112

10/01/04 ID# Diane J . Keenan 2 .50


1228 West St
CK# Grinnell, Ia 50112

07/23/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grin-ell, Is 50112

08/06/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

08/20/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

09/03/04 m# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

09/17/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, Ia 50112

10/01/04 ID# Pamela L . Kessler 5 .00


255 420th Ave
CK# Grinnell, la 50112

07/23/04 ID# Unitesaized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 18 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# Unitemized Receipt 1 .00


CK#

08/20/04 ID# Uniteaized Receipt 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

10/01/04 ID# Unitettized Receipt 1 .00


CK#

07/23/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

08/06/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

08/20/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

09/03/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

09/17/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 19 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 1IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

10/01/04 ID# Kimberly K. Kriegel 2 .50


616 Main St
CK# Brooklyn, Ia 52211

07/23/04 ID# Unitemized Receipt 1 .00


CK# z
08/06/04 ID# Unitemized Receipt 1 .00
CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 ID# Unitenized Receipt 1 .00


CK#

09/17/04 ID# Unitenized Receipt 1 .00


CK#

10/01/04 m# Unitemized Receipt 1 .00


CK#

07/23/04 ID# Sharon L. Krtmm 2 .50


15415 N 75th Ave E '
CK# Grinnell, Ia 50112

08/06/04 ID# Sharon L. Krtmm 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

08/20/04 ID# Sharon L. Krumm 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 20 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/03/04 ID# Sharon L . Kxlarm 2 .50


15415 N 75th Ave E
CK# Grimm 11, Ia 50112

09/17/04 ID# Sharon L . Krum 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112 x

10/01/04 ID# Sharon L . Krtmm 2 .50


15415 N 75th Ave E
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 m# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Uaitenized Receipt 1 .00

CK#

07/23/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 21 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/06/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Ia 50112

08/20/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Is. 50112 s

09/03/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Ia 50112

09/17/04 ID# Debra E . Lewis 5 .00


1202 Elm Street
CK# Grinnell, Ia 50112

10/01/04 ID# Debra E . Lewis 5 .00


1202 Elm Street _
CK# Grinnell, Ia 50112

09/03/04 ID# Uaitemized Receipt 2 .50

CK#

09/17/04 ID# Unitemized Receipt 2 .50

CK#

10/01/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcom, Ia 50157

08/06/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcom, Ia 50157

SUB-TOTAL I$ 37 .50

TOTAL (if last page of this schedule) 1$

`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 relative) and affinity (relatives 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 .
Page 22 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE PROM 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 .

08/20/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcom, Ia 50157

09/03/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Boot 8
CK# Malcom, la. 50157 s

09/17/04 ID# - Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcom, Ia 50157

10/01/04 ID# Susan J . Mc Cain 2 .50


4370 Highway 63, Box 8
CK# Malcom, Ia 50157

07/23/04 m# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitenized Receipt 1 .00

CK#

08/20/04 ID# Uniteaized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Uniteaized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 23 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 1IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID## Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Unitemized Receipt 2 .50


CK#

10/01/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Rhonda R . Mvyes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

08/06/04 m# Rhonda R . Moyes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)

`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 relative) and affinity (relatives 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 .
Page 24 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
C3C# Grinnell, la 50112

09/03/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

09/17/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
C3C# Grinnell, Ia 50112

10/01/04 ID# Rhonda R . Mayes 5 .00


302 2nd Ave
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50


CK#

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50


CK#

09/17/04 m# Unitemized Receipt 2 .50


CK#

10/01/04 ID# Unitemized Receipt 2 .50


CK#

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 25 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Rebecca L . Northcutt 2 .50


705 E Flood St Box 819
CK# Montezuma, Ia 50171

08/06/04 ID# Rebecca L . Northcutt 2 .50


705 E Flood St Box 819
CK# Montezuma, Ia 50171 z

08/20/04 ID# Rebecca L . Northcutt 2 .50


705 E Flood St Box 819
CK# Monteztmia, la 50171

09/03/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, Ia 50171

09/17/04 ID# Rebecca L . Northcutt 2 .50


705 E Flood St Box 819
CK# Monteztmrla, Ia 50171

10/01/04 ID# Rebecca L . Northcutt 2 .50


705 E Wood St Box 819
CK# Montezuma, Ia 50171

07/23/04 ID# Uaitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Uniteaized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 26 of -- 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

FI CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

09/17/04 ID# LMiteaized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Unitemizexl Receipt 2 .50

(3#

08/06/04 ID# Unitemized Receipt 2 .50

CK#

08/20/04 m# Uhiteaized Receipt 2 .50

CK#

09/03/04 ID# Uaitemized Receipt 2 .50

CK#

09/17/04 ID# Uniteaized Receipt 2 .50

CK#

10/01/04 ID# Uniteaaized Receipt 2 .50

CK#

07/23/04 ID# Michael D . Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

08/06/04 m# ' Michael D . Pawlowski 5 .00


902 Hknover Drive
CK# South Lake, Tx 76092

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 27 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

08/20/04 ID# Michael D. Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

09/03/04 ID# Michael D. Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, TSc 76092
a

09/17/04 ID# Michael D. Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, TSc 76092

10/01/04 ID# Michael D. Pawlowski 5 .00


902 Hanover Drive
CK# South Lake, Tx 76092

07/23/04 ID# Linda M . Pease 5 .00


1108 Steer St
CK# Grinnell, la 50112

08/06/04 ID# Linda M . Pease 5 .00


1108 Steer St
CK# Grinnell, Ia 50112

08/20/04 ID# Linda M. Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

09/03/04 ID# Linda M. Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

09/17/04 ID# Linda M. Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

10/01/04 ID# Linda M. Pease 5 .00


1108 Summer St
CK# Grinnell, Ia 50112

SUB-TOTAL 1$ 50 .00
TOTAL (if last page of this schedule) I5
*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 relative) and affinity (relatives 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 .
Page 28 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION: Section 688.32A(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

07/23/04 ID# James R. Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

08/06/04 ID# James R. Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112
a

08/20/04 ID# James R. Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

09/03/04 ID# James R. Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

09/17/04 m# James R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

10/01/04 ID# James R . Phelps 2 .50


1602 10th Avenue Place
CK# Grinnell, Ia 50112

07/23/04 ID# Jan K. Pope 5 .00


603 Van Horne Cir
CK# Grinnell, la 50112

08/06/04 ID# Jan K. Pope 5 .00


603 Van Horne Cir
CK# Grinnell, Ia 50112

08/20/04 ID# Jan K. Pope 5 .00


603 Van Horne Cir
CK# Grinnell, Ia 50112

09/03/04 m# Jan K. Pope 5 .00


603 Van Horse Cir
CK# Grinnell, la 50112

SUB-TOTAL IS 35 .00
TOTAL (if last page of this schedule) 1$_

'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 relative) and affinity (relatives 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 .
Page 29 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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
v'
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Jan K . Pope 5 .00


603 Van Horne Cir
CK# Grinnell, Ia 50112

10/01/04 ID# Jan K . Pope 5 .00


603 van Horne Cir
CK# Grinnell, Ia 50112

07/23/04 ID# - Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Uaitemized Receipt 1 .00

CK#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Uniteaized Receipt 1 .00

CK#

07/23/04 ID# Unitel ;tized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives by
marriage) (See (sage 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 .
Page 30 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688 .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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 m# Unitemized Receipt 1 .00

CK#

09/03/04 m# Unitenized Receipt 1 .00

CK#
s

09/17/04 m# Unitemized Receipt 1 .00

CK#

10/01/04 m# Uhitemized Receipt 1 .00

CK#

07/23/04 m# Uaitemized Receipt 1 .00

CK#

08/06/04 m# Unitemized Receipt 1 .00

C3C#

08/20/04 m# Uhitetilized Receipt 1 .00

CK#

09/03/04 m# Unitemized Receipt 1 .00

CK#

09/17/04 m# Unitemized Receipt 1 .00

CSC#

10/01/04 m# Unitemized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page - 3 1 - of - 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688 .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 JIF FOR
RECEIVED (if applicablel TO CANDIDATE` RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Barbara J . Sabultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

08/06/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112 ,

08/20/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

09/03/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

09/17/04 ID# Barbara J . Scbultz 2 .50


510 Pearl St -
CK# Grinaell, Ia 50112

10/01/04 ID# Barbara J . Schultz 2 .50


510 Pearl St
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemu.zed Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt _ 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CK#

09/03/04 ID# Uhi temized Receipt 1 .00

CK#

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 32 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLETROM 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 I IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Uaitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#
a

07/23/04 ID# - Unitemized Receipt 2 .50

CK#

08/06/04 XD# Unitemized Receipt 2 .50

CK#

08/20/04 ID# Uniteaized Receipt 2 .50

CK# -

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 ID# Uaitemized Receipt 2 .50

CK#

10/01/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Unitemized Receipt 1 .25

CK#

08/06/04 ID# Unitemized Receipt 1 .25


CK#

TOTAL (if last page of this schedule)

*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 relative) and affinity (relatives 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 .
Page 33 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 JIF FOR
RECEIVED (if applicable) TO CANDIDATE"' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

08/20/04 m# Unitemized Receipt 1 .25


CK#

09/03/04 ID# Unitemized Receipt 1 .25


CK#
a

09/17/04 ID# - Unitemized Receipt 1 .25


CK#

10/01/04 ID# Unitemized Receipt 1 .25


CK#

07/23/04 ID# Michele L . Sisson 3 .00


1421 4th Ave
CK# Grinnell, la 50112

08/06/04 ID# Michele L . Sisson 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

08/20/04 ID# Michele L . Sissam 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

09/03/04 ID# Michele L . Sissm 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

09/17/04 ID# Michele L . Sissom 3 .00


1421 4th Ave
CK# Grinnell, Ia 50112

10/01/04 ID# Michele L . Sissm 3 .00


1421 4th Ave
CK# Gr nne ll, Ia 50112

SUB-TOTAL IS 23 .00
TOTAL (if last page of this schedule) I $

'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 relative) and affinity
(relatives 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 .
Page 34 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

a
(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 y PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

07/23/04 ID# Unitemized Receipt 2 .50

CK#

08/06/04 ID# Unitemized Receipt 2 .50

CK#
s

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#

09/17/04 m# Unitemized Receipt 2 .50

CK# -

10/01/04 m# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Kathy V . Stanek 2 .50


PO Box 926
CSC# Grinnell, Ia 50112

08/06/04 ID# Kathy V . Stanek 2 .50


PO Box 926
CZC# Grinnell, Ia 50112

08/20/04 ID# Kathy V . Stanek 2 .50


PO Bcx 926
CK# Grinnell, Ia 50112

09/03/04 ID# Kathy V . Stanek 2 .50


PO Bcx 926
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 35 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .

CAUTION: Section 688.32A(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

09/17/04 ID# Kathy V . Stanek 2 .50


PO Boot 926
CK# Grinnell, Ia 50112

10/01/04 ID# Kathy V . Stanek 2 .50


PO Box 926
CK# Grianell, Ia 50112
s

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

CSC# -

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Unitemized Receipt 2 .50


CK#

08/06/04 m# Unitemized Receipt 2 .50

CK#

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 36 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688 .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

08/20/04 ID# Unitemized Receipt 2 .50

CK#

09/03/04 ID# Unitemized Receipt 2 .50

CK#
s

09/17/04 ID# - Unitemized Receipt 2 .50

CK#

10/01/04 ID# Unitemized Receipt 2 .50

CK#

07/23/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Montezuma, Ia 50171

08/06/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Monteztmia, la 50171

08/20/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Mcntemmia, Ia 50171

09/03/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63 -
CK# Monteztmia, Ia 50171

09/17/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Monteztmia, Ia 50171

10/01/04 ID# Marcia Tarvin 2 .50


5027 Hwy 63
CK# Montez uma, Ia 50171

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 37 of -- 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

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


0 CHECK THIS BOX IF
AMENDING FORM

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

07/23/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, la 50251

08/06/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251
a

08/20/04 ID# - Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

09/03/04 ID# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

09/17/04 In# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251 '

10/01/04 m# Karen Van Soelen 2 .50


12695 S 92nd Ave E
CK# Sully, Ia 50251

07/23/04 ID# Unitemized Receipt 1 .00


CK#

08/06/04 ID# Unitemized Receipt 1 .00


CK#

08/20/04 ID# Unitemized Receipt 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 38 of 44
(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 688.32A(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/Y R) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#
s
07/23/04 ID# _ Marlis R . Van Zante 2 .50
14017 Ewy F-62 E
CK# Lynnville, Ia 50153

08/06/04 ID# Marlis R . Van Zante 2 .50


14017 Ewy F-62 E
CK# Lynnville, Ia 50153

08/20/04 ID# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, Ia 50153

09/03/04 ID# Marlis R . Van Zante 2 .50


14017 Ewy F-62 E
CK# Lynnville, Ia 50153

09/17/04 ID# Marlis R . Van Zante 2 .50


14017 Hwy F-62 E
CK# Lynnville, Ia 50153

10/01/04 ID# Marlis R . Van Zante 2 .50


14017 Ewy F-62 E
CK# Lynnville, la 50153

07/23/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grin- 11, Ia 50112

08/06/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, la. 50112

TOTAL (if last page of this schedule)

'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 relative) and affinity (relatives 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 .
Page 39 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

1-01 CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

08/20/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, Ia 50112

09/03/04 M# Karla L . Vanderleest 2 .00


15270 N 75th Ave $
CK# Grinnell, Is 50112 s

09/17/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, Ia 50112

10/01/04 ID# Karla L . Vanderleest 2 .00


15270 N 75th Ave E
CK# Grinnell, la 50112

07/27/04 ID# Verizon Good GovernlInent Club - Tx 1,250 .00


816 Congress Ave ., Suite 1500 _
CK# Austin, Tx 78701

07/23/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuutla, la 50171

08/06/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

08/20/04 In# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, la 50171

09/03/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Montezuma, Ia 50171

09/17/04 m# Deborah D . Walker 4 .98


238 Horseshoe Dr
CK# Monteztmia, Ia 50171

SUB-TOTAL

TOTAL (if last page of this schedule)


'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 relative) and affinity (relatives 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 .
Page 40 of -- 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

10/01/04 ID# Deborah D . Walker 4 .98


238 Horseshoe Dr
C3C# Montezuma, Ia 50171

07/23/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112 s

08/06/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, la 50112

08/20/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

09/03/04 ID# David L . Weaver 2 .50


179 Walnut Road -
CK# Grinnell, Ia 50112

09/17/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

10/01/04 ID# David L . Weaver 2 .50


179 Walnut Road
CK# Grinnell, Ia 50112

07/23/04 ID# Joann L . Wells .. 5 .00


256 Neuburg Road
(3t# Grinnell, la 50112

08/06/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CC# Grinnell, la. 50112

08/20/04 ID# Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 41 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLETROM 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 1IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

09/03/04 ID# Joana L . Wells 5 .00


256 Newburg Road
CK# Grimm 11, Ia 50112

09/17/04 ID# Joam L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Ia 50112
x

10/01/04 ID# " Joann L . Wells 5 .00


256 Newburg Road
CK# Grinnell, Ia 50112

07/23/04 m# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt 1 .00

(3C#

09/03/04 ID# Unitemized Receipt 1 .00

CK#

09/17/04 ID# Unitemized Receipt 1 .00

CK#

10/01/04 ID# Unitemized Receipt 1 .00

CK#

07/23/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

TOTAL (if last page of this schedule)


"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 relative) and affinity (relatives 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 .
Page 42 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

08/06/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

08/20/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112 ,

09/03/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

09/17/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue
CK# Grinnell, Ia 50112

10/01/04 ID# Linda J . Winchell 2 .50


315 2nd Avenue -
CK# Grinnell, Ia 50112

07/23/04 ID# Unitemized Receipt 1 .00

CK#

08/06/04 ID# Unitemized Receipt 1 .00

CK#

08/20/04 ID# Unitemized Receipt - 1 .00


CK#

09/03/04 ID# Unitemized Receipt 1 .00


CK#

09/17/04 ID# Unitemized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)


*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 relative) and affinity (relatives 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 .
Page 43 of 44

(for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

(including candidate's personal funds) (Rev . 06/97) RECEIPTS

CHECK THIS BOX IF


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

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


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 THHE 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

10/01/04 ID# Uniteaized Receipt 1 .00


CK#

TOTAL (if last page of this schedule)


`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 relative) and affinity (relatives 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 .
Page 44 of 44
(for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

2
(Rev . 09/97) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION 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)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE -(DESCRIBE TRANSACTION) EXPENDED
_EXPENDED (if applicable) /Disbursement/ WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER

09/14/04 Boyle Pttali c Service Q' mi dsim 500 .00


420 S. 11th Street Gmai 2004/m
amin , NE 68508 Ra7.itical Clo3tributicu
00125

09/17/04 Th 0 11 OomnLtbee stabs ~~4eq~ ,Ilatur/n p 200 .00


DmV Qnxau Gmecal. 2004/ia
alt 244 400 w ,, ; t;,tal alo3tributim
001128 Gdrr,p , ra 50112

08/26/04 state aoumn,a


--isature
, /xep 50 .00
manic Lhvi.tt General 2004/4
611 w Adffixxi
00123 TniifiA ola, JIL 50125

09/14/04 Denrr3en for Stabs Ctmmittee slate Sew 50.00


3]13 Kine%r Avema Geoezal 2004/ia
Des M: d~ls, le. 50309 Pulit LCa
00126

09/17/04 ftai fCr Seriate state 200 .00


6038 la Fraim coal 2004/aM
Rt. 1 ia l i timl ( lootr butirn
00134 F.. MKbscn, la 52627

09/1704 state VnNM/jerjlje] ;1h1EWrEP 500 .00


P O Boot 220 Co~~ ' al 2004/ia
as 9he7.1 p4C)C, Ia 50670 Piolitlcal Clomt! dbuti
00137

09/14/04 31* Gerald Vap-p JbUc Sevice Pttalic Service Comndssim 500 .00
1200 lath Street Gececal 2004/ne
all Casts, NE 68508 A'11 7 tLcal Cbritilibuti
00124

09/17/04 Qpp flog Pepreamtative aounittee $t3te Eb mel/l sg; al at*,.Wnp 200 .00
586 alalck Girp G,e~n~e~r~al~ 2~0(4/ia031
CIA 212 High Pa" ' " ' . .aL Cbat 1but m
00133 Daolorah, Ia 52101

SUB-TOTAL I $ 2,200 .00

TOTAL fif last page of this schedule) 1 $

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)(1) .)

Page 1 of 3

(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 IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 01 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)

VERIZON IOWA STATE GOOD GOVERNMENT CLUB


CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE .,(DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) /Disbursement) WAS MADE
(MIG1/DD%YR) AND PAC
CHECK
NUMBER

09/17/04 31* ati711901115 iw Grcwtel sly sew 200 .00


Gaeluai 2004/
,220 BeCEett to Political Ocntributim
00132 Cb ric il BI&Es, M!L 51503

08/26/04 Poser fiat State AeFcesecitatiw state 1133W n,-T';h=e/ny 50 .00


Gai Steer G93ea3. 2004/ia
CK# 23.3 7th Street W Ctlatributim
00121 Altoaa, Th 50009
10/04/04 Zawn 1C pamty State Phtititat EwLty 500.00
9098 1345 lilbiboar Peria lay Gaeat 20Wia
C0 'Des Mbdnes, Ta 50310 Pclitical Oontrib tim
00138
09/1704 ficr
191191:13M state s~ 200 .00
Stewart 1yersaz General 2004/ia005
CEO 3020 Dotes- Wil ;,.na Hoed w,7 ; ticsl CtntrAm&;m
00130 nags, Ia 50071
10/11/04 m# JnoCi7s Q=IrLttee State - MhT ,*Q/gyp
Rs+ 200 .00
808 58th street General 2004/ii
00 Rest Des Motives, 1a 52339 Ptlitical Otlotributim
00139
09/17/04 Kibbde bor Senate State Senate 200 .00
P0BI3C190 Gealaal. 2004/sdD4
Cid# HmmtdmaV, Ia 50536 Pa ticalOtint .ibutim
00129
08/26/04 31* Iiaby_fcc ion Senate State sa~ate 50.00
Gaul 2004/ia
CKk TO BICK 563 O~ibutim
00122 Narim, 7a 52302
08/3.9/04 Ommittee to Meat M9tt. W(by State Seflate 100 .00
Gaul 2004/kEll
C[# 4720 mad pale. Mitiaal crnra,trim
00120 Des Moines, la 50320
SUB-TOTAL /$ 1,500.00

TOTAL (if last page of this schedule) 1 $

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)(1) .)

Page 2 of 3

(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 IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE MX 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/


VERIZON IOWA STATE GOOD GOVERNMENT CLUB
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
h(MM/bb/YR) AND PAC
CHECK
NUMBER

07/ZI/04 for State Papreestative State An


-aa:/lar-; =a/reV 100.00
HA-- Mac#V
Patrick c a12004/ii=
1155 N Gbm*ieew Aim . D T dsib j1-im
00118 ,Dds3M, Ta 52001.
09/17/04 R* Palmw 5C State Papre9eritative State Via m/3 aw-A al /iep 50.00
114 First Alle. E Gereral 20%/ii
Oeialoaea, la 50635 Po titvsl amtributim
00136 a

07/27/04 I ll Hell fcc Str7b8 ]tatlve 100.00


611 E. 17th St. N. Gwelca1 2004/is
CHI! Nswlai, la 50208 Cbl3tribttiM
00119
09/17/04 31* Raw isr Sa e Sens 100 .00
083eca3 2004/sd20
1365 170th Street
00135 Oladzoak, 1'a 50635
09/17/04 31* PAw Nicao Party of Ialaa state Pout Lcal party 500 .00
521 E. Locust Street Coal 2004/ia
(30 'pes i"nes, Ea 50309 Pontiaal rrr*r,b ,tim
00131
09/14/04 IDN 1bd sobeism PuWirn dim Cbmwdsikicn 100 .00
1200 Math Street
o1vto , M 68508 P nUtical ( tintr'Ib ,rirn
00127

SUB-TOTAL 1$ 950 .00


TOTAL (if last page of this schedule) l $ 4,650.00

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)(1) .)

Page 3 of 3
(for Schedule B)