Verizon Iowa State Good Government Club

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

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#

CK#

CK#

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

1654 Fisher Ave
CK# New Sharon, Ia 50207

1654 Fisher Ave
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
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)
MX CHECK THIS BOX IF


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
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
NUMBER INCOME
09/17/04 ID# RodneyD . Anderson 5 .00

1654 Fisher Ave

1654 Fisher Ave
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
08/20/04 ID# Michelle R . Barman 2 .50

1515 Reed St
09/03/04 ID# Michelle R . Barntmr< 2 .50

1515 Reed St
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
07/23/04 ID# Ronald D . Brown 2 .50

PO Box 226

PO Box 226
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
Page 2 of 44
(for Schedule A)
b6/97)
F
(including candidate's personal funds) (Rev . RECEIPTS
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME

PO Box 226

PO Box 226

PO Box 226
10/01/04 ID# Ronald D . Brawn 2 .50

PO Box 226
07/23/04 ID# Unitemized Receipt 1 .00

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

CK#

CK#
CK#

CK#
`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
Page 3 of 44
(for Schedule A)
RX CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT f IF FOR
NUMBER INCOME
07/23/04 ID# Cheryl A . Christinson 2 .50

1428 Reed Street

1428 Reed Street
CK# Grinnell, la 50112
08/20/04 m# Cheryl A . Christinson 2 .50

1428 Reed Street

1428 Reed Street

1428 Reed Street
10/01/04 ID# Cheryl A. Christinson 2 .50

1428 Reed Street
07/23/04 ID# Cynthia S . Cloyed 5 .00

1221 Prince Street

1121 Prince Street

1121 Prince Street

1221 Prince Street
Page 4 of 44
(for Schedule A)
~X CHECK THIS BOX IF


DISCLOSURE BOARD .
CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT JIF FOR
NUMBER INCOME
1 21 Prince Street

11-21 Prince Street
07/23/04 ID# Uniteaized Receipt 2 .50

CK#

CK#

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

CK#

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
Page 5 of 44
(for Schedule A)
COMMITTEE NAME (Must be same as on Statement of Organization)

M CHECK THIS BOX IF
AMENDING FORM
DISCLOSURE BOARD .
NUMBER INCOME
08/20/04 ID# Jay M . ~mmins 2 .50
1408 Old 6 Rd-.
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 .
10/01/04 ID# Jay M . Cummings 2 .50

1408 Old 6 Rd .

CK#

CK#

CK#

CK#

CK#

CK# '
SUB-TOTAL IS 19 .00
Page 6 of 44
(for Schedule A)
COMMITTEE NAME (Must be same as on Statement of Organization) 0 CHECK THIS BOX IF

AMENDING FORM

DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT /IF FOR
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

1414 350th Ave

1414 350th Ave

1414 350th Ave

CK#

CK#

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

CK#

CK#
SUB-TOTAL I$ 16 .80
TOTAL (if last page of this schedule) 1 $ '
Page 7 of 44
(for Schedule A)

DISCLOSURE BOARD.
CAUTION: Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
A/
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
CK#
07/23/04 ID# Susan M. Edelen 4 .00

3630 90th St

3630 90th St

3630 90th St

3630 90th St

3630 90th St

3630 90th St
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
08/20/04 ID# Romaine K. Fenner 5 .00

4234 20th Street
SUB-TOTAL 1$ 40 .00
TOTAL (if last page of this schedule) 1 $

committee. Relationship must be shown to the third degree of consanguinity (blood relative) and affinity Irelatives by
Page 8 of 44
(for Schedule A)
nX CHECK THIS BOX IF

COMMITTEE NAME /Must be same as on Statement of Organization/ ' AMENDING FORM
DISCLOSURE BOARD.
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

CSC#

CK#

CK#

C3C#

CK#

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

1024 21st
CK# W . Des Moines, la 50265
SUB-TOTAL IS 33 .50

Page 9 of 44
(for Schedule A)

R CHECK THIS BOX IF
AMENDING FORM

DISCLOSURE BOARD.
NUMBER INCOME

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

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

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

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

1024 21st
CK# W . Des Moines, Is. 50265
07/23/04 m# Patricia A . Gosselink 2 .50

15346 S 84th Ave E
08/06/04 ID# Patricia A . Gosselink 2 .50

15346 S 84th Ave E

15346 S 84th Ave E

15346 S 84th Ave E
09/17/04 ID# Patricia A. Gosselink 2 .50

15346 S 84th Ave E
Page 10 of 44
(for Schedule A)
FX CHECK THIS BOX IF


DISCLOSURE BOARD .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ,/IF FOR
NUMBER INCOME

15346 S 84th Ave E
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
08/06/04 ID# Andrew J. Grosenbach 5 .00

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

1116 Reed St Ap t 101
Page . 11 of 44
(for Schedule A)
CHECK THIS BOX IF


STATE CANDIDATES NOTE : iF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
DISCLOSURE BOARD.
CAUTION: Section 68B .32A(6) . Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
NUMBER INCOME
09/03/04 ID# Andrew J . Grosenbach 5 .00

1116 Reed St Ap t 101


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

409 Clay St
08/06/04 ID# Jennifer Gunderson 2 .50

409 Clay St

409 Clay St

409 Clay St
CK# Male=, Ia 50157

409 Clay St
10/01/04 m# Jennifer Gunderson 2 .50

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

121 Adair St
CK# Kellogg, Ia 50135
Page_ 12 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
CAUTION: Section 688 .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
NUMBER INCOME

121 Adair St
CK# Kellogg, la 50135
08/20/04 m# Traci A . Guthrie 8 .00

121 Adair St

121 Adair St
CK# Kellogg, Ia 50135 ,

121 Adair St

121 Adair St
CK#
CK#
CK#

CK#
CK#
Page 13 of 44
(for Schedule A)

DISCLOSURE BOARD.
CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting
contributions or
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT (IF FOR
NUMBER INCOME
C3C#
07/23/04 ID# Ann M . Ranssen 6 .00

PO Box 246
08/06/04 ID# Ann M . Hanssen 6 .00

PO Box 246
08/20/04 ID# Ana M . Hanssen 6 .00

PO Box 246 '
09/03/04 ID# Ana M . Hanssen 6 .00

PO Box 246
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#

C2C#

CK#
SUB-TOTAL IS 44 .50
Page 14 of 44
(for Schedule A)

.0 CHECK THIS BOX IF
AMENDING FORM

DISCLOSURE BOARD.
NUMBER INCOME
CK#
CK#
CC#
CK#
CK#
CK#
CC#

CC#
CC#

CK#
I I I I I I I
Page 15 of 44
(for Schedule A)
(Rev . 06/97) RECEIPTS

(including candidate's personal funds)


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.
NUMBER INCOME
CK#
CK#
CK#
CK#
CK#
CK#
08/06/04 ID# Uni temized Receipt 1 .00
CK#
CK#
CK#
CK#
! I I I j ~ I
SUB-TOTAL
Page 16 of 44
(for Schedule A)

CHECK THIS BOX IF
AMENDING FORM

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

522 9113 Avenue

522 9th Avenue

522 9th Avenue
CK# Grinnell, la. 50112

522 9th Avenue

522 9th Avenue
07/23/04 ID# Diane J . Keenan 2 .50

1228 West St

1228 West St

1228 West St
CK# I Grinnell, Ia 50112
Page 17 of 44
(for Schedule A)
.~ CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP 'AMOUNT (IF FOR
NUMBER INCOME

1228 West St

1228 West St

1228 West St
07/23/04 ID# Pamela L . Kessler 5 .00

255 420th Ave

255 420th Ave
08/20/04 ID# Pmnela L . Kessler 5 .00

255 420th Ave

255 420th Ave
CK# Grinnell, Is 50112

255 420th Ave

255 420th Ave
CK#
Page 18 of 44
(for Schedule A)
rX CHECK THIS BOX IF


DISCLOSURE BOARD .
NUMBER INCOME
CK#
CK#
CK#
09/17/04 ID# Unitemmized Receipt 1 .00
CK#
C3C#
07/23/04 ID# Kimberly K . Kriegel 2 .50

616 Main St
CK# Brooklyn, la 52211

616 Main St
CK# Brooklyn, la. 52211

616 Main St
CK# Brooklyn, la. 52211

616 Main St

616 Main St
Page 19 of 44
(for Schedule A)


DISCLOSURE BOARD.
NUMBER INCOME

616 Main St
CK#
CK#
CK#
CK#
CK#
10/01/04 ID# uhitemized Receipt 1 .00
CK#
07/23/04 ID# Sharon L . Krtmm 2 .50

15415 N 75th Ave E
08/06/04 ID# Sharon L . Kxlamn 2 .50

15415 N 75th Ave E
08/20/04 m# Sharon L . Krtmm 2 .50

15415 N 75th Ave E

Page 20 of 44
(for Schedule A)
SCHEDULE
For Instructions, See Back of Form
nX CHECK THIS BOX IF

(Must be same as on Statement of Organization) AMENDING FORM
COMMITTEE NAME
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
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
09/17/04 ID# Sharon L . Kx1af 2 .50

15415 N 75th Ave E
10/01/04 ID# Sharon L . Krtnnn 2 .50

15415 N 75th Ave E
cK# Grinnell, Ia 50112
CK#
CK# '
CK#
CK#
CK#
CK#
07/23/04 ID# Debra E . Lewis 5 .00

1202 Elm Street

Page 21 of 44
(for Schedule A)
EX CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME
08/06/04 m# Debra E . Lewis 5 .00

1202 Elm Street
08/20/04 ID# Debra E . Lewis 5 .00

1202 Elm Street
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
10/01/04 ID# Debra E . Lewis 5 .00

1202 Elm Street
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
Page 22 of 44
(for Schedule A)

n CHECK THIS BOX IF
AMENDING FORM

DISCLOSURE BOARD.
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

CK# Malcam, la 50157
10/01/04 m# Susan J . Mc rain 2 .50

CK# Malcam, Ia 50157
07/23/04 m# Uniteoized Receipt 1 .00
CK#
CK#
08/20/04 ID# Uniteoized Receipt 1 .00
CK#
CK#
CK#
CK#

Page 23 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME
CK#
CK#
CK#
CK#
CK#
CK#
CK#
C3C# '
07/23/04 ID# Rhonda R . Mayes 5 .00

302 2nd Ave
C3C# Grinnell, la 50112

302 2nd Ave
Page 24 of 44
(for Schedule A)
I
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT %f IF FOR
NUMBER INCOME
08/20/04 ID# Rhonda R. Mayes 5 .00

302 2nd Ave
CK# Grim 11, Ia 50112

302 2nd Ave

302 2nd Ave
10/01/04 ID# Rhonda R . Moyes 5 .00

302 2nd Ave

CK#

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

CK#

CK#

CK#

CK#

Page 25 of 44
(for Schedule A)


DISCLOSURE BOARD.
NUMBER INCOME
07/23/04 ID# Rebecca L . Northcutt 2 .50

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

705 E Wood St Box 819

CK# Montezuma, la 50171



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

Page 26 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ,/ IF FOR
NUMBER INCOME
CK#
CK#
CK#
08/06/04 ID# Unitettized Receipt 2 .50
CK#
CK#
CK#
CK#
CK#
07/23/04 ID# Michael D . Pawlowski 5 .00

902 Hanover Drive
CK# South Lake, Tx 76092

902 Hanover Drive
CK# South Lake, TSc 76092
TOTAL (iflast page of this schedule)

Page 27 of 44
(for Schedule A)
For Instructions. See Back of Form SCHEDULE
(including candidate's personal funds) (Rev .'06/97) RECEIPTS


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -I IF FOR
NUMBER INCOME

902 Hanover Drive
CC# South Lake, TSc 76092

902 Hanover Drive

902 Hanover Drive

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

1108 summer St
09/03/04 ID# Linda M . Pease 5 .00

1108 Summer St
09/17/04 ID# Linda M . Pease 5 .00

1108 Summer St
10/01/04 ID# Linda M . Peace 5 .00

1108 Summer St
committee . Relationship must be shown to the third degree of consanguinity (blood relative) and affinity Irelatives by
Page 28 of 44
(for Schedule A)


DISCLOSURE BOARD.
41
NUMBER INCOME
07/23/04 ID# James R . Phelps 2 .50

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


1602 10th Avenue Place '


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

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

603 Van Horne Cir
08/06/04 ID# Jan K . Pope 5 .00

603 Van Borne Cir
08/20/04 ID# Jan K . Pope 5 .00

603 Van Home Cir
09/03/04 ID# Jan K . Pope 5 .00

603 Van Horne Cir
CK# Grim 11, la 50112

Page 29 of 44
(for Schedule A)
M CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -I IF FOR
NUMBER INCOME
09/17/04 ID# Jan K . Gape 5 .00

603 Van Home Cir
10/01/04 ID# Jan K . Pope 5 .00

603 Van Horne Cir
07/23/04 ID# Unitmized Receipt 1 .00
CK#
CK#
CK#
CK#
09/17/04 In# Unitemized Receipt 1 .00
CK#
CK#
CK#
CK#

Page 30 of 44
(for Schedule A)


DISCLOSURE BOARD.
NUMBER INCOME

CK#

CK#

CK#

CK#

CK#

CK#

CK#

CK#

CK#

CK#
SUB-TOTAL I$ 10 .00

committee. Relationship must be shown to the third degree of consanguinity (blood relative) and affinity Irelatives by
Page 31 of 44
(for Schedule A)
RX CHECK THIS BOX IF


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

510 Pearl St

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

510 Pearl St

510 Pearl St

510 Pearl St

510 Pearl St
CK#
CK#
CK#
CK#
Page -32 of 44
(for Schedule A)

M CHECK THIS BOX IF
AMENDING FORM

DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ,'IF FOR
AND PAC CHECK (if applicable) RAISER
(MM/DD/YR)
NUMBER INCOME

CK#

CK# '

CK#

CK#

CK#

CK#

CK#

CK#
07/23/04 m# Unitemized Receipt 1.25

CK#

CK#

Page 33 of 44
(for Schedule A)


M CHECK THIS BOX IF
AMENDING FORM

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.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -I IF

FOR
NUMBER INCOME
CK#
09/03/04 ID# Uniteoized Receipt 1 .25
CK#
CK#
CK#
07/23/04 ID# Michele L. Sisson 3 .00

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

1421 4th Ave
08/20/04 In# Michele L. Sisson 3 .00

1421 4th Ave
09/03/04 ID# Michele L . Sisson 3 .00

1421 4th Ave
09/17/04 m# Michele L. Sisson 3 .00

1421 4th Ave

1421 4th Ave
I I I I I ~ I
Page 34 of 44
(for Schedule A)


DISCLOSURE BOARD.
for any commercial purpose by any person other than statutory political committees . '
NUMBER INCOME

CK#

CK#

CK#

CK#

CK#

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

PO Boot 926
CK# Grim 11, Ia 50112

PO Box 926

PO Box 926

PO Box 926
Page 35 of 44
(for Schedule A)
F
CHECK THIS BOX IF


DISCLOSURE BOARD.
v1

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

PO Box 926
CK# Grime11, Ia 50112

PO Boat 926
CK#
CZ#
08/20/04 m# Uniteaized Receipt 1 .00
CK#
CK#
CK#
Cat#
Cat#
CZ#
committee. Relationship must be shown to the third degree of consanguinity Iblood relative) and affinity (relatives by
Page 36 of 44
(for Schedule A)
FX CHECK THIS BOX IF


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.
NUMBER INCOME
CK#
CK#
09/17/04 ID# Unitemdzed Receipt 2 .50
CK#
CK#
07/23/04 ID# Marcia Tarvin 2 .50

5027 Hwy 63
CC# Montem-, is 50171

5027 Hwy 63
CK# Molnteztana, Ia 50171 .

5027 Hwy 63
CC# Monteztmla, Ia 50171

5027 Hwy 63
09/17/04 ID# Marcia Tannin 2 .50

5027 Hwy 63
CC# Monteztmia, Ia 50171

5027 Hwy 63
CC# Monteztmla, Ia 50171
1 I I I I I I
Page 37 of 44
(for Schedule A)
FRI CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME
07/23/04 ID# Karen Van Soelen 2 .50

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

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

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

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

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

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

Page _ 38 - of 44
(for Schedule A)


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ,/IF FOR
NUMBER INCOME
CK#
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

E 14017 Hwy F-62 E '
t 09/03/04 ID# Marlis R . Van Zante 2 .50

14017 Ewy F-62 E
09/17/04 m# Marlis R . Van Zante 2 .50

14017 Hwy F-62 E

14017 Hwy F-62 E
07/23/04 ID# Karla L . Vanderleest 2 .00

15270 N 75th Ave E

15270 N 75th Ave E
Page 39 of 44
(for Schedule A)


DISCLOSURE BOARD .
CAUTION: Section 68B.32A(6) . Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
NUMBER INCOME

15270 N 75th Ave E

15270 N 75th Ave E

15270 N 75th Ave E '

15270 N 75th Ave E
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

238 Horseshoe Dr
C3C# Montezuma, Ia 50171

238 Horseshoe Dr
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 $
committee. Relationship must be shown to the third degree of consanguinity (blood relative) and affinity
(relatives by
Page 40 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -/IF FOR
NUMBER INCOME

238 Horseshoe Dr

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

179 Walnut Road

179 Walnut Road '

179 Walnut Road

179 Walnut Road

179 Walnut Road

179 Walnut Road
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
1 i I I I I I

Page 41 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT %I IF FOR
NUMBER INCOME
08/20/04 ID# Joann L . Wells 5 .00

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

256 Newburg Road
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#
CK#

CK#

CK#

CK#

CK# '
Page 42 of 44
(for Schedule A)

AMENDING FORM

DISCLOSURE BOARD .
NUMBER INCOME
07/23/04 ID# Linda J . Winchell 2 .50

315 2nd Avenue
ID# Linda J . Winchell 2 .50

08/06/04
315 2nd Avenue

315 2nd Avenue

315 2nd Avenue

315 2nd Avenue

315 2nd Avenue
CK#
CK#
CK#
~# I 1 1
Page 43 of 44
(for Schedule A)
0
CHECK THIS BOX IF


DISCLOSURE BOARD.
(MM/DD/YR)
NUMBER INCOME
CK#
CK#
1 I I ~ l i '
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 .

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
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)

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

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
(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
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
Page 2 of 4
(for Schedule B)

(Rev..09/97) EXPENDITURES
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.

(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
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 .)
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
Page 3 of 4
(for Schedule B)

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

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

CHECK THIS BOX IF


DISCLOSURE BOARD.
-DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT %I IF FOR
NUMBER INCOME
CK#

CK#
s
08/20/04 ID# - Uniteaized Receipt 1 .00
CK#
CK#
CK# -
CK#
07/23/04 m# Rodney D . Anderson 5 .00

1654 Fisher Ave

1654 Fisher Ave

1654 Fisher Ave
09/03/04 m# Rodney D . Anderson 5 .00

1654 Fisher Ave
Page 1 of 44
(for Schedule A)

CHECK THIS BOX IF

STATE CANDIDATES NOTE : . IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
" NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT dIF FOR

` rATE - -- PAC ID NUMBER
NUMBER INCOME
09/17/04 ID# RodneyD. Anderson - 5 .00

1654 Fisher Ave
10/01/04 ID# RodneyD . Anderson 5 .00

1654 Fisher Ave
a
07/23/04 ID# - Michelle R. B rnum 2 .50

1515 Reed St
08/06/04 ID# Michelle R. Barntmi 2 .50

1515 Reed St
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
09/17/04 ID# Michelle R . Barntmt 2 .50

1515 Reed St
10/01/04 ID# Michelle R. Barnum 2 .50

1515 Reed St

PO Box 226
08/06/04 ID# Ronald D. Brawn 2 .50

PO Box 226
Cat# New Sharon, Ia 50207
SUB-TOTAL
Page 2 of 44
(for Schedule A)

CHECK THIS BOX IF

AND CAMPAIGN
DISCLOSURE BOARD .
. ._
NUMBER INCOME
08/20/04 ID# Ronald D . Broom 2 .50

PO Boot 226
09/03/04 ID# Ronald D . Broom 2 .50

PO Boot 226
a

PO Box 226

PO Box 226
CK#
CK#
08/20/04 ID# Unitelaized Receipt 1 .00
CK#
CK#
CK#
CK#
Page 3 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
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
NUMBER INCOME

1428 Reed Street
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
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 _

1428 Reed Street

1121 Prince Street
CK# Grinaell, la 50112

1221 Prince Stmt

1221 Prince Street
CK# Grinaell, Ia 50112

1221 Prince Street
TOTAL (if fast page of this schedule)
Page 4 of - 44
(for Schedule A)
CHECK THIS BOX IF

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

DISCLOSURE BOARD.
NUMBER INCOME

1221 Prince Street

1221 Prince Street
07/23/04 ID# Unitetiized Receipt 2 .50
CK#
CK#
08/20/04 ID# Uniteaized.Receipt 2 .50
CK#
CK#
CK#

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 .

Page 5 of 44
(for Schedule A)
FI CHECK THIS BOX IF


STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
DISCLOSURE BOARD .
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-
NUMBER INCOME
08/20/04 ID# Joy M . semings 2 .50

1408 Old 6 Rd .
09/03/04 ID# Joy M . inrna 2 .50

1408 Old 6 Rd .
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 .
Cat#
Cst#
CK#
09/03/04 ID# Unitemized Receipt - 1 .50
CK#
Cat#
x
CK#
Page 6 of 44
(for Schedule A)


DISCLOSURE BOARD.
CAUTION : Section 68B .32A(6) . Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or
NUMBER INCOME

1414 350th Ave

1414 350th Ave
CK# Brooklyn, Ia 52211 z

1414 350th Ave

1414 350th Ave

1414 350th Ave -
CK#
CK#
CK#
CK#
CK#
committee. Relationship must be shown to the third degree of consanguinity Wood relative) and affinity (relatives by
Page 7 of - - 44
(for Schedule A)
CHECK THIS BOX IF

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

DISCLOSURE BOARD.
NUMBER INCOME
CK#

3630 90th St

3630 90th St
Cat# Grinnell, Ia 50112

3630 90th St
09/03/04 ID# Susan M . Edelen 4 .00

3630 90th St -

3630 90th St

3630 90th St
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
08/20/04 ID# Rcmainsa K . Fenner 5 .00

4234 20th street
Cat# Grinnell, Ia 50112
Page 8 of 44
(for Schedule A)
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DISCLOSURE BOARD.
NUMBER INCOME
09/03/04 ID# Romaine K . Fenner 5 .00

4234 20th Street
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
07/23/04 ID# Unitmized Receipt 1 .00

CK#
08/06/04 ID# Unitmlized Receipt 1 .00

CC#

C(#

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

CK#

C(#

1024 21st
SUB-TOTAL 1$ 33 .50
Page 9 of 44
(for Schedule A)
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DISCLOSURE BOARD .
for any commercial purpose by any person other than statutory political committees . ,
NUMBER INCOME

1024 21st

1024 21st
09/03/04 ID# John S . Flannexy 12 .50

1024 21st

1024 21st

1024 21st -

15346 S 84th Ave E
CK# Grim 11, Ia 50112

15346 S 84th Ave E

15346 S 84th Ave E

15346 S 84th Ave E

15346 S 84th Ave E
CK# Grim 11, Ia 50112
marriage) (See Page 2 of forms packetl . If surname of contributor is the same as candidate, but there is no
Page 10 of 44
(for Schedule A)
a
CHECK THIS BOX IF


DISCLOSURE BOARD.
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
NUMBER INCOME

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



CK# Grinnell, la 5a112
Page 11 of 44
(for Schedule A)

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

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
(if applicable) TO CANDIDATE" RECEIVED FUND-
RECEIVED
(MM/DD/YR)
NUMBER INCOME

1116 Reed t 101
CK# Grinnell, Ia
St 12 N1
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

409 Clay St "

409 Clay St

409 Clay St
09/17/04 ID# Jennifer Gunderson - 2 .50

409 Clay St

409 Clay St

121 Adair St
Page 12 of 44
(for Schedule A)
a
CHECK THIS BOX IF

ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
NUMBER INCOME

121 Adair St
CK# Kellogg , Ia 50135

121 Adair St
CK# Kellogg, Ia 50135 s

121 Adair St

121 Adair St

121 Adair St -
CK#
CK#
CK#
CK#
CK#
Page 13 of 44
(for Schedule A)
a
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR . RELATIONSHIP AMOUNT ;IF FOR
NUMBER INCOME
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
08/20/04 m# Ana M . Ran ssen 6 .00

PO Bcac 246
09/03/04 ID# Ann M . Ranssen 6 .00

PO Box 246
09/17/04 ID# Ann M . Manssen 6 .00

PO Bcx 246
10/01/04 ID# Ann M . Hanssen 6 .00

PO Box 246
CK#
08/06/04 ID# Uaitemized Receipt 2 .50
CK#
CK#
Page 14 of 44
(for Schedule A)
a
CHECK THIS BOX IF

AMENDING FORM

DISCLOSURE BOARD.
NUMBER INCOME
09/03/04 m# Unitenized Receipt 2 .50
CK#
CK#
CK#
CK#
CK#
CK#
CK#
09/17/04 m# Unitemized Receipt - 2 .50
CK#
CK#
CK#
SUB-TOTAL IS 23 .50
TOTAL (if last page of this schedule) 1$ -
Page 15 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 11F FOR
NUMBER INCOME

CK#

CK#

CK#

CK#

CK#

CK#

CK#

CK#

CK#
09/17/04 m# Uniteaized Receipt 1.00

CK#
marriage) (See Page 2 of forms packetl . If surname of contributor is the same as candidate, but there is no
Page 16 of 44
(for Schedule A)
a
CHECK THIS BOX IF
AMENDING FORM

PAC IDENTIFICATION
STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE
AND CAMPAIGN
DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT %f IF FOR
NUMBER INCOME
10/01/04 ID# IInitemized Receipt 1 .00
CK#

522 9th Avenue
CK# Grinnell, Ia 50112 a

522 9th Avenue
CK# Grim 11, Ia 50112

522 9th Avenue
09/03/04 ID# Peggyr A . Jantzen 2 .50

522 9th Avenue

522 9th Avenue

522 9th Avenue
07/23/04 ID# Diane J . Keenan , 2 .50

1228 West St
08/06/04 ID# Diane J . Kee^a n 2 .50

1228 West St

1228 West St
CK# Grim 11, Ia 50112
SUB-TOTAL $ 23 .50 1
Page 17 of 44
(for Schedule A)
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DISCLOSURE BOARD.
NUMBER INCOME
1228 West St

1228 West St

1228 West St

255 420th Ave
CK# Grin-ell, Is 50112

255 420th Ave

255 420th Ave
09/03/04 m# Pamela L . Kessler 5 .00

255 420th Ave

255 420th Ave

255 420th Ave
07/23/04 ID# Unitesaized Receipt 1 .00

CK#

Page 18 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME

CK#

CK#

CK#

CK#
10/01/04 ID# Unitettized Receipt 1 .00

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

616 Main St

616 Main St

616 Main St

616 Main St

616 Main St
Page 19 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 1IF FOR
NUMBER INCOME

616 Main St

CK# z
CK#

CK#

CK#

CK#

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

15415 N 75th Ave E '
08/06/04 ID# Sharon L. Krtmm 2 .50

15415 N 75th Ave E
08/20/04 ID# Sharon L. Krumm 2 .50

15415 N 75th Ave E
Page 20 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
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#
CK#
CK#
CK#
CK#
10/01/04 ID# Uaitenized Receipt 1 .00
CK#
07/23/04 ID# Debra E . Lewis 5 .00

1202 Elm Street
Page 21 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME
08/06/04 ID# Debra E . Lewis 5 .00

1202 Elm Street
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
09/17/04 ID# Debra E . Lewis 5 .00

1202 Elm Street
10/01/04 ID# Debra E . Lewis 5 .00

1202 Elm Street _
CK#
CK#
CK#
07/23/04 ID# Susan J . Mc Cain 2 .50

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

SUB-TOTAL I$ 37 .50
Page 22 of 44
(for Schedule A)
CHECK THIS BOX IF


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

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

10/01/04 ID# Susan J . Mc Cain 2 .50

CK#
CK#
CK#
CK#
CK#
CK#
Page 23 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
NUMBER INCOME
07/23/04 ID## Unitemized Receipt 2 .50
CK#
CK#
CK#
CK#
CK#
CK#

CK#
CK#
07/23/04 ID# Rhonda R . Mvyes 5 .00

302 2nd Ave
08/06/04 m# Rhonda R . Moyes 5 .00

302 2nd Ave
Page 24 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
for any commercial purpose by any person other than statutory political committees . .-
NUMBER INCOME

302 2nd Ave
C3C# Grinnell, la 50112

302 2nd Ave

302 2nd Ave

302 2nd Ave
CK#

CK#
CK#

CK#

CK#

CK#

Page 25 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME


CK# Montezuma, Ia 50171 z

CK# Monteztmia, la 50171


CK# Monteztmrla, Ia 50171

CK#
CK#
CK#
CK#
Page 26 of -- 44
(for Schedule A)


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.
NUMBER INCOME
09/17/04 ID# LMiteaized Receipt 1 .00
CK#
CK#
07/23/04 ID# Unitemizexl Receipt 2 .50
(3#
CK#
08/20/04 m# Uhiteaized Receipt 2 .50
CK#
CK#
CK#
10/01/04 ID# Uniteaaized Receipt 2 .50
CK#

902 Hanover Drive
08/06/04 m# ' Michael D . Pawlowski 5 .00

902 Hknover Drive
Page 27 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
NUMBER INCOME
08/20/04 ID# Michael D. Pawlowski 5 .00

902 Hanover Drive

902 Hanover Drive
a

902 Hanover Drive

902 Hanover Drive
07/23/04 ID# Linda M . Pease 5 .00

1108 Steer St
08/06/04 ID# Linda M . Pease 5 .00

1108 Steer St
08/20/04 ID# Linda M. Pease 5 .00

1108 Summer St
09/03/04 ID# Linda M. Pease 5 .00

1108 Summer St
09/17/04 ID# Linda M. Pease 5 .00

1108 Summer St
10/01/04 ID# Linda M. Pease 5 .00

1108 Summer St
SUB-TOTAL 1$ 50 .00
TOTAL (if last page of this schedule) I5
Page 28 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
RECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-
NUMBER INCOME
07/23/04 ID# James R. Phelps 2 .50


a


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


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

603 Van Horne Cir
08/06/04 ID# Jan K. Pope 5 .00

603 Van Horne Cir
08/20/04 ID# Jan K. Pope 5 .00

603 Van Horne Cir
09/03/04 m# Jan K. Pope 5 .00

603 Van Horse Cir
SUB-TOTAL IS 35 .00
TOTAL (if last page of this schedule) 1$_
Page 29 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
__
v'
NUMBER INCOME
09/17/04 ID# Jan K . Pope 5 .00

603 Van Horne Cir
10/01/04 ID# Jan K . Pope 5 .00

603 van Horne Cir
07/23/04 ID# - Unitemized Receipt 1 .00
CK#
CK#
CK#
CK#
CK#
CK#
07/23/04 ID# Unitel ;tized Receipt 1 .00
CK#

CK#
marriage) (See (sage 2 of forms packet) . If surname of contributor is the same as candidate, but there is no
Page 30 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
NUMBER INCOME
CK#
09/03/04 m# Unitenized Receipt 1 .00
CK#
s
CK#
10/01/04 m# Uhitemized Receipt 1 .00
CK#
07/23/04 m# Uaitemized Receipt 1 .00
CK#
C3C#
08/20/04 m# Uhitetilized Receipt 1 .00
CK#
CK#
CSC#
CK#
Page - 3 1 - of - 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
for any commercial purpose by any person other than statutory political committees . . _ -
RECEIVED (if applicablel TO CANDIDATE` RECEIVED FUND-
NUMBER INCOME
07/23/04 ID# Barbara J . Sabultz 2 .50

510 Pearl St

510 Pearl St
CK# Grinnell, Ia 50112 ,

510 Pearl St

510 Pearl St
09/17/04 ID# Barbara J . Scbultz 2 .50

510 Pearl St -

510 Pearl St
07/23/04 ID# Unitemu.zed Receipt 1 .00
CK#
08/06/04 ID# Unitemized Receipt _ 1 .00
CK#
CK#
CK#

Page 32 of 44
(for Schedule A)
CHECK THIS BOX IF


NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLETROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
"-DATE -- PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT I IF FOR
NUMBER INCOME
CK#
CK#
a
CK#
08/06/04 XD# Unitemized Receipt 2 .50
CK#
CK# -
CK#
CK#
CK#
CK#

CK#
Page 33 of 44
(for Schedule A)
CHECK THIS BOX IF

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

DISCLOSURE BOARD.
RECEIVED (if applicable) TO CANDIDATE"' RECEIVED FUND-
NUMBER INCOME

CK#

CK#
a

CK#

CK#

1421 4th Ave

1421 4th Ave
08/20/04 ID# Michele L . Sissam 3 .00

1421 4th Ave
09/03/04 ID# Michele L . Sissm 3 .00

1421 4th Ave
09/17/04 ID# Michele L . Sissom 3 .00

1421 4th Ave
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 $
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
Page 34 of 44
(for Schedule A)
a
CHECK THIS BOX IF

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

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.
DATE y PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
NUMBER INCOME
CK#
CK#
s
CK#
CK#
CK# -
CK#

PO Box 926
CSC# Grinnell, Ia 50112

PO Box 926
CZC# Grinnell, Ia 50112

PO Bcx 926

PO Bcx 926

Page 35 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
'DATE` PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT (IF FOR
NUMBER INCOME

PO Boot 926

PO Box 926
CK# Grianell, Ia 50112
s
CK#
CK#
CSC# -
CK#
CK#
CK#

CK#
CK#
Page 36 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
DATE ~' PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT [IF FOR
NUMBER INCOME
CK#
CK#
s
CK#
CK#

5027 Hwy 63

5027 Hwy 63
CK# Monteztmia, la 50171

5027 Hwy 63
CK# Mcntemmia, Ia 50171

5027 Hwy 63 -
CK# Monteztmia, Ia 50171

5027 Hwy 63

5027 Hwy 63
CK# Montez uma, Ia 50171
Page 37 of -- 44
(for Schedule A)

0 CHECK THIS BOX IF
AMENDING FORM

DISCLOSURE BOARD .
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT -/IF FOR
NUMBER INCOME

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

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

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

CK#

CK#

CK#

CK#

Page 38 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
--DATE -- PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT v' IF FOR
(MM/DD/Y R) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
CK#
CK#
s
07/23/04 ID# _ Marlis R . Van Zante 2 .50
14017 Ewy F-62 E

14017 Ewy F-62 E

14017 Hwy F-62 E

14017 Ewy F-62 E

14017 Hwy F-62 E

14017 Ewy F-62 E

15270 N 75th Ave E
CK# Grin- 11, Ia 50112

15270 N 75th Ave E
Page 39 of 44
(for Schedule A)
1-01 CHECK THIS BOX IF


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.
NUMBER INCOME

15270 N 75th Ave E
09/03/04 M# Karla L . Vanderleest 2 .00

15270 N 75th Ave $
CK# Grinnell, Is 50112 s

15270 N 75th Ave E

15270 N 75th Ave E
07/27/04 ID# Verizon Good GovernlInent Club - Tx 1,250 .00

816 Congress Ave ., Suite 1500 _
CK# Austin, Tx 78701

238 Horseshoe Dr
CK# Montezuutla, la 50171

238 Horseshoe Dr
08/20/04 In# Deborah D . Walker 4 .98

238 Horseshoe Dr

238 Horseshoe Dr
09/17/04 m# Deborah D . Walker 4 .98

238 Horseshoe Dr
SUB-TOTAL

Page 40 of -- 44
(for Schedule A)
CHECK THIS BOX IF

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

DISCLOSURE BOARD.
for any commercial purpose by any person other than statutory political committees . ..,
NUMBER INCOME

238 Horseshoe Dr
C3C# Montezuma, Ia 50171

179 Walnut Road
CK# Grinnell, Ia 50112 s

179 Walnut Road

179 Walnut Road

179 Walnut Road -

179 Walnut Road

179 Walnut Road
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

Page 41 of 44
(for Schedule A)
CHECK THIS BOX IF


NUMBER AND THE PAC CHECK NUMBER IN THHE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLETROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
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
x
10/01/04 ID# " Joann L . Wells 5 .00

256 Newburg Road
CK#
CK#
(3C#
CK#
CK#
CK#

315 2nd Avenue

Page 42 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD.
for any commercial purpose by any person other than statutory political committees . ---
NUMBER INCOME

315 2nd Avenue

315 2nd Avenue
CK# Grinnell, Ia 50112 ,

315 2nd Avenue

315 2nd Avenue

315 2nd Avenue -
CK#
CK#
08/20/04 ID# Unitemized Receipt - 1 .00

CK#

CK#

CK#

Page 43 of 44
(for Schedule A)
CHECK THIS BOX IF


DISCLOSURE BOARD .
for any commercial purpose by any person other than statutory political committees . .,.
NUMBER INCOME

CK#

Page 44 of 44
(for Schedule A)
2
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF

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 $
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
Page 1 of 3
(for Schedule B)

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 01 CHECK THIS BOX IF

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
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
Page 2 of 3
(for Schedule B)

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

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

Page 3 of 3
(for Schedule B)

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FOR INSTRUCTIONS, SEF.

DISCLOSURE SUMMARY PAGE

COMMITTEE NAME (Must be same as on Statement of Org

IMPORTANT: Indicate type of committee you are reporting for:

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE :

STATEMENT OF CASH ON HAND

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

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

.~X CHECK THIS BOX IF

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

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

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

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

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

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

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

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

08/20/04 ID# Anderson 5 .00

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

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

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

MX CHECK THIS BOX IF

VERIZON IOWA STATE GOOD GOVERNMENT CLUB

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

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

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

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

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

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

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

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

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

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

TOTAL (if last page of this schedule)

CHECK THIS BOX IF

VERIZON IOWA STATE GOOD GOVERNMENT CLUB

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

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

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

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

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

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

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

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

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

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

TOTAL (if last page of this schedule)

CONTRIBUTIONS -- MONEY TAKEN IN A MONETARY

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

RX CHECK THIS BOX IF

VERIZON IOWA STATE GOOD GOVERNMENT CLUB

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

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

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

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

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

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

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

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

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

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

TOTAL (if last page of this schedule)