Oct-26-04 02 :06P Citizens Savings Bank 1 563 562 3027 P .

02

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

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DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Offl e seDnl /
Comm, 0
STEPHEN D . BOUSKA
Logged In
IMPORTANT : Indicate by # type of committee you are reporting for
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned -
(4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other
Computer _
Political Subdivision Candidate ( 8 )Guilt, y PAC,( 9 )City PAC, , ( 10 )SrditS Board or Other Political
Subdivision PAC ( 11 ) Local Ballot Issudj : :' . Audited -
CANDIDATE COMMITTEES ONLY : `
Candidate Name Pol'lical Party (if applicable)
Late reports are subject to
STEPHEN D . BOUSKA ' D MOCRATIC possible civil and criminal
Office Sought Distict (if Senate or House) penalties .

UNTY SUPERVISOR

(563) 737-2723
I N URE OF PERSON FILING REPORT TELEPHONE

e
I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR
(report date) Indicate by #

Local Committees, enter Date of Election

FICHECK IF AMENDMENT TO REPORT DATED
NOV . 2 . 2004
County & Local Committees, enter County in
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . which Election is held
(You must continue to file reports until a DR-3 is filed .)
WINNESHIEK

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the
committee . This amount MUST be the same as the cash on hand at the end
of the last reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0
ADD TOTAL MONEY TAKEN IN THIS PERIOD NO SEPERATE CHECKING ACCOUNT
CANDIDATES PERSONAL FUNDS
Schedule A: Cash Contributions total (Attach Schedule A) ('also see in-kind below) . . 994 .79
Schedule F Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . . S 994 .79
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ("also see debts and loans below) . . .
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... ... . . .. . . . . . . . . .. . . . . . . .. . . . ... . ... . . . . . . - $ 0

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

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

a
"OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $ 0
Oct-26-04 02 :06P Citizens Savings Bank 1 563 562 3027 P-03

Reut:Form SCHEDULE
FOR INSTRUCTIONS, SEE BACK OF FORM
B I MONETARY
EXPENDITURES -- MONEY SPENT, FROM, COMMITTEE ACCOUNT (Rev . 07/03) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE -6R LFGISLATIVE CHECK THIS BOX IF
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 AMENDING FORM
ETHICS ti CAMPAIGN DISCLOSURE BOARD

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

STEPHEN D . BOUSKA
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
ID#
DECORAH NEWS CO .
10/14/04 ADVERTISING
CK# PO BOX 350 $
8093 DECORAH, IA 52101 - 136 .80
ID#
THE OSSIAN BEE
[10/14/04 107 WEST MAIN STREET ADVERTISING
CK#
8094 OSSIAN, IA 52161 64 .00
ID#
CALMAR COURIER
10/15/04 PO BOX 507 ADVERTISING
CK#
8095 CALMAR, IA 52132 i
ID#
SIGN CITY
7/08/04 3249 NORTH WINN ROAD SIGNS
CK#
VISA DECORAH, IA 52101 673 .99
ID#
7/6/04 COPYLAND
224 W . WATER STREET PRINTING
CK#
CASH DECORAH, IA 52101 _ 60 .00
1D#

CK#

ID#

C K#

I D#

C K#

SUB-TOTAL $
994 .79
TOTAL (if last page of this schedule) rs
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 68A.402(3)(i) .)

(for Schedule B)