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(Title) (Date)
 THICS AND CAMPAIGN DISCLOSURE BOARD
510 EAST 12th, SUITE 1A VERIFIED STATEMENT
REGISTRATION
DES MOINES, IA 50319
(Out-of-State Committees)
www.iowa.gov/ethic s (Rev . 07/03)
IED STATEMENT REGISTRATION For office use only
(Out-of-State Committee) Comm . #
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND Audited
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM . '
THIS FORM MUST BE FILED FOR EACH CONTRIBUTION IN EXC ESS OF $50 Computer

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym) .
D .R .I .V .E .-Democrat, Republican, Independent Voter Education
Mailing Address
25 Louisiana Ave, NW

Washington, DC r"1 O ate, Zip Code ~~ Code

624-64}ephone
No .

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)
Name of Jurisdiction
Federal Election Commission International Brotherhood of Teamsters
Mailing Address
999 E . Street, NW 25 Louisiana Ave, NW Mailing Address
f t&Q be20463 Telephone ity~ , State, Zip Code
Washington, DC 20001

PURPOSE OF COMMITTEE

Dispensing Campaign Contributions

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Steve Mandernach Committee to Elect Jeanette Woods
Mailing Address Mailing Address
5661 Fleur Dr. 3843 8th Place ; Des Moines, IA 50313
City, State, Zip Code Telephone Date If In-Kind Contribution, Describe
Des Moines, IA 50321 11/14/05
Amount Check # Committee . ID #
$ 250 .00 002146 11169

VERIFIED STATEMENT OF COMMITTEE :

I C . Thomas Keegel , attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of my knowledge. I also attest that the reports filed in the named jurisdiction comply
with requirements that are
substantially similar to Iowa Code section 68A.6, including the disclosure of all contributions received and all expenditures made. I further attest that
the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under
Iowa Code
section 68A.15, u ss the Iowa recipient committee is a ballot issue committee. 1 understand that potential civil and criminal penalties may apply
unless a copy of
thi~ Las b r fled with the Iowa Epicsand Caraqaign Disclosure Board within 15 days of the date of the contribution .

-- Treasurer 11/15/05
(Title) (Date)
 ~' `(CSI 0'~U 000+

THICS AND CAMPAIGN DISCLOSURE BOARD Form

VERIFIED STATEMENT
510 EAST 12th, SUITE 1A REGISTRATION
DES MOINES, IA 50319 (Out-of-State Committees)
www .iowa .gov/ethics (Rev . 07/03)

D STATEMENT REGISTRATION For office use oniv

(Out-of-State Committee) Comm . #
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
Audited
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM .
THIS FORM MUST BE F ILED FOR EACH CONTRIBUTION IN EXCESS OF $50 Computer

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym) .
uDR.LV .E .-Democrat, Republica n, Independent Voter Education
Mailing Address
25 Louisiana Ave, NW ; Washington, DC 20001
City, State, Zip Code ,1
81 Code 624-69T&Sephone No .

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

Name
Federal Election Commission International Brotherhood of Teamsters --------------
999 E St ., NW
Mailing Address 25 Louisiana Ave, NW Mailing Address
---- --------------- -----
Tele 200C1ity, State, Zip Code
W$W"p bls!e20001 Re 694-1100
)__-_______ Washington, DC ----- -------- ----- --

PURPOSE OF COMMITTEE

Dispensing Campaign Contributions

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Namc ` Io,:JF Resident Name of Committee
Steve Mandemach Vote No Merger Committee
__-___-__-__--_-Mailing ------------- -------------------------------
Address Mailing Address
5661 Fleur Drive 2913 Southern Hills Circle ; Des Moines, IA 50321

City, State, Zip Code Telephone Date If In-Kind Contribution, Describe

Des Moines, IA 50322 515 244-7292 10/26/04 -----------
------- ----- -----)-------_____
Amount Check # TCommittee. ID #
$ 1000 .00 000972

VERIFIED STATEMENT OF COMMITTEE :

I C- Thomas__Kee X21 -___-____-, attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of my knowledge. 1 also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 68A.6, including the disclosure of all contributions received and all expenditures made . 1 further attest that the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under Iowa Code
sec6 68A.15, u ss the Iowa recipient committee is a ballot issue committee. 1 understand that potential civil and criminal penalties may apply unless a copy of
thiy q m has b led with the Iowa E*csjnd CanAgn Disclosure Board within 15 days of the date of the contribution .
10/28/_0_4
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Date)