Professional Documents
Culture Documents
1 F C E I VEM19IL
(Rev. 12/2005) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization) j
: ED For Office Use Only
Late reports are subject to possible civil and criminal penalties . Pursuant to Iowa Code section 68B .32A(7)
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is the
individual responsible for filing timely and accurate reports .
10/10/06
0 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 DR-3 is filed .) which Election is held
Warren
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) $ $ 1 .24
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 THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 68B .32A(6), 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
07/31/06 ID# Whittier Elementary School PTO
(PTO = Parent Teacher Organization) $500
CK# 1306 W Salem Avenue
Indianola, IA 50125
ID# Emerson Elementary School PTO $500
07/31/06 1109 E Euclid Avenue
CK# Indianola, IA 50125
C K#
08/23/06 ID# Indianola Schools Athletic Boosters $500
1304 East 1 st Avenue
CK# Indianola, IA 50125
* 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 relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page __1 of _2_
familial relationship, enter "not applicable" in the relationship column . (for- Schedule A)
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 THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 68B .32A(6), 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 q IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Brad Jermeland
10/31/06 1112 Ann Parkway $30
CK# Indianola, IA 5015
I D#
C K#
I D#
C K#
I D#
C K#
I D#
C K#
I D#
C K#
I D#
C K#
ID#
C K#
ID#
C K#
I D#
C K#
SUB-TOTAL
$30 .00
TOTAL (if last page of this schedule)
$2730 .00
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 relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page 2_ of _2_
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 07/03) 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 .
2nd
CK#1001 1801 Street #2 $501 .00
Indianola, IA 50125
09/07/06 ID# Parker Sign and Graphics Printing of 2 color 22" X 28" fold $1,409 .80
Indianola, IA 50125
09/13/06 ID# DLH Grafx Screen Printing Printing and Assembly of 2 6'-0 $207 .76
Indianola, IA 50125
11/15/06 ID# Parker Signs and Graphics Lettering and Assembly of 3, 548 .55
Indianola, IA 50125
I D#
CK#
ID#
C K#
I D#
C K#
(for Schedule B)