Generated On: 1/16/2009 5:15:05 PM

DR-2 Disclosure Summary Page DR-2

Chelesvig for Supervisor Status: Amended
Committee Type: County Candidate - Supervisor Statutory Due Date 1/19/2009

County: Wright Adjusted Due Date

District: 1 Filed Date 1/16/2009 4:52:17 PM

Committee Code: 18402 Postmark Date

Political Party: Republican Amendment Date 1/16/2009 4:52:33 PM

Report Date: 2008 Candidate Name: Chelesvig, Carolyn K

Treasurer
Last Name: McClintock First Name: Stephen MI: W
Address: 1577 Tyrrell Lane
City: Belmond State: IA Zip Code: 50421 Phone: 641-444-7124
E-Mail: stephenmcclintock@frontiernet.net

Chairperson
Last Name: Chelesvig First Name: James MI:
Address: 903 4th Ave. N.E.
City: Belmond State: IA Zip Code: 50421 Phone: 641-444-4629
E-Mail: jechelesvig@yahoo.com

Statement of Cash On Hand

Cash on Hand at Start of Period $747.02
Schedule A: Cash Contributions Total $20.00
Schedule F1: Loans Received Total $0.00
Schedule H2: Campaign Property Sales $0.00
Sub-Total $767.02

Schedule B: Expenditure Total $767.02

Schedule F2: Cash Loan Repayments $0.00
Cash on Hand at End of Period $0.00

Additional Assets and Liabilities

Loans in Place at Start of Period $0.00
Schedule D: Unpaid Bills $0.00
Schedule E: In-Kind Contributions $0.00
Schedule F2: Forgiven Loans $0.00
Schedule F2: Outstanding Loans $0.00
Schedule G: Consultant Breakdown No
Schedule H1: Campaign Property Value $0.00

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1
 Generated On: 1/16/2009 5:15:07 PM

Schedule A: Contributions Sch-A

Chelesvig for Supervisor Status: Filed
Committee Type: County Candidate - Supervisor Statutory Due Date 1/19/2009

County: Wright Adjusted Due Date

District: 1 Filed Date 1/16/2009 4:53:08 PM

Committee Code: 18402 Postmark Date

Political Party: Republican Amendment Date

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Raiser

Date Committee ID Candidate Amount
Check # Paca, Dianne
11/7/2008 950 Fairway Circle None $20.00
Garner, IA 50438

Total Regular Contributions $20.00

Total Fundraiser Contributions $0.00
Grand Total All Contributions $20.00

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1
 Generated On: 1/16/2009 5:15:08 PM

Schedule B: Expenditures Sch-B

Chelesvig for Supervisor Status: Filed
Committee Type: County Candidate - Supervisor Statutory Due Date 1/19/2009

County: Wright Adjusted Due Date

District: 1 Filed Date 1/16/2009 4:53:08 PM

Committee Code: 18402 Postmark Date

Political Party: Republican Amendment Date

Expenditure Expenditure Expenditure Name & Address Purpose Expenditure

Date Committee ID Amount
Check # Belmond Independent
11/7/2008 1006 215 E. Main Advertising $232.89
Belmond, IA 50421
Ad
Check # P.S.I.
11/7/2008 1007 524 River Ave. N Advertising $105.60
Belmond, IA 50421
Ad
Check # Wright County Monitor
11/14/2008 1008 P.O.Box 153 Advertising $236.26
Clarion, IA 50525
Ad
9201 Wright County Republican Central
1/15/2009 Check # Committee Political Contribution $192.27
1009 119 Central Ave W
Clarion, IA 50525-0388

Total Amount $767.02

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 1