Professional Documents
Culture Documents
File with :
Iowa Ethfcs and Cami
Disclosure Board
Fax: 515-281-3701
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
IndLv,~dun,I,responslble for filing timely and accurate reports.
~ /-,)~ f~ - r,~
GNATURE OF PERSON RUNG REPORT TELEPHONE DATE SIGNED
F1 CHECK I " AMEIIDMENT TO REPORT GATED Local Committees . enter Dote rf Elector
Chock if 0-Is I : final (termination) report and attach Notioe of Dissolution Form DR-3 .
County & Local Committee .°. . crier County in
(-You mu :t continue to file reports until a DR-3 i^ filed .) which Election is held
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . ., ., . . . . .... . . . . ., . . . . . . . . . . . . . . . . ., ., " , " . . . " .,
Schedule B Expenadures total (Attach Schedule 8) ("also sea debts and loans below). . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (d foal report bounce must 1,736,91
no zero) (Attach DR-3) . . . . . . . . . . . " . . . . " . . . . . . . . . . . .. . . . . . . . . . . . " . . . . . . . "" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . .. . . . . .. . . . . . . . .. . . . . . . . . . . .5
"UNPAID BILLS ('ram Schedule D - Attach Scredule D) . . . . . . . . . . . . . . . . . . . . . " . . . " . . . . . . " . . . . . . . . . . . . . .. . . . . .... . . . . . . . . . . . . . .. . . . . . . . . . . . .5
STATE COMMITTEES : Submit a reconciled campaign acrounl rank statement In January of each year .
_,~~_=PI11 " ~ . TN's! 1 c
STATE CANDIDATES NOTE : IF A CO1ITP15U71ON IS RECE VED ROM A STATE PAC (POUTCfkL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATIOrl
rAJMBER ArID THE PAC CHECK NUMBER IN THE DESIGNATEC COLJfsN A LIST OF ID NUPABEI" S IS AVAILABLC FROM THE CV.,,A ETHICS AND CAMP,dGri
DISCLOSURE ?CARD
NOTE : Af..Y 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 698 .32A(6), prohibits the use of Information copied from report^ and statements for soliciting contributions or for any
commercial purpose by any person other than statutory political committees.
DATE PAC IU NUMt3ER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT " IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUrID-
(MMIDDIYR) AND PAC CHECK (if app )cable) RAISER
NUMBER iP1C^,^.1c
I D#
Dean Bacckrnann 5325 .00 ,/
5122.'116 1861 160th Street
CK#
Wavcrly, IA 50677
ID#
Jon Coda: 20 .00
8)22;-06 CK# ! 121 Cedar St
N c i06tiS
iD#
David Eastman 0 .00
8, . . ..,06 CKht 3339 Hwy 9
Riceville, LA 50366 _
I U#
Keith Eaetman
5,22!06 20 .00
CK# j(11 W 3ru St
Rirrvilic- TA '; 0466
ID !
Tom EdSin~ ;on
68 .50
S , 22 .!06 CK9 .;476 Dogwood A% c FT/
St . :knse:+r. LL5002
El
IDJi
Shannon Gornes 20 .00
S;`22/06 CK# 205 Rainbow Dr
Waverl , IA 50677
I DF~
"fom hloogestrnvtt =
"10 .00
SJ22106 CK# 805 Florence
Parkersbure. IA 50665
ID#
Christy Marchand 350.00
3'22/06 CKtt 1815 1-add Avc
_ Britt, U 50-123
ID#
Frank Moors
Ei22`0G 20 .00
CK# 15726 115th Slrcct
Crcsco . IA 5 1-136
ID#
Stcvc NCclcy 20 .00
4)22!06 4451 Echo
CK#
St . AnSear, IA 50472
SUB-TOTAL
S 913.50
- DLncfosuro Inv, roquirns cenci data clJmmlneas l0 dlacloge The relationship of any relative making a contribution To the
c+ommlttre . RcIaGonship must be shown to the lnim degrae of conganqulniry (blood relatives) and affinity (relatives by l
mamage) . If surname of contributor is the same as candidate, but II Is no Pago of _""
familial relationship, enter 'not aopllcable' In the relationship column . (for Schedule A)
(iii 11 -09--101~r 1, THII ) ' 7 1 2 F -
J
CHECK THIS BOX I . i
COMMITTEE NAME (Must bo same as on Statement of Organization) AMENDING FOR,',n
STATE CANDIDATES NOTE : IF A CONTRIPUTION IS RECEIVED FPOM A STATE PAC IPOuTICAL ACTION COMMITTED, LIST THE PAC IDENTIFICATION
NUMBER Avr THE PAC CHECK NUMBER IN THE DESIGNATED CCLUrdN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE ~OvvA ETHICS AND CAMPAIGri
DI ;CLOSUPE BOARD .
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN 5750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD.
CAUTION : Section 63B.32A(6), oronibits the use of information copied from report and statements for sollcltlng contrlbutlons or for any
commercial purpose by any person other than statutory political committees .
DA I E PAC ID NUMBER NAME AND ADDRESS U1= CONTRIBUTOR RELATIONSHIP AMOUNT S IF FOP
RECEIVED (if applicable) TO CANDIDATE* RECEIVED
(MM1DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
Charlev 1'errv :61 .00
8'22.'06 CK# 2712 155th St
Charles CiR, lA "0616
ID#
Lavern Riekenberg 20 .00
512 .2106 CKA 1686 NN'hitculil Avc
Sumner TA 1(1(,7 :. _^ .
I I Dst
John Schwarck 100 .00
CK .1 3317 390th
RiccvilIc, L,% 60466
10 .4
Tina Shin{- 32_50
S ;ZZ:Oo CK# -1317 Panamar Dr
ID#
oug 2-}-}.()0
8i22/0G CK ;t PDO Box 116CrJ
Readlvn, 1A 5066b
t Dlit
U nknown
C
110 .00
8!22106 CK#
i
I
1D
8/22106 I CK#
I
ID#
8!22!06 C K#
I
I D#
I
CK#
3, 22,!06 CK#
SUB-TOTAL
DL^.;IOSUre I,iw requiros candidate commiltonS to disdCse the relalronship of .any rnla :ive marina a contribution to the
committee Reaucnship must be shown to the third degree of con;angulnlty (blood rolaloes) and affinity (reletives by :r
rnarriag))
of II surname of contrlbulor In the same as candld3lo, but there Is no Page - _
familial relationship, enter "not applicable' In the relationship column . (for Schedule A)