FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

(Rev . 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
Dov ~ G'tiaZ3 Gg Wi2NO2 F9& Comm . #
IMPORTANT : Indicate by # type of committee you are reporting for : I Logged In ~% -~ "- -
( 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
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if applicable)
Late reports are subject to
vav%L-wS 1,fryf3 L-% < Wni possible civil and criminal
Office Sought FJiSQrict (if Senate or House) penalties.

GnvtiR.Na2 N 1 04

SI S z~y~Z-~ f-
SIGNATURE OF PERSON FILING REPORT TELEPHOf4E DATE SIGNED

I AM FILING A T11" V 6 ~'`1 )I. Z° V S REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate by #

Local Committees, enter Date of Election

OCHECK IF AMENDMENT TO REPORT DATED

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 .)

STATEMENT OF CASH ON HAND

HAND at the beginning of the reporting period . (Total of all funds held by the
1-CASH ONcommittee . 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 .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . . .
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . .. . . $ 4"13 .38

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
`IO 853 .
be zero) (Attach DR-3) . . . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$

**UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

2.~u
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
*"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . . . . . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
0 CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

ID gv6 ~Mff i-- a ,a-- G9vk kNOiti

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM ASTATE 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.

CAUTION : Section 68B .32A(6), Iowa Code, 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 .

PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR

DATE
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#

EJ
ID#

CK#

E:1
ID#

CK#

E:I_
ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL
$ l.N~,Sy
TOTAL (if last page of this schedule)

making a contribution to the

Disclosure law requires candidate committees to disclose the relationship of any relative
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
Page ( Of
marriage) . If surname of contributor is the same as candidate, but there is no A)
(for Schedule
familial relationship, enter "not applicable" in the relationship column .
Committee Name : Doug Gross for Governor
ID : 5107
Schedule A: Contributions - Money Taken In

Date PAC Ck Rel . to Page

Rec'd # # Name and Address of Contributor Cand . Amount Total

1/31/2004 Interest Income, First American Bank 84 .03

1207 Central Avenue
Fort Dodge IA 50501

2/29/2004 Interest Income, First American Bank 75 .86

1207 Central Avenue
Fort Dodge IA 50501

3/31/2004 Interest Income, First American Bank 88 .55

1207 Central Avenue
Fort Dodge IA 50501

4130/2004 Interest Income, First American Bank 80 .32

1207 Central Avenue
Fort Dodge IA 50501

5/31/2004 Interest Income, First American Bank 66 .61

1207 Central Avenue
Fort Dodge IA 50501

6/30/2004 Interest Income, First American Bank 36 .54

1207 Central Avenue
Fort Dodge IA 50501

7/31/2004 Interest Income, First American Bank 30 .82

1207 Central Avenue
Fort Dodge IA 50501

8/31/2004 Interest Income, First American Bank 34.47

1207 Central Avenue
Fort Dodge IA 50501

9/30/2004 Interest Income, First American Bank 33 .34

1207 Central Avenue
Fort Dodge IA 50501

10/31/2004 Interest Income, First American Bank 23 .29

1207 Central Avenue
Fort Dodge IA 50501

11/17/2004 Interest Income, First American Bank 32 .55 586 .38

1207 Central Avenue
Fort Dodge IA 50501

Page 1 of 2
Committee Name : Doug Gross for Governor
ID: 5107
Schedule A: Contributions - Money Taken In

Date PAC Ck Rel . to Page

Rec'd # # Name and Address of Contributor Cand . Amount Total

11/30/2004 Interest Income, First American Bank 16 .01

1207 Central Avenue
Fort Dodge IA 50501

12/31/2004 Interest Income, First American Bank 39.15 55 .16

1207 Central Avenue
Fort Dodge IA 50501

641 .54
 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.

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

D dv ~ G ~A sJ Fb2 G ov1tLwa112.-
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
I D#

CK#
LI 'T 617 A c N4 4 $ LAB 2~1 .y 9
ID#

CK#

I D#

CK#

ID#

CK#

I D#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $ Z~ _ y 1
TOTAL (if last page of this schedule) $ 2`9.
y~ y9

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)(1).)

(for Schedule B)
Committee Name: Doug Gross for Governor
ID: 5107
Schedule B: Expenditures--Money Spent From Committee Account

Date Ck Amount Page

Expended # Name and Address - Purpose - Expended Totals

1/12/2004 First American Bank Bank service fee . 13 .25

12333 University Avenue
Clive, IA 50325

1/14/2004 1541 Sigler Printing & Publishing Printing . 1,465 .76

PO Box 887
Ames, IA 50010-0887

2/10/2004 1542 U .S. Postal Service P .O. Box rent. 68 .00

Ash Creek Station
Des Moines, IA 50322-3855

2/10/2004 First American Bank Bank service fee . 71 .24

12333 University Avenue
Clive, IA 50325

3/5/2004 1543 First American Bank Federal Income Tax 371 .00
12333 University Avenue
Clive, IA 50325

3/5/2004 1545 First American Bank Iowa Income Tax 70 .00

12333 University Avenue
Clive, IA 50325

3/31/2004 First American Bank Bank service fee . 16.99

12333 University Avenue
Clive, IA 50325

4/30/2004 First American Bank Bank service fee . 16.79

12333 University Avenue
Clive, IA 50325

5/11/2004 1546 Committee of '82 Contribution to non- 15,000 .00

666 Grand Ave ., Ste . 2000 profit entity for its
Des Moines, IA 50309 research purposes .

5/31/2004 First American Bank Bank service fee . 15.84

12333 University Avenue
Clive, IA 50325

6/1/2004 1547 Arthur J. Finkelstein & Associates, Inc . Polling services . 30,000.00 47,108.87
16 North Astor
Irvington, NY 10533
Committee Name: Doug Gross for Governor
ID: 5107
Schedule B: Expenditures--Money Spent From Committee Account

Date Ck Amount Page

Expended # Name and Address Purpose Expended Totals

6/30/2004 First American Bank Bank service fee . 16.37

12333 University Avenue
Clive, IA 50325

7/31/2004 First American Bank Bank service fee . 15.59

12333 University Avenue
Clive, IA 50325

8/31/2004 First American Bank Bank service fee . 15 .72

12333 University Avenue
Clive, IA 50325

9/30/2004 First American Bank Bank service fee . 15.69

12333 University Avenue
Clive, IA 50325

10/19/2004 1549 Senate Legislative Majority Fund Political contribution. 1,000.00

621 East 9th Street
Des Moines, IA 50309

First American Bank Bank service fee . 15 .60

10/31/2004
12333 University Avenue
Clive, IA 50325

First American Bank Bank service fee . 16.21

11/30/2004
12333 University Avenue
Clive, IA 50325

Bank service fee . 15.44 1,110 .62

12/31/2004 First American Bank
12333 University Avenue
Clive, IA 50325

48,219.49
FOR INSTRUCTIONS, SEEBACK OF FORM
SCHEDULE

THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY H

(Rev. 07/03)
I CAMPAIGN
PROPERTY

COMMITTEE NAME (Must be same as on Statement of Organization) ATTACH SCHEDULE H TO

EACH REPORT, MAKING
CHANGES AS REQUIRED.
D ,% \4 6 1t q Ss >F oW-- GvvCtiN4IZ
El CHECK THIS BOX IF
AMENDING FORM
PART I - ONGOING INVENTORY OF CAMPAIGN PROPERTY PART II - SALES OR TRANSFERS OF CAMPAIGN PROPERTY **

Date Purchased
(Schedule B) Purchase Current
or Date Received Description of Property Price or Est. Value at Fair Date Name and Address of Purchaser/Donee Description of Property Sold? Sale Value of
(Schedule E) Value When Market This (MM/DDIYR) Y/N Price Donation
MM/DD/YR Acquired* Report

2 lz,l A cannfIr1 14- 2,, -I -L s'q'q NoN~

'l 1 ~e V 'L ~-a ^-f v j*4- 3 da

TOTAL VALUE CAMPAIGN PROPERTY THIS REPORT ** PROPERTY SALES & TRANSFERS TOTAL TOTALS
(TRANSFER TO SUMMARY PAGE) $ (TRANSFER TO SUMMARY PAGE) $-

* If estimated, show est. beside figure. (Attach Additional Schedules if Needed) Page I of 1 Pages
(For Schedule H)