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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form

VERIFIED STATEMENT
510 EAST 122 SUITE 1A
REGISTRATION
DES MOINES, IA 50319 (Out-of-State Committees)
www.iowa.gov/ethic s (Rev . 03/05)

N"G, 3 I VERIFIED 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 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) .
International 11nion of Painter-, & Allied Trades, Pnlitir "al Artion t'nmmittee
Mailing Address
1750 New York Avenue, NW
City, State, Zip Code Area Code & Telephone No .
Washington, DC 20006 (202) 637-0700

CONTACT PERSON FOR THE COMMITTEE:

Sandra Brooks
Name
1750 Now Y*rk Avenue, NW Washington, DC 20006
Mailing Address City, State, Zip
SBrooks(a-,)iupat.org (202) 637-0772
Email Address (Optional) Area Code & Telephone Number

Purpose of Committee/Contribution : (Please indicate by checking appropriate box)

1:1
OCandidate Ballot Issue PAC Other PAC F1 Party (State or Central Committee)

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 Name

Federal Election Commission International Union of Painters & Allied Trades
Mailing Address Mailing ss
999 E Street, NW 1750 New York Avenue,
Cit State, Zip Code Area Code & Telephone No . Cit , State, Zip Code
Wshington, DC (2021694-1100 Washington. DC 2006

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Mrs . Deborah Groene Jeanette Woods for School Board
Mailing Address Mailing Address
723 36th Street 4320 N.W. 2nd Avenue Des Moines, IA 50313

City, State, Zip Code Area Code & Telephone No . Date If In-Kind Contribution, Describe
Des Moines, IA 50312 (515) 289-0482 08/17/2005
Amount Check # Committee. ID #
$ 500.00 3033
VERIFIED STATEMENT OF COMMITTEE:

I Co e6 (r C A" L 1S ,
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 68A402A6, 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
section 68A .503, unless the Iowa recipient committee is a ballot issue committee. I understand that potential civil and criminal penalties may apply unless a copy
of this foov4as been filed with the Iowa Ethics and Campaign Disclosure Board within 15 days of the date of the contribution .

C--
7R'e7+SUk6-e_ 2 ~-U 5
(Person submitting form) (Title) (Date)
 IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form
VERIFIED STATEMENT
510 EAST 12 th , SUITE 1A REGISTRATION
'I .. DES MOINES, IA 50319 (Out-of-State Committees)
www.lowa.gov/ethics (Rev. 03/05)

VERIFIED 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 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) .
Tnternational TTninn of Painterc & Allied Trades Political Action Committee
Mailing Address
1750 New York Avenue, NW
City, State, Zip Code Area Code & Telephone No.
Washington, DC 20006 (202) 637-0700

CONTACT PERSON FOR THE COMMITTEE :

Sandra Brooks
Name
1750 Ncw York Avenue, NW Washington, DC 20006
Mailing Address City, State, Zip
SBrooks(& iupat.org (202) 637-0772
Email Address (Optional) Area Code & Telephone Number

Purpose of Committee/Contribution : (Please indicate by checking appropriate box)

OCandidate El Ballot Issue PAC ® Other PAC 1:1 Party (State or Central Committee)

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 Name

Federal Flection Commission International Union of Painters & Allied Trades
Mailing Address Wss
999 E Street, NW 1750 New York Avenue,
Cit State, Zip Code Area Code & Telephone No . Cit , State, Zip Code
Wshini ton, DC (202) 694-1100 Washington. DC 2006

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Mrs. Deborah Groene Joe Morr for School Board
Mailing Address Mailing Address
409 S. W. Walnut Street Ankney, IA 50023
723 36th Street
City, State, Zip Code Area Code & Telephone No . Date If In-Kind Contribution, Describe
Des Moines, IA 50312 (515) 289-0482 08/17/2005
Amount Check # Committee . ID #
$ 500.00 3034

VERIFIED STATEMENT OF COMMITTEE :

I E)E c k6,E C-7 x}--Li-S , 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 68A402A6, 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.503, unless the Iowa recipient committee is a ballot issue committee. I understand that potential civil and criminal penalties may apply unless a copy
of this form has been filed with the Iowa Ethics and Campaign Disclosure Board within 15 days of the date of the contribution .

2EA-Su 122 g, - 2~- D5

(Person swbmitting form) (Title) (Date)