pclk cccnty democratic central committee · 19/05/2004 · 515-255-7696 april 23, 2005...
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FORINSTRUCTIONS, SEE BACK OF FORM
DISCLOSURE SUMMARY PAGE
20F
COMMITTEE NAME (Must be same as on Statement of Organization)
,PCLK CCCNTY DEMOCRATIC CENTRAL COMMITTEE
IMPORTANT: Indicate type of committee you are reporting for:
( 1 )Statewide/Legislative Candidate (2 )Statewide PAC ( 3 )State Party (4 )County/Local Candidate( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee( 8 )Support Slate of Candidates
515-255 -7696
April 23, 2005SIGNATURE OF TREASURER (or person filing this report)
TELEPHONE
DATE SIGNED
Penalties Due For Late Filed Reports Range from $10 to $400
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:
[NCHECK IF AMENDMENT TO REPORT DATED May
19,
2Q C /I
p Check if this is final (termination) report and attach Notice of Dissolution Form DR-3.(You must continue to file reports until a Notice of Dissolution is filed.)
STATEMENT OF CASH ON HAND
FORM
DR-2
I DISCLOSURE(Rev . 09/97)
REPORT
For Office Use Only
Comm . #
915Indexed
AuditedComputer
I AM FILING A
REPORT FORAN/A (1) ELECTION /(2)NON-ELECTION YEAR .(report date)
Indicate one
Local Committees, enter Date of Election
County & Local Committees, enter County inwhich Election is hell
CASH ON HAND at the beginning of the reporting period . (This is the totalof all monies held by the committee. This amount MUST be the
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL .. . . . $
46661!A9
-~'SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1q!1. . . . . . . . . . . . . . . . . . . .Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .g1 . .~
23915-10249 1 .36
_R 3 .
~>
CASH ON HAND at the end of this reporting period (if final report, balance mustbe zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20255-03
UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
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?) YES NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
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
9137-15
Schedule A: Cash Contributions total (Attach Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44254-34Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 0C . 0 0Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person otherthan statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
545.00
Page
1
of
4 0(for Schedule A)
SCHEDULEMONETARYRECEIPTS
(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE- RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME
ID# Frederic S . LaCroix01/05/04 1128 45th St. $ 20.00
CK# 1144 Des Moines, IA 50311
ID# Marilyn Murphy01/05/04 1925 S.E . 82nd St . $ 150.00
CK# 8804 Runnells, IA 50237
ID# Ronald W. Nielsen01/05/04 6004 Terrace Dr. $ 25.00
CK# 6961 Johnston, IA 50131
ID# Lynn O'Hern01/05/04 6085 Greywood Circle $ 20.00
CK# 8087 Johnston, IA 50131
ID# Diane Krell01/05/04 1620 S . 43rd St . $ 100.00
CK# 1114 West Des Moines, IA 50265
ID# Lorraine M . Hackett01105/04 816 45th St. $ 20.00
CK# 2253 West Des Moines, IA 50265
ID# Gerald O . Ott01105/04 2854 Druid Hill $ 40.00
CK# 4124 Des Moines, IA 50315
ID# Robert R . Waddill01/05/04 924 45th St . $ 50.00
CK# 2961 West Des Moines, IA 50265
ID# Robert E . Jester01/05/04 4201 Timberwood Dr . $ 100.00
CK# 10080 West Des Moines, IA 50265
ID# Daniel C . Aten01/05/04 5904 Dakota Drive $ 20.00
CK# 3864 West Des Moines, IA 50266
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
5,450.00
Page
2
of
4 0',(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Walter D . Felker
01/05/04 2701 N .E . Delaware Ave . $ 150.00CK# 5324 Ankeny,IA 50021
ID# Timothy J . Brien01/09/04 3919 Urbandale Avenue $ 100.00
CK# 10824 Des Moines, IA 50310
ID# Rebecca McCreary01/09/04 5513 Kensington Circle $ 50.00
CK# 5817 Johnston, IA 50131
ID# Laura R . Belin01/14104 1705 Plaza Circle $ 25.00
CK# 1422 Windsor Heights, IA 50322
ID# Charles R . Montgomery01/14/04 940 45th Street $ 20.00
CK# 10271 Des Moines, IA 50312
ID# James E . Wilson01/14/04 2813 Scenic Place $ 40.00
CK# 8199 West Des Moines, IA 50265
ID# A.D . Bachman01/14/04 1012 28th Street $ 20.00
CK# 5572 West Des Moines, IA 50266
ID# Taramattie Ganpat-Puffet01/14/04 5116 69th Street $ 20.00
CK# 4231 Urbandale,IA 50322
ID# Lori Burgess01/16/04 5134 68th Street $ 25.00
CK# 2081 Urbandale, IA 50322
ID# Jeffrey Krinsk01/16/04 567 Gage Lane $ 5,000.00
CK# 945 San Diego, CA 92106
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
525.00'
Page
3
of
40(for Schedule A)
SCHEDULE MONETARYRECEIPTS
(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Howard Hoy
01/19/04 2624 Boyd St. $ 250.00CK# 3978 Des Moines, IA 50317
ID# Sara Bisterfeldt01/19/04 1821 75th St. $ 50.00
CK# 10824 Windsor Heights, IA 50322
ID# Jane E . Brown01/19/04 11646 121st St . $ 50.00
CK# 9352 Granger, IA 50109
ID# Maxine Grove01/19/04 608 N . James St . $ 25.00
CK# 9009 Granger, IA 50111
ID# Linda Newsom01/19/04 2637 S .E . 88th St. $ 25.00
CK# 3287 Runnells, IA 50237
ID# Steve Burch01/19/04 601 Grand Oaks Dr. $ 25.00
CK# 3263 West Des Moines, IA 50265
ID# Luann Johnson01/19/04 2818 36th St. $ 25.00
CK# 8694 Des Moines, IA 50310
ID# Korpella Engineering01/19/04 1239 73rd St. $ 25.00
CK# 2584 Windsor Heights, IA 50311
ID# Lisa Sandos01/19/04 3702 132nd Circle $ 25.00
CK# 1192 Urbandale, IA 50322
ID# Brian Millard01/19/04 3920 Lynner Drive $ 25.00
CK# 3289 Des Moines, IA 50310
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
250.00
Page
4
of
49(for Schedule A)
SCHEDULEA MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Sheila Pottebaum
01/19/04 651 44th St . $ 25.00CK# 5316 Des Moines, IA 50312
ID# Robert Mannheimer01/19/04 3363 Grand Ave . $ 25.00
CK# 3353 Des Moines, IA 50312
ID# Sherri Saul01/19/04 4310 Pleasant St . $ 25.00
CK# 12141 Des Moines, IA 50312
ID# Colleen Jennings01/19/04 120849th St . $ 25.00
CK# 1117 West Des Moines, IA 50266
ID# Betty Brim-Hunter01/19/04 452 Wilmers Ave . $ 25.00
CK# 8468 Des Moines, IA 50315
ID# Denise Tutty01/19/04 903 45th $ 25.00
CK# 1328 Des Moines, IA 50312
ID# Harold Belken01/19/04 416 SE Gray $ 25.00
CK# 1982 Des Moines, IA 50315
ID# Nancy Keunen01/19/04 416 SE Gray $ 25.00
CK# 5259 Des Moines, IA 50315
ID# Jo Ellen McGrane01/19/04 3130 Beaver Ave . $ 25.00
CK# 1050 Des Moines, IA 50310
ID# Alan Hutchison01/19/04 4328 New York Ave . $ 25.00
CK# 7494 Des Moines, IA 50310
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
215.00'
Page
5
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# George Wells
01/19/04 3935 14th St . $ 25.00CK# 10172 Des Moines, IA 50313
ID# Ilo Stark01/19/04 1203 W. Euclid Ave . $ 25.00
CK# 1876 Des Moines, IA 50313
ID# Renee Friend01/19/04 1264 NE 64th St . $ 25.00
CK# 1359 Altoona, IA 50009
ID# Marcia Nichols01/19/04 5917 Greendale Place $ 20.00
CK# 6444 Johnston, IA 50131
ID# Robert Galde01/19/04 1750 SE McKinley Ave . $ 20.00
CK# 2150 Des Moines, IA 50320
ID# Vivian Givant01/19/04 4820 Elm St. $ 20.00
CK# 7305 West Des Moines, IA 50265
ID# Beverly Long01/19/04 4025 11th St . $ 20.00
CK# 13438 Des Moines, IA 50313
ID# Carl Pierce01/19/04 7205 Jefferson Ave. $ 20.00
CK# 2600 Urbandale,IA 50322
ID# Shirleen Erickson01/19/04 733 NE 9th St. $ 20.00
CK# 8064 Ankeny,IA 50021
ID# Suzanne Meyers01/19/04 4205 Walnut St . $ 20.00
CK# 2955 West Des Moines, IA 50265
-
For, Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
165.00 I /
Page
6
of
4 9(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Kathryn Vasey
01/19/04 218 SW Herold $ 20.00CK# 5612 Des Moines, IA 50315
ID# Barbara Mentzer01/19/04 111 Kenyon $ 20.00
CK# 5315 Des Moines, IA 50315
ID# Bonnie King01/19/04 2916 E . Tiftin Ave . $ 20.00
CK# 7036 Des Moines, IA 50317
ID# Ellen Laws01/19/04 2415 E . 14th St. $ 20.00
CK# 262 Des Moines, IA 50316
ID# Elma Marquadt01/19/04 409 SE 9th ST . $ 20.00
CK# 1477 Ankeny,IA 50021
ID# Frances Dailey01/19/04 4129 Beavercrest $ 20.00
CK# 2536 Des Moines, IA 50310
ID# Lorraine Appell01/19/04 442 E . Hart Ave . $ 15.00
CK# 1692 Des Moines, IA 50315
ID# David Schilling01/19/04 5135 SE 104th $ 10.00
CK# 4223 Runnells, IA 50237
ID# Ruth Davis01/19/04 711 Loomis $ 10.00
CK# 1385 Des Moines, IA 50315
ID# Sharla Yeutsy01/19/04 4313 75th St . $ 10.00
'DICK# 4779 Urbandale, IA 50322
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationship''column .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
100.001
Page 7 of 49(for Schedule A)
SCHEDULEA MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Bonnie Yazel
01/19/04 3950 52nd St . $ 10.00CK# 11406 Des Moines, IA 50310
ID# Krista Kulas01/19/04 5808 Crabapple Lane $ 10.00
CK# 1344 Johnston, IA 50131
ID# Craig Torkelson01/19/04 411 46th Place $ 10.00
CK# 3897 West Des Moines, IA 50265
ID# Polly Antonelli01/19/04 1807 6th St . $ 10.00
CK# 4529 Altoona, IA 50009
ID# Lesvia Lucas01/19/04 1124 Locust St . $ 10.00
CK# 5680 West Des Moines, IA 50265
ID# Teresa Jones01/19/04 733 26th St. $ 10.00
CK# 1764 Des Moines, IA 50312
ID# Melissa Keeton01/19/04 1001 Frederick Ave. $ 10 .00
CK# 2606 Des Moines, IA 50315
ID# Barbara Post-Althaus01/19/04 1510 Thompson Ave . $ 10 .00
CK# 7896 Des Moines, IA 50316
ID# Karen Person01/19/04 203 5th St. $ 10.00
CK# 1274 Waverly, IA 50677
ID# David Beck01/19/04 1937 NW 89th St . $ 10.00
CK# 3601 Clive, IA 50325
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
50.00
Page
8
of
4 9(for Schedule A)
SCHEDULE MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Alecia Fry01/19/04 1644 Hull $ 5.00
CK# 1827 Des Moines, IA 50313
ID# J . Drue Cavanaugh01/19/04 11281 NW Towner $ 5.00
CK# 7157 Grimes, IA 50111
ID# Christina Gonzalez01/19/04 2420 Maple St. $ 5 .00
CK# 5347 Des Moines, IA 50317
ID# Eileen Kiess01/19/04 1056 56th St. $ 5 .00
CK# 5597 Des Moines, IA 50311
ID# Janet Maldonado01/19/04 1110 Orchard Lane $ 5.00
CK# 3080 Des Moines, IA 50313
ID# Mirsada Juhl01/19/04 2710 25th St . $ 5.00
CK# 1018 Des Moines, IA 50310
ID# Rita Mason01/19/04 2744 Arnold Rd . $ 5.00
CK# 5503 Des Moines, IA 50310
ID# Fuad Bejtovic01/19/04 2424 Payne Rd . $ 5.00
CK# 3899 Des Moines, IA 50310
ID# Barbara Braak01/19/04 3829 82nd St . $ 5 .00
CK# 9289 Urbandale,IA 50322
ID# Martha Raymond01/19/04 2571 Guthrie $ 5.00
1:]-CK# 4308 Des Moines, IA 50317
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
298.001,.-
Page
9
of
4 9(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Linda Russell
01/19/04 3821 13th St. $ 5.00CK# 1236 Des Moines, IA 50313
ID# Edith Munro01/19104 2015 68th St . $ 25.00
CK# 2457 Windsor Heights, IA 50322
ID# Todd Russell01/19/04 6805 Timmons Dr . $ 20.00
CK# 2742 Des Moines, IA 50322
ID# Carl McPherson01/19/04 1537 21 st St . $ 10 .00
CK# 6168 Des Moines, IA 50311
ID# Jodi Bogue01/19/04 1700 38th St. $ 10.00
CK# 5937 Des Moines, IA 50310
ID# Evelyn Christianson01/19/04 116 5th Ave . NW $ 3.00
CK# 32113 Altoona, IA 50009
ID# Carole Kavanaugh01/19/04 3000 Sylvania $ 100.00
CK# 3798 West Des Moines, IA 50265
ID# Marybeth Gardem01/19/04 1629 NW 102nd $ 50.00
CK# 3235 Clive, IA 50325
ID# Randy Hansen01/19/04 3400 Valdez Dr . $ 50 .00
CK# 2303 Des Moines, IA 50310
ID# John Casper01/19/04 223 E . Court Ave. $ 25.00
CK# 5235 Winterset, IA 50273
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
* Disclosure law requires candidate committees to disclose the relationship of -any relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationship
Page
1 0
of
4 4column .
(for Schedule A)
TOTAL (if last page of this schedule)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Devonne Douglas01/19/04 5357 NW 66th Ave . $ 25.00
CK# 6447 Johnston, IA 50131
ID# Monica Moore01/19/04 6151 Country Ridge Lane $ 20.00
CK# 1574 Johnston, IA 50131
ID# Patricia Wengert01/19/04 4213 41st St. $ 10 .00
CK# 6285 Des Moines, IA 50310
ID# Lora Rogerson01/19/04 3610 SW 36th $ 10.00
CK# 1156 Des Moines . IA 50321
ID# August Luthens01/19/04 8 W. Howard St. $ 10.00
CK# 2326 Colfax, IA 50054
ID# Grace L. Connell01/19/04 701 Morton Ave . $ 5 .00
CK# 3980 Des Moines, IA 50316
ID# Michael Trier01/19/04 7640 NW 16th $ 100.00
CK# 4520 Ankeny,IA 50021
ID# Cash contributions received at caucus "bucket pass"01/19/04 $ 16,706 .18
CK# CASH
ID# David Perret02/03/04 5321 Shriver Ave . $ 100.00
CK# 1070 Des Moines, IA 50312
ID# David Van Sickel H02/03/04 509 57th Court $ 20.00CK# 8290 West Des Moines, IA 50266
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
' $
450.00
Page 11 of 49(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Marlene Alberigo
02/15/04 524 Sixth $ 250.00CK# 172 West Des Moines, IA 50265
ID# Sally Troxell03/12/04 701 54th St. $ 25.00
CK# 1714 Des Moines, IA 50312
ID# Jerry Overman03/12/04 2118 Morton Ave . $ 25.00
CK# 1024 Des Moines, IA 50317
ID# He Lives Ministry NSL03/13/04 1309 University Ave . $ 20.00
CK# 1159 Des Moines, IA 50314
ID# Lark W . Roberts03/13/04 4904 W. Park Dr . $ 20.00
CK# 13295 West Des Moines, IA 50266
ID# Richard Bame03/13104 5821 Brentwood Circle $ 20.00
CK# 9512 Johnston, IA 50131
ID# Denise Mernka03/13/04 4328 New York Ave . $ 20.00
CK# 7547 Des Moines, IA 50310
ID# R . Saffin Sams03/13/04 812 57th St . $ 25.00
CK# 3266 West Des Moines, IA 50266
ID# Susan A. Pohl03/13/04 8689 Sunny Hill Dr . $ 25.00
CK# 5643 Des Moines, IA 50325
ID# Judie Horka03/13/04 704 62nd St . $ 20.00
CK# 7497 Des Moines, IA 50312
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
240.00'
Page
1 2
of
4 9'(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Victoria Purcell
03/13/04 2019 68th StreetCK# 2215 Windsor Heights, IA 50322 20
ID# Alyssa Mowitz03/13/04 716 - 17th St .
CK# 654 Des Moines, Iowa 50314 20
ID# Dale A . Berry03/13/04 7039 Oak Brook Drive
CK# 8818 Urbandale, Iowa 50322 40
ID# Joyce A. Shackelford03/13/04 2011 E . 29th St.
CK# 6522 Des Moines, Iowa 50317 40
ID# Lawrence P . Staunton03/13/04 5512 Dakota Dr .
CK# 6122 West Des Moines, Iowa 50266 20
ID# Paul E . Knupp, Jr.03/13/04 1804 - 44th Street
CK# 3546 Des Moines, Iowa 50310 20
ID# Frank Affannato03/13/04 1128 22nd St .
CK# 2813 Des Moines, Iowa 50311-4412 20
ID# Mary P . Maloney03/13/04 3415 Witmer Pky.
CK# 10054 Des Moines, Iowa 50310-4434 20
ID# Emily Westergaard03/13/04 4009 E . 23rd St .
CK# 650 Des Moines, Iowa 50317 20
ID# John E . Kaiser03/13/04 5800 SE 2nd St.
CK# 5452 Des Moines, Iowa 50315 20
-
For' Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn.
TOTAL (if last page of this schedule)
Page
1 3
of- 49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Marcia L . McFall03/13104 4333 Park Ridge Ave. #37
CK# 5783 Pleasant Hill, Iowa 50327 20
ID# Gary Thompson03/13/04 7209 SW 17th St.
CK# 3518 Des Moines, Iowa 50315 20
ID# Sara Goul03/13/04 3220 Brinkwood
CK# 1376 Des Moines, Iowa 50310 20
ID# Cathy M . Bienkowski03/13/04 9373 Lincoln Avenue
CK# 4407 Clive, Iowa 50325-6325 20
ID# Kyle J . Carlson03/13/04 7419 Canterbury Rd .
CK# 1533 Urbandale, Iowa 50322-4616 20
ID# Phyllis Blood03113104 3848 Beaver
CK# 13480 Des Moines, Iowa 50310 20
ID# William A . Genzen03/13104 2335 E . 39th Street
CK# 5106 Des Moines, Iowa 50317 20
ID# Deborah A . Baker03/13/04 1009 Grant Street S .
CK# 8880 Bondurant, Iowa 50035-2026 20
ID# Bonnie J . Davies03/13/04 1141 N.W . Prairie Ridge Dr.
CK# 5547 Ankeny, Iowa 50021 20
ID# Amy Fokuo03/13/04 2200 Prospect Avenue
CK# 3126 West Des Moines, Iowa 50265 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
200.00'
Page
14
of
4 9(for Schedule A)
SCHEDULEA MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DDNY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Sally B . Bowzer
03/13/04 3209 86th Street, Apt . 215CK# 1100 Urbandale, Iowa 50322 20
ID# Leland Searles03/13/04 603 Little Beaver Drive S .
CK# 1245 Grimes, Iowa 50111 20
ID# Elisabeth M . Lewin03/13/04 1307 8th Street
CK# 3192 Des Moines, Iowa 50314 20
ID# Daniel C . Aten03/13/04 5904 Dakota Drive
CK# 3933 West Des Moines, Iowa 50266 20
ID# Ray W . Peters03/13/04 405 NW . Irvinedale Dr .
CK# 4135 Ankeny, Iowa 50021-8962 20
ID# Nancy E . Kuenen03/13/04 359 NW 50th Place
CK# 5306 Des Moines, Iowa 50313 20
ID# Carol L . Horner, D.O .03/13/04 1417 - 48th St .
CK# 5249 Des Moines, Iowa 50311 20
ID# Samantha J . Keltner03/13/04 513 NE 15th Street
CK# 1219 Ankeny, Iowa 50021 20
ID# Chris R . Acton03/13/04 1831 Fuller Rd ., Unit 16
CK# 211 Des Moines, Iowa 50265 20
ID# Michelle S . Wilcox03/13/04 5156 69th Street
CK# 3064 Urbandale, Iowa 50322 20
-
For'Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
200.00
Page
1 5
of- 4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Craig R . Leager03/13/04 6502 Lincoln Avenue
CK# 1216 Windsor Height, Iowa 50322 20
ID# Kyle A . Campos03/13/04 9344 Sandler Circle
CK# 12154 Urbandale, Iowa 50322 20
ID# Kenneth E . Briggs, Jr .03/13/04 1433 NW 91st Street
CK# 5904 Clive, Iowa 50325 20
ID# Marilyn Y . Scott03/13/04 4325 NE 29th, NO 98
CK# 2814 Des Moines, Iowa 50317 20
ID# Charlotte P . Hutchison03/13/04 1328 Birch Lane
CK# 2789 Des Moines, Iowa 50315 20
ID# Michael J . Ferjak03/13/04 12057 NW 131st Court
CK# 2082 Madrid, Iowa 50156 20
ID# Sally Troxell03/13/04 701 54th Street
CK# 1719 Des Moines, Iowa 50312 20
ID# Michael L . McGill03/13/04 802 SE 80th Avenue, Lot #42
CK# 4199 Des Moines, Iowa 50320 20
ID# Timothy E . Runkel03/13104 731 Polk Blvd .
CK# 2859 Des Moines, Iowa 50312 20
ID# Theresa M . Broussard03/13/04 1101 E . 36th Ct .
CK# 3241 Des Moines, Iowa 50317 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
200.001 /
Page
1 6 of- 49(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Christy Vangundy
03/13/04 2507 E . 16th St.CK# 2102 Des Moines, Iowa 50316 20
ID# John H . Edsill03/13/04 2610 E . 29th Ct.
CK# 2287 Des Moines, Iowa 50317 20
ID# Lu Ann M . Pedrick03/13/04 3921 75th St.
CK# 526 Urbandale, Iowa 50322 20
ID# Charlene Teed03/13/04 2301 SW Oralabor Road, #97
CK# 4336 Ankeny,Iowa 50021 20
ID# Tamyra L. Wissmiller03/13/04 100 - 5th NW, Apt. 12
CK# 2546 Altoona, Iowa 50009 20
ID# Patience A . Dorr03/13/04 6425 NW 97th St .
CK# 3491 Johnston, Iowa 50131 20
ID# Timothy L . Hardy03/13/04 200 Center Avenue S .
CK# 2041 Mitchellville, Iowa 50169 20
ID# Shelley T . Wolfe03/13/04 6750 School St., #161
CK# 4829 Windsor Heights, Iowa 50311 20
ID# Lacey Jilek03/13/04 1315 E . 33rd Ct.
CK# 2856 Des Moines, Iowa 50317 20
ID# John H . Middents, III03/13/04 1110 SE Mill Pond Ct.
CK# 1974 Ankeny,Iowa 50021 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
' Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
TOTAL (if last page of this schedule)
Page
1 7
o f-49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# John L. Creswell03/13/04 906 SE Wanda Dr .
CK# 8431 Ankeny, Iowa 50021 20
ID# Jason Plunkett03/13/04 705 Linnwill PI .
CK# 2775 West Des Moines, Iowa 50265 20
ID# Mary Frances Reese03/13/04 3912 48th PI .
CK# 4590 Des Moines, Iowa 50310 20
ID# Jenny A. Gustafson03/13/04 300 57th Ct .
CK# 940 West Des Moines, Iowa 50266 20
ID# Mary A . O'Bannon03/13/04 5255 NW 55th
CK# 3951 Johnston, Iowa 50131 40
ID# Barbara E . B . Galloway03/13/04 4004 Fagen Drive
CK# 8265 Des Moines, Iowa 50310 20
ID# Patricia L . W . Kinner03/13/04 5701 Waterbury Rd .
CK# 7861 Des Moines, Iowa 50312 20
ID# Mary Beth Reiff03/13/04 1813 Hillside
CK# 2093 West Des Moines, Iowa 50265 20
ID# Sandy Weldon03/13/04 2827 Wolcott Ave .
CK# 7809 Des Moines, Iowa 50321 20
ID# Christophe R . Kaler03/13/04 1005 22nd St .
CK# 237 West Des Moines, iowa 50265 20
-
For'Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
220.00'
Page
1 8
of
4 4(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DDIYY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Randel L . Vonnahme
03/13/04 1509 NW Wagner Blvd .CK# 6333 Ankeny, Iowa 50021 20
ID# Julius J . Satre03/13/04 4305 68th St .
CK# 2353 Urbandale, Iowa 50322 20
ID# R.D . Bice03113/04 3210 Lindlavista Way
CK# 7180 Des Moines, Iowa 50310 20
ID# Amanda C . Lundberg03/13/04 9339 Golden Valley Dr.
CK# 1506 Norwalk, Iowa 50211 20
ID# Joani Hollingsworth03/13/04 13903 Bryn Mawr Dr .
CK# 7242 Urbandale, Iowa 50323 20
ID# Randall L . Stephenson03/13/04 460 NW 66th Place
CK# 7034 Des Moines, Iowa 50313 20
ID# lone G . Shadduck03/13/04 3431 Brookview Dr .
CK# 3476 West Des Moines, Iowa 50265 20
ID# Nancy L . Steward03/13/04 1070 37th St.
CK# 2337 Des Moines, Iowa 50311 20
ID# John Haan03/13/04 3804 - 11th St .
CK# 5638 Des Moines, Iowa 50313 20
ID# Mykle Fallis03113/04 2741 Thompson
CK# 16007 Des Moines, Iowa 50317 40
-
Fot Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
220.00
Page''
19
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Judy Kline03/13/04 6601 New York Circle
CK# 6486 Des Moines, Iowa 50322 40
ID# Bruce Sullivan03113/04 1233 Prairie View Dr. 177
CK# 1123 West Des Moines, Iowa 50266 20
ID# Connie Boesen03113/04 3011 Don Lee Ct .
CK# 8211 Des Moines, Iowa 50317 20
ID# Michael A . Espinosa03/13/04 706 27th Street
CK# 7115 Des Moines, Iowa 50312 20
ID# Nancy Bobo03113/04 1146 - 38th St .
CK# 7038 Des Moines, Iowa 50311 20
ID# G . Kay Bolton03/13/04 804 37th St .
CK# 9674 West Des Moines, Iowa 50265 20
ID# Brian R . Lynner03/13/04 1804 Woodland Ave .
CK# 1421 Des Moines, Iowa 50309 20
ID# Jill Whitten03/13/04 217 Cedarwood Ct.
CK# 4053 Grimes, Iowa 50111 20
ID# Robert E . Jackson, Sr .03/13/04 3925 NE 48th St.
CK# 12162 Des Moines, Iowa 50317 20
ID# Tanya H . Keith03/13/04 4556 50th St .
CK# 1858 Des Moines, Iowa 50310 20
-
Foe Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
TOTAL (if last page of this schedule)
Page 2 0
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Debra Storey Salowitz03/13/04 708 36th St.
CK# 1085 West Des Moines, Iowa 50265 20
ID# Gerald J . Szumski03/13/04 2705 - 39th St .
CK# 8712 Des Moines, Iowa 50310 20
ID# David L. Stanley03/13/04 1924 E . 27th St .
CK# 2371 Des Moines, Iowa 50317 20
ID# Terri A. Pollard03/13/04 1241 E . 33rd St .
CK# 9163 Des Moines, Iowa 50317 20
ID# Steve Breeden03/13/04 1010 NE 8th Ct .
CK# 2069 Ankeny, Iowa 50021 20
ID# Danielle K. Christensen03/13/04 3210 Be]-Afire Rd .
CK# 2126 Des Moines, Iowa 50310 20
ID# Steven L . Greenquist03/13/04 7230 NW 21st St .
CK# 6735 Ankeny, Iowa 50021 20
ID# Kathleen A. Fikenauer03/13/04 5921 Winwood Dr ., #310
CK# 2292 Johnston, Iowa 5131 20
ID# Virginia L . Campbell03/13/04 5344 NW 91st Court
CK# 822 Johnston, Iowa 50131 20
ID# Joyce D . Giles03/13/04 6818 Mill Pond Dr .
CK# 5412 Urbandale, Iowa 50322 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
' Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
TOTAL (if last page of this schedule)
Page 2 1
of
49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Dennis E . Thompson03/13/04 P.O . Box 872
CK# 4354 Ankeny, Iowa 50021 20
ID# Leanna L. Thornton03/13/04 10200 NE 76th Aveue
CK# 8573 Mitchellville, Iowa 50169 20
ID# Colleen A . Robinson03/13104 1014 Falcon Dr .
CK# 5311 Altoona, Iowa 50009 20
ID# Richard K . Bame03/13/04 5821 Brentwood Circle
CK# 9511 Johnston, Iowa 50131 20
ID# Karl B. McLain03/13/04 3811 Hillcrest Drive
CK# 8094 Des Moines, Iowa 50310 20
ID# Dan Josephsen03/13/04 4611 Stonebridge Rd.
CK# 3207 West Des Moines, Iowa 50265 20
ID# Barbara L . Lemons03/13/04 2616 56th Street
CK# 2061 Des Moines, Iowa 50310 40
ID# Sharon L . Yon03/13104 3904 Waveland Drive
CK# 4348 Des Moines, Iowa 50311 20
ID# Kenneth C . Choquette03/13/04 1410 Pensylvania
CK# 2347 Des Moines, Iowa 50316 20
ID# P.T . Ball03/13/04 3305 E . Aurora
CK# 6325 Des Moines, Iowa 50317 20
-
Fo'r Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
TOTAL (if last page of this schedule)
Page
22
of49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# James M . Cornick03/13/04 624 Glenview Dr .
CK# 2907 Des Moines, Iowa 50312 20
ID# Brant W . Bruhn03/13/04 2102 York Street
CK# 2842 Des Moines, Iowa 50316 20
ID# Ray M . Blase03/13/04 913 NE 34th Street
CK# 7964 Ankeny, Iowa 50021 20
ID# A . C . Lubbert03/13104 3317 - 3rd St .
CK# 4957 Des Moines, Iowa 50313 20
ID# Bonita Severson03/13/04 4530 Waveland Ct .
CK# 6969 Des Moines, Iowa 50312 20
ID# Thomas g . Fisher, Jr.03/13/04 3239 Elmwood Drive
CK# 3780 Des Moines, Iowa 50312 20
ID# Lauran M . Anderson03/13/04 1920 44th Street
CK# 1125 Des Moines, Iowa 50310 20
ID# Dr . F . Dow Bates03/13/04 3706 E . 28th St .
CK# 6945 Des Moines, Iowa 50317 40
ID# Alan W. Young03/13/04 169 Burr Oak Blvd .
CK# 3073 Pleasant Hill, Iowa 50327 20
ID# Jill Callahan Knoff03/13/04 1733 NW 122nd Ct .
CK# 9373 Clive, Iowa 50325 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
Page
2 3
of
49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DDIYY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Diana Lynn Hansen03/13/04 3827 Lindlavista Way
CK# 11777 Des Moines, Iowa 50310 20
ID# Michael A. Sadler03/13/04 9927 Hammontree Drive
CK# 2958 Urbandale, Iowa 50322 20
ID# Clementine J . Karl03/13/04 1111 29th Street, #2
CK# 1717 Des Moines, Iowa 50311 20
ID# Patricia K . Wengert03/13104 4213 41st Street
CK# 6453 Des Moines, Iowa 50310 20
ID# R . Saffin Sams03/13/04 812 - 57th St .
CK# 3265 West Des Moines, Iowa 50266 20
ID# Carol S . Maddux03/13/04 302 NW Rockcreek Cir .
CK# 3890 Ankeny,Iowa 50021 40
ID# M . Amjed03/13/04 12841 Sunset Ter .
CK# 9019 Clive, Iowa 50325 20
ID# Michel J . Pogge03,13/04 1033 NW Greenwood St .
CK# 503 Ankeny, Iowa 50021 20
ID# Hardin M . Whiteman03/13/04 1416 Thompson Ave .
CK# 3443 Des Moines, Iowa 50316 20
ID# Eileen E . Bleskacek03/13/04 610 Oakhurst Dr .
CK# 5824 Grimes, Iowa 50111 20
-
Fo`r Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
' $
200.00
Page'
2 4
of
49(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME
ID# Jamie Nelson03/13/04 4211 Beaver Crest Dr.
CK# 502 Des Moines, Iowa 50310 20
ID# Scott J . Saunders03/13/04 939 Leland Avenue
CK# 2760 Des Moines, Iowa 50315 20
ID# Joann T . Muldoon03/13/04 1338 18th Street
CK# 1673 Des Moines, Iowa 50314 20
ID# Catherine H . Engel03/13/04 907 - 27th St .
CK# 6580 West Des Moines, Iowa 50265 20
ID# John F . Rooney03/13/04 2212 - 51st St .
CK# 3375 Des Moines, Iowa 50310 20
ID# Nancy Heimbaugh03/13/04 3923 29th Street
CK# 5878 Des Moines, Iowa 50310 20
ID# Rodney H . Powell03/13/04 2717 71 st St .
CK# 8816 Urbandale, Iowa 50322 20
ID# Rose M . Cordaro03/13/04 1628 E . Virginia Ave.
CK# 2186 Des Moines, Iowa 50320 20
ID# Judith K . Lowe03/13/04 3418 Kingman Blvd .
CK# 3247 Des Moines, Iowa 50311 20
ID# Janet L. Haselhoff03/13/04 3843 8th Pl .
CK# 1687 Des Moines, Iowa 50312 20
-
Foi Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
200.00 1 e,
Page
2 5
of
49(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# William J . Schadle03/13/04 P.O . Box 35983
CK# 1577 Des Moines, Iowa 50315 20
ID# Barbara J . Miller03/13/04 669 61 st St.
CK# 8687 Des Moines, Iowa 50312 20
ID# Joe Youngwirth03/13/04 3824 Lay St.
CK# 7204 Des Moines, Iowa 50317 20
ID# Sarah Bolten03/13/04 626 SW 61st St.
CK# 4117 Des Moines, Iowa 50312 20
ID# Robert E . Tucker03/13/04 3111 SW 24th Ct.
CK# 1278 Ankeny,Iowa 50021 20
ID# Vince Bechtel03/13/04 305 SW State Street
CK# 3051 Ankeny, Iowa 50021 20
ID# Dirk R . Bliss03/13/04 700 5th Avenue SW
CK# 15976 Altoona, Iowa 50009 20
ID# E . Copeland-Clark03/13/04 1410 Beaver Ave .
CK# 2614 Des Moines, Iowa 50311 20
ID# Paula M . Thompson03/13/04 219 Plesantview Drive
CK# 5368 Des Moines, Iowa 50315 20
ID# Paul A . Caligiuri03/13/04 3020 Stanton
CK# 3780 Des Moines, Iowa 50321 20
-
For'Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
200.00 1,/
Page' 2 6
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# John Pederson
03/13/04 1075 44th StreetCK# 1323 Des Moines, Iowa 50311 20
ID# Kent R . Ryan03/13/04 1314 Cummins Pky .
CK# 3163 Des Moines, Iowa 50311 20
ID# Joshua T . Mandelbaum03/13/04 650 Polk Blvd ., Apt . 2
CK# 2013 Des Moines, Iowa 50312 20
ID# Patricia D . Hollinger03/13104 7526 Barnsley Dr .
CK# 4094 Johnston, Iowa 50131 20
ID# Beverly D . Bunker03/13/04 2730 SE Leach
CK# 4627 Des Moines, Iowa 50320 20
ID# Julie Rutz-Cota03113/04 7701 Hickman Rd ., #7
CK# 6187 Urbandale, Iowa 50322 20
ID# Beth Myers03/13/04 1244 48th Street #A
CK# 2357 Des Moines, Iowa 50311 20
ID# Rachel Paine03/13/04 1264 Office Park Dr #14
CK# 2271 West Des Moines, Iowa 50265 20
ID# Coby K . Koester03/13/04 4208 Adams Ave .
CK# 1528 Des Moines, Iowa 50310 20
ID# Lark W . Roberts03/13/04 4904 W . Park Dr .
CK# 13294 West Des Moines, Iowa 50266 20
-
For'Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees.
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
220.001,/
Page
2 7
of
4 9(for Schedule A)
SCHEDULEA MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Christa Addy
03/13/04 301 E . Bell AvenueCK# 1028 Des Moines, Iowa 50315 20
ID# Christine M . Drabek03/13/04 9810 SE Vandalia Dr .
CK# 4793 Runnells, Iowa 50237 40
ID# Danny C . Warren, Jr .03/13/04 3206 - 54th St .
CK# 6359 Des Moines, Iowa 50310 20
ID# Jeffrey D . Goetz03/13/04 701 54th St.
CK# 1782 Des Moines, Iowa 50312 20
ID# Marilyn Delay03/13/04 4024 Boulder Dr.
CK# 5545 West Des Moines, Iowa 50265 20
ID# Penni S . Guyler03113/04 323 E . Leach
CK# 1814 Des Moines, Iowa 50315 20
ID# Chuck Lierman03/13/04 508 NW Beechwood
CK# 6948 Ankeny, Iowa 50021 20
ID# Cindy Coppock03/13/04 719 - 47th St .
CK# 3585 West Des Moines, Iowa 50265 20
ID# Kathleen A . Richardson03/13/04 3917 Maquoketa Dr .
CK# 10125 Des Moines, Iowa 50311 20
ID# Mrs . Marvin R . Briles03113/04 1015 Luster Lane
CK# 6064 Des Moines, Iowa 50315 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown 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 familial relationship, enter "not applicable" in the relationship'column .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
240.001,.-
Page 2 8
of
40,(for Schedule A)
SCHEDULEA MONETARYRECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Dennis Beers
03/13/04 5505 Boulder DriveCK# 6602 West Des Moines, Iowa 50266 40
ID# Michael L. McCarthy03/13/04 2906 39th St.
CK# 1092 Des Moines, Iowa 50310 20
ID# Susan E . Voss03/13/04 323 E . 5th Street
CK# 7238 Des Moines, Iowa 50309 20
ID# Dallas J . Janssen03/13/04 520 - 35th St ., Suite 100
CK# 6199 Des Moines, Iowa 50312 20
ID# William D . Thompson03/13/04 7500 SE Bloomfield Rd .
CK# 5746 Des Moines, Iowa 50320 20
ID# Madith Burnett03/13/04 1422 Penn Ave . #8
CK# 1306 Des Moines, Iowa 50316 20
ID# Matthew Ballard03/13/04 613 - 18th Ct. SW
CK# 7815 Altoona, Iowa 50009 20
ID# Kimberly J . Spitzig03/13/04 609 SW Southlawn Circle
CK# 8014 Ankeny, Iowa 50021 20
ID# Arvid D . Oliver03/13/04 1709 NE Lowell Ct .
CK# 2236 Ankeny, Iowa 50021 40
ID# Araceli Goode03/13104 7085 Bloomfield Rd., Lot 261
CK# 2398 Des Moines, Iowa 50320 20
-
FoV Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same ason Statement of Organization)Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL 1 $ 220.001,,,
Page
2 9
of49(for Schedule A)
SCHEDULEMONETARYA RECEIPTS
(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME
ID# Ben A . Hildebrandt03/13/04 2607 Emma Ave .
CK# 5917 Des Moines, Iowa 50321 40
ID# Jesse F . Taylor03/13/04 1612 Lincoln Ave .
CK# 1743 Des Moines, Iowa 50314 20
ID# Carl B . Brush03/13/04 1134 69th Street
CK# 1021 Des Moines, Iowa 50311 20
ID# Janel R. Bellah03/13104 3117 Garden Avenue
CK# 2286 Des Moines, Iowa 50310 20
ID# Marla P . Stidolph03/13/04 866 - 40th PI .
CK# 5470 Des Moines, Iowa 50312 20
ID# Ken Rains03/13/04 4800 Euclid Ave .
CK# 1658 Des Moines, Iowa 50310 20
ID# William L . Brauch03/13/04 3313 38th St .
CK# 3734 Des Moines, Iowa 50310 20
ID# Linda S . Tossey03/13/04 3616 SW 26th St .
CK# 3799 Des Moines, Iowa 50321 20
ID# John M . Forrest03/13/04 P.O . Box 65114
CK# 1039 West Des Moines, Iowa 50265 20
ID# Eugene M . Rittman03/13/04 407 SE Delaware Ave., 306
CK# 399 Ankeny, Iowa 50021 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If sumame of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
TOTAL (if last page of this schedule)
SUB-TOTAL
I $
200.001/
Page
3 0
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Barbara L . Bernard
03/13/04 2 E . Wall AvenueCK# 1440 Des Moines, Iowa 50315 20
ID# Matthew J . Beedle03/13104 2720 Columbia St .
CK# 3138 Des Moines, Iowa 50313 20
ID# Davon A . Hoye03/13/04 201 Motley St.
CK# 2532 Des Moines, Iowa 50315 20
ID# JoAnn Hively03/13/04 3915 - 5th Avenue
CK# 4968 Des Moines, Iowa 50313 20
ID# Mary L . McGee03/13/04 201 Locust, Apt. 341
CK# 5993 Des Moines, Iowa 50309 20
ID# Berla J . Edsill03/13/04 2610 E . 39th Ct.
CK# 3415 Des Moines, Iowa 50317 20
ID# Evelyn J . Christianson03/13/04 116 - 5 Avenue NW #2
CK# 12167 Altoona, Iowa 50009 20
ID# Marijean Sears03/13/04 4147 54th
CK# 6397 Des Moines, Iowa 50310 20
ID# Colleen A. Jennings03/13/04 1208 49th Street #4
CK# 4945 West Des Moines, Iowa 50266 20
ID# Jack Hatch03/13/04 1623 Woodland Avenue
CK# 1344 Des Moines, Iowa 50309 20
-
For'Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
TOTAL (if last page of this schedule)
Page 3 1
of-4 9(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME
ID# Kristin Knudson Harris03/13/04 4038 Morton Avenue
CK# 2000 Des Moines, Iowa 50317 20
ID# Steven R . Belieu03/13/04 816 E . 27th Ct.
CK# 3710 Des Moines, Iowa 50317 20
ID# Stanley R. Pelts03/13/04 7004 Sheridan Cir.
CK# 8966 Urbandale, Iowa 50322 20
ID# Ken A . Balduchi03/13/04 406 Plumwood Ct. SW
CK# 5017 Altoona, Iowa 50009 40
ID# Rose Mary Pratt03/13/04 4411 46th St.
CK# 4710 Des Moines, Iowa 50310 20
ID# Steve Tasler03/13/04 4024 Adams Avenue
CK# 2113 Des Moines, Iowa 50310 20
ID# Kristi Aney Smith03/13/04 358 Evergreen Avenue
CK# 7344 Des Moines, Iowa 50320 20
ID# Jana Jongewaard03,13/04 1761 NW 99th Street
CK# 2168 Des Moines, Iowa 50325 20
ID# Jeff Gronstal03/13/04 2710 - 34th St .
CK# 9359 Des Moines, Iowa 50310 20
ID# Michael O'Deay03/13/04 1108 Park Ave .
CK# 4743 Des Moines, Iowa 50315 20
-
Fob Instructions, See Back of Form
CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationship
Page
32
of
49column .
(for Schedule A)
TOTAL (if last page of this schedule)
SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Ruth Michener03/13/04 10820 NE 78th Ct.
CK# 8229 Bondurant, Iowa 50035 40
ID# Irene H . Tan Creti03/13/04 3901 Western Hills Drive
CK# 8238 West Des Moines, Iowa 50265 20
ID# Patricia A . Cook03/13/04 1426 Pioneer Road
CK# 3587 Des Moines, Iowa 50320 20
ID# Lory Nels Johnson03/13/04 909 SE Uehlamar Drive
CK# 2794 Ankeny, Iowa 50021 20
ID# Todd A. McFadden03/13/04 3117 E . 43rd St.
CK# 1482 Des Moines, Iowa 50317 20
ID# Mary K . Kelly03/13/04 2421 Pine Circle
CK# 1804 Urbandale, Iowa 50322 20
ID# Musau Wakabongo03/13/04 1456 E . 17th Ct.
CK# 1161 Des Moines, Iowa 50316 20
ID# Caroline Sondag03/13/04 1255 E . 35th St .
CK# 5018 Des Moines, Iowa 50317 20
ID# Martha Anderson03/13/04 1717 Marella Trail
CK# 7813 Des Moines, Iowa 50310 20
ID# Joe Kluepel03/13/04 3141 - 8th St .
CK# 1150 Des Moines, Iowa 50313 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(including candidate's personal funds)
COMMITTEE NAME (Mustbe same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
TOTAL (if last page of this schedule)
SUB-TOTAL
1 $
200.00
Page 3 3'
of
49(for Schedule A)
SCHEDULE
A MONETARYRECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOMEID# Alba A . Bassett-Armijo
03/13/04 2803 Columbia St .CK# 5066 Des Moines, Iowa 50313 20
ID# William L . Strate03/13/04 7015 Sunset Terrace
CK# 2114 Winsor Heights, IA 50311 20
ID# Jeanette M . Ellington03/13/04 1003 E . Thornton Ave .
CK# 2581 Des Moines, Iowa 50315 20
ID# Alan R. Koslow03/13/04 2716 Jordan Grove
CK# 8145 West Des Moines, Iowa 50265 20
ID# Christian D . Capaldo03/13/04 245 NE 142nd Ave .
CK# 2134 Alleman, Iowa 50007 20
ID# Thomas J . Griffin03/13/04 3404 Scott St .
CK# 1459 Des Moines, Iowa 50317 20
ID# Matthew W . Russell03113/04 75333 Independence
CK# 2023 Anita, IA 50020 20
ID# Joseph H.Jongewaard03/13/04 4039 Ovid Ave .
CK# 2371 Des Moines, Iowa 50310 20
ID# Natalie Burnham03/13/04 1910 74th St.
CK# 4703 Windsor Heights, Iowa 50322 20
ID# Sarah T . Fuller03/13/04 1607 Center St .
CK# 1601 Des Moines, Iowa 50314 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE 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 orfor any commercial purpose by ny person other than statutory political committees .
* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown 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 familial relationship, enter "not applicable" in the relationshipcolumn .
SUB-TOTAL
I $,
TOTAL (if last page of this schedule)
200 . 00
Page
3 4
of
4 9(for Schedule A)
SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)
CHECK THIS BOX IF
AMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Deborah Kilgore03/13/04 3414 SW 35th St .
CK# 1545 Ankeny, Iowa 50021 20
ID# David C . Huston03/13/04 1512 48th St .
CK# 4801 Des Moines, Iowa 50311 20
ID# John Wenck03/13/04 3410 Aurora Avenue
CK# 3856 Des Moines, Iowa 50310 20
ID# Patricia Lyman03/13/04 2305 Glenwood Dr.
CK# 1112 Des Moines, Iowa 50321 20
ID# Karen S . Kelleher03/13/04 2304 - 2nd Street SW
CK# 5575 Altoona, Iowa 50009 20
ID# Tony G . Salem03/13/04 2623 Sherwood Dr.
CK# 5735 Des Moines, Iowa 50310 20
ID# Lucille L . Krauss03/13/04 1005 - 45th St .
CK# 2888 Des Moines, Iowa 50311 20
ID# Lila P.M . Starr03/13/04 1614 NW 99th Ct .
CK# 6774 Clive, Iowa 50325 20
ID# Bandstra Law Firm03/13/04 505 5th Avenue, Ste. 810
CK# 4148 Des Moines, Iowa 50309 20
ID# Brian K . Schon03/13/04 295 NE 64th St .
CK# 2463 Des Moines, Iowa 50327 20
-
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Polk County Democratic Central Committee
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA
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