forinstructions, seebackofform form … · 2008-01-06 · 1604 grandoaks check# 7316 !, west...

FOR INSTRUCTIONS, SEE BACK OF FORM

DISCLOSURE SUMMARY PAGECOMMITTEE NAME (Must be same as on Statement of On,

Gayle Collins for City Council

IMPORTANT : Indicate by # type ofcommittee you are reporting for :( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2(4 )County Central Committee ( 5 )County Candidate ( 6 )City CandidPolitical Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )SSubdivision PAC ( 11 ) Local Ballot IssueCANDIDATE COMMITTEES ONLY:

Candidate Name

Office Sought

SIGNAJURE OF PERSON FILING REPORT

I AM FILING A

12

(report date)

CHECK IF AMENDMENT TO REPORT DATED Alit I I ~,

Rese FORM

DR-2(Rev . 07/2004)

For Office Use OnlyComm . #Logged InScanned'ComputerAudited

Political Party (if applicable)

District (if Senate or House)

5j"5-'w,T

13TELEPHONE

Ft l<-e lys pinor tv ~r~rr~tr

6tv~~n~ Check if this i

final (terminate n) report

nd attach Notice of Dissolution Form DR-3 .(You must continue to file reports until a DR-3 is filed .)

REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .Indicate by # 1-1

STATEMENT OF CASH ON HANDCASH ON HAND at the beginning of the reporting period . (Total of all funds held by the

committee. This amount MUST be the same as the cash on hand at the endof 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) . . . . . . . . . .

21,093 .00Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0

Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0

(Schedule H applies to Candidates' Committees Only)

SUB-TOTAL . . . . .$

21,266 .86SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . .

14,407.04

Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

0

CASH ON HAND at the end of this reporting period (if final report balance must

6859.82be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

**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?)

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)

$

Late reports are subject topossible civil and criminalpenalties .

8/,76/0/_

DATE SIGNED

DISCLOSUREREPORT

Local Committees, enter Date of Election

ty 11, ZO0'yCounty & Local Committees, enter County inwhich

lection is held~WK

173 .86

YES NO

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Schedule A: Contributions -- Money Taken In,Committee Name'iGayle Collins for City Council

Status Filed Committee Type Municipal Candidate - CityCouncil

Committee ID 13303

04/16/2004 01 :15:06

Statutory Due Date 14/8/2004Adjusted Due DateFiled Date

14/15/2004Amended DateReceived Date

Schedule AContributions

SCh-A

Fund-Raiser

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Page 1 of 16

IOWA ETHICS ANDCAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028

Contribution ContributionDate Committee ID Name and Address of Contributor Relationship To

Candidate(,ContributioniAmount

3/9/2004 Nahas, Edward None $500.00

219 4th StreetCheck #

3817 Des Moines, IA 50309-2253

3/9/2004 Ryan, Susan None $100.00

,3307 SW 24th StreetCheck #6050 Des Moines, IA 50321-2616

3/12/2004 Ceilley, MD, Roger I None $500.00

16000 UniversityCheck # Ste. 4502452 Des Moines, IA 50266

3/12/2004 Hurd, David None $250.001

1300 Walnut StreetI

Check #18312425 Des Moines, IA 50309

3/12/2004 ' Kirsner, Alvin H None I, $250.00

3131 Fleur DriveCheck# Apt 8073789 Des Moines, IA 50321

3/12/2004 !, Kruidenier, David None $1,000.00

715 Locust Street

j Check # 9th Floor1059 Des Moines, IA 50309

Committee Name

jGayle Collins for City Council

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Status Filed

i

Check #

II,1994

Committee TypeMunicipal Candidate - City_Council__

Committee ID 13303

11 416 SE Gray Street

(Des Moines, IA 50315-1744

04/1612004 01 :15:06 Schedule AContributions

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Page 2 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1(515) 281-4028

Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004

Amended DateReceived Date

ContributionDate

Contribution'Committee ID

Name and Address of Contributor Relationship ToCandidate

Contribution Fund-Amount (Raiser

3/12/2004 McCoy, Matthew None $125.00

4720 Woodland Ave.

Check #

4833 Des Moines, 1A 50312

3/12/2004 Politte, James D None $500 .00

1604 Grand OaksCheck #

7316 !, West Des Moines, IA 50265

3/12/2004 Quinn, MD, Jon Edward None $100 .00

2711 Glenwood DriveCheck #

1844 Des Moines, IA 50321

3/12/2004 IISporrer, Kim M None $50.00

1012 Polk BlvdCheck #


3/16/2004 Babb, Deborah None $100.00 X

6005 E . Oakwood Drive

~!, Check #1,3307 Pleasant Hi ll, IA 50327

3/16/2004 Belken, Harold & Nadine None $50.00' X


!Committee Name

IGayle Collins for City Council


Committee ID 13303

04/16/2004 01 :15:06 Schedule AContributions

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Page 3 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 i (515) 281-4028

Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004Amended DateReceived Date

Contribution ContributionDate Committeei-

3/16/2004

ID Name and Address of Contributor

Brown, Gregory A

Relationship ToCandidate

None

ContributioniAmount

$25.00''1

Fund-Raiser

X

12714 Ingersoll AvenueCheck # j Apt. 3053056 Des Moines, IA 50312

3/16/2004 Buhr, Glenn & Florence None j $50.00 X

4127-30th StreetCheck #


13/16/2004 II, Caracciolo, Ralph & Katherine None $25.00 X

1822 SW PorterCheck #

X9671 Des Moines, IA 50315

13/16/2004 Carney, James W None $50 .00 X

400 Homestead Bldg .Check # 303 Locust Street12157 Des Moines, IA 50309

3/16/2004 Celsi, Claire None $25.001 X

743-37th Street'Check #

~~10422 Des Moines, IA 50312'

13/16/2004 Colosimo, Anthony J None $100.0011 X

14092 Willow DriveII,I1

Check#6447- Clive, IA 50325

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Contributions


Page 4 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 I (515) 281-4028

Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date

Filed Date 4/15/2004

Municipal Candidate - City Amended DateStatus Filed Committee Type

Council Received Date__

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser

3/16/2004 Conner, Pamela None $25.00' X

i 2715 E . 40th StreetCheck #2359 Des Moines, IA 50317-3939

3/16/2004 Connolly, Angela None $25 .001I

X

4707 NW Beaver DriveCheck #2395 Des Moines, IA 50310

3/16/2004 i Curran, Susan A None $25.00 X

4015 Muskogee Avenue

I

Check #

3/16/2004

'3268 - Des_ Moines, IA 503 1 2

' Dearden, Dick None $100.00 X

113113 Kinsey AvenueCheck #

4672 Des Moines, 1A 50317-6603

3/16/2004 Flaherty, Patrick D None $25.00 X

5146 Aspen CircleCheck #6082 Pleasant Hill, IA 50327

3/16/2004 Flansburg, James S. & Carol M None $25.00' X

3709 UrbandaleCheck #

1 1820__ Des Moines, IA 50310 _

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Committee Name

Committee ID 13303Gayle Collins for City Council


04/16/2004 01 :15:06 Schedule A

Contributions

Statutory Due DateAdjusted Due DateFiled DateAmended DateReceived Date

4/8/2004

4/15/2004


Page 5 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1 (515) 281-4028

Contribution ContributionDate Committee ID

Name and Address of Contributor Relationship ToCandidate

ContributionAmount

Fund-Raiser

3/16/2004 Fundraiser at Java Joes N/A $538.00', X

214-4th Street ~I I

Des Moines, IA 50309

3/16/2004 Giovannetti, E.J .i

None $25.00 X

;3004 Melanie DriveCheck #

19293 Urbandale, IA 50322-6848

'3/16/2004 Gorsuch, Gordon Troy None $25.00' X

4007-39th PlaceCheck #

money order !Des Moines, IA 50310-2832

3/16/2004 Gray, WilliamI

NoneI

$25.00 X

4617 Franklin Avenue I

Check #


3/16/2004 Harding, Kimberly K N/A $25.00 X

4803-38th PlaceCheck #

10206 Des Moines, IA 50310-4304

3/16/2004 Jensen, Darrell L None $25.00' X

III1423 175th Place!~ Check #

1133 Ackworth, IA 50001

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Contributions


Page 6 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 i (515) 281-4028

!Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date


Municipal Candidate - City Amended DateStatus Filed Committee Type Council Received Date

Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser

3/16/2004 Kaiser, John E None

_~.._$25

.00, X

5800 SE 2nd StreetCheck #5456 Des Moines, IA 50315

3/16/2004 Kirsner, Lawrence None $250 .00 X

(Check3662 Ingersoll Ave

# #4071235 Des Moines, IA 50312

3/16/2004 Marturello, Connie None $50 .00 X

3620 SW 9th StreetCheck #


3/16/2004 McAninch, Dwayne & Glennis !None $250 .00~ X

PO Box 1486Check#

_ _ 8429 Des Moines, IA _ 50306

3/16/2004 McIntosh, Edwin None $250.00 X i

1677 NW 109th St .Check #

8945 Clive, IA 50325

3/16/2004 Meyer, Stephen P None $450.00 (! X

II300 Walnut StreetCheck # Unit 115

X 5563 Des Moines, IA 50309-2242


Committee Name

iGayle Collins for City Council

'Status Filed

1

Committee Type Municipal Candidate - City. Council

Committee ID 13303

04/16/2004 01 :15 :06 Schedule AContributions


4/8/2004

4/15/2004


Page 7 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028

Contribution ContributionName and Address of Contributor Relationship To Contribution Fund-

Date Committee ID Candidate Amount Raiser

3/16/2004 Mundy, Bruce Nonei! $25 .00 ; X

200 GrandCheck # #220


3/16/2004 Noon, Fred L None $25.00 X

349 Forest AvenueCheck #


3/16/2004 Oldson & Oakley, Joanne & Brice None $100.00 ; X

418 - 38th PlaceCheck #


3/16/2004 Pederson, Merle None $250.00' X

6034 N. Waterbury RdCheck #

_-241402 Des Moines , IA 503 12

3/16/2004 Person, Steven O None $25.00 X

11300 Walnut StreetCheck # Unit 73~~2649 Des Moines, IA 50309-2241

3/16/2004 Raker, Robert D None $30.00, X

3201 Bel Aire RoadCheck #


Committee Name


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Committee ID 13303

3726

Des Moines, 1A 50312

04/16/2004 01 :15 :06 Schedule AContributions

Statutory Due Date 14/8/2004Adjusted Due DateFiled Date

14/15/2004Amended DateReceived Date


Page 8 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1 514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028

Contribution ContributionDate Committee ID Name and Address of Contributor Relationship To

Candidate'Contribution(Amount

Fund-Raiser

3/16/2004 Renda, John None $500.00 X

1120-5th StreetCheck # #82146 West Des Moines, IA 50265

3/16/2004 Sackett, Jill E ' None $250.00 X


4189 Windsor Heights, IA 50322

3/16/2004 Sackett, Randy J None $250.001 X

1817 - 77th StreetCheck #4188 Windsor Heights, IA 50322

3/16/2004 Scearcy, Thomas H None $200.00 X

1526 CarpenterAvenueCheck #1190 Des Moines, IA 50314

3/16/2004 Stillians, Nancy None $25.00 X

1604-24th Street PlaceCheck #16510 Des Moines, 1A 50310

3/16/2004 Wegner, Ferol & Fredrick None $25.00'1j

X

6215 Pleasant DriveCheck#

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2893

I Des Moines, IA 50309

04116/2004 01 :15 :06 Schedule AContributions


Page 9 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1 (515) 281-4028



Municipal Candidate - City Amended DateStatus Filed Committee Type

Council Received Date

Contribution li Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID !Candidate Amount Raiser

3/16/2004I

Wegner, Fredrick None $25.00 X

6215 Pleasant DriveCheck #

6324 Des Moines, IA 50312-1255

3/16/2004I

Winters, Craig G None $500.00 Xi

512 Tuttle StreetCheck #

_ 5462 Des_Moines, IA 50309

3/16/2004 Wolnerman, Michael J None $25 .00 X

422 Glenview DriveCheck #

2861 Des Moines, _ 1A 50312

3/18/2004

-

Coppola, Michael A None $250 .00

4521 Fleur DriveCheck #1944 Des Moines, IA 50321

3/18/2004 Farley, Patrick None $50 .00

4702 University AvenueCheck #

5456 Des Moines , IA 5031 1

3/18/2004 Gerleman, Bruce W None $250.00

303 Locusti

Check# Suite 150

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;Committee Name

I,Gayle Collins for City Council

'Status Filed

Contribution i ContributionDate

Committee ID

Check#

2380

Committee Type Municipal Candidate - CityCouncil

Name and Address of Contributor ' Relationship To 'ContributionCandidate Amount

11000 Walnut Street


Committee ID 13303

04116/2004 01 :15 :06

Statutory Due DateAdjusted Due DateFiled DateAmended Date

4/8/2004

4/15/2004

Received Date


__

_ I

Fund-Raiser

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Page 10 of 16


3/18/2004 ICI Huser, Geri None $250.00

213-7th Street NWCheck #8671 Altoona, IA 50009

3/18/2004 Jochum, Tom None $500.00

1137-36thCheck #1217 - Des Moines, IA 50311

3/18/2004 Skinner, Ed I None $250.00

PO Box 367Check #

2677 ;Altoona, IA 50009

3/18/2004 Skinner, Lois None $250.00

PO Box 367Check #

7988 Altoona, IA 50009

3/18/2004 Skinner, Robert Bradley None $250.00

1810 Andrews Drivei

Check #,2468 Pleasant Hill, IA 50327

3/19/2004 Dana, Monique None $50.00,,I

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04116/2004 01 :15 :06nn

__

-

-I!Committee Name~Gayle Collins for City Council

Status Filed Committee Type Municipal Candidate - CityCoun cil

Committee ID 13303


Fund-Raiser


Page 11 of 16



ContributionDate

3/19/2004

ContributionCommittee ID Name and Address of Contributor

Stoffer, Dick

RelationshipCandidate

None

To '(Contribution(Amount

$25.00

5411 PonderosaCheck #

4117 West Des Moines, IA 50266

3/23/2004 Barnes, Evie J None $250.00

615 Park StreetCheck # Suite 30032371 Des Moines, IA 50309

3/23/2004 Barnes, Michael D None $250 .00

615 Park StreetCheck # Suite 300~I32370 ~ Des Moines, IA 50309

3/23/2004 fY ~~Central IA Building & Construction

I!N/A $500.00Trades Council PAC

PO Box 7310Check #3118 Des Moines, IA 50309-7310

3/23/2004 Claypool, Alicia P None $100.00

5754 Gallery CourtCheck#8706- West Des Moines, IA 50266

3/23/2004 Goodwin, William N None $1,000.00


13032 - Des Moines, IA 50312-2144 l

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Committee Name




FundRaiser


Page 12 of 16



ContributionDate

ContributionCommittee

Relationship ToID

Name and Address of ContributorCandidate

ContributionAmount

3/23/2004 Graham, Wayne None $1,000.00

5626 Glen Oaks PointCheck #

5673 West Des Moines, IA 50266-6625

3/23/2004 Margeas, Dr. Robert None $500.00

1056 Polk BlvdCheck #

11 1122 Des Moines, IA 50311

3/23/2004 Margulies, Richard B None $500.00

12100 Westown ParkwayCheck # Suite 22043041 West Des Moines, IA 50265-1539

3/23/2004 Smith, Kari Hillebo None $50.00

300 WalnutCheck # #415186 Des Moines, IA 50309

3/23/2004 Spina, Marilyn ! None $50.00

12545 E . Ovid AvenueCheck #1761 'Des Moines, IA 50317

3/23/2004 Wasker, C.F . None $100.00

4201 Westown Pky.Suite 250West Des Moines, IA 50266-6720

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Page 13 of 16




Municipal Candidate - City Amended DateStatus Filed Committee Type Council Received Date

( Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser

3/24/2004 Bierma, Lon _None I $500.p0',

2825 Grand Avenue

j Check # #4022246 Des Moines, IA 50312

3/24/2004 Bookey&Bass-Bookey, Harry &

None $500 .00Pamela

400 Locust StreetCheck # Suite 79012463 Des Moines IA 50309

3/24/2004 Farver, Charles S None $500.00

617 Franklin Place1 Check # Suite 200

;3/24/2004

1014 Pella, IA 502 1 9-1679

Riley, Jr ., Robert G None $100.00

'3121 Dean AvenueCheck #4831 Des Moines, 1A.50317

3/24/2004 Wilson, Jonathan C ' None $100.00i

2924 Druid Hill DriveCheck #201 3 Des Moines, IA 5031 5

3/26/2004 'Flagg, George E None $100.00

13101 Onondaga Point j

Check #2990 Des Moines, IA 50321

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0411612004 01 :15:06 Schedule AContributions

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04/16/2004 01 :15 :06

Page 14 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 I (515) 281-4028



Municipal Candidate - City Amended DateStatus Filed Committee Typ

Council_ Received Date

[Contribution ! Contribution

_

Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate /Amount Raiser

3/26/2004 Hubbell, III, James W None $500 .00

9286 Harding Street j

Check #

10140 Indianola, IA 501 25

3/26/2004 F Nesbit, Michael J & Maria H . None $300.00

PO Box 12039Check #

7136 Des Moines, IA 50312-9401

3/26/2004 Schroeder, Larry J None $500.00

4537 51 st StreetI

Check #6486 Des Moines, IA- 50310 _-

3/30/2004 Ainsworth, Leonard L None $250 .00

108 N . Hickory BlvdCheck #0161 33 Pleasant Hill, IA 50327

3/30/2004 Hedberg, Mark T None $500.00'

840 Fifth AvenueCheck #5000010177 Des Moines, IA 50309

3/30/2004 Nelson, Steven L None $250.00

5300 Shriver AvenueCheck#

_ _ cash - Des Moines , IA 503 12-2044


Committee Name


04/16/2004 01 :15:06

Fund-Raiser


Statutory Due DateAdjusted Due DateFiled Date

4/8/2004

4/15/2004

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Page 15 of 16

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 I (515) 281-4028

Status Filed

Contribution ContributionDate Committee


IDName and Address of Contributor

Amended DateReceived Date

Relationship To ~ContributionCandidate (Amount

3/31/2004 Brick, James E None $500.00

550 39th StreetCheck # Ste. 200

II8526 Des Moines, IA 50312-3529

, 3/31/2004 Civil Servants Political Education N/A $1,000.00League

12121 DelawareCheck #1055 Des Moines, IA 50317

3/31/2004 Lillis, William J None $100 .00

3000 Patricia DriveCheck #

12565 I Des Moines, IA 50317

(13/31/2004T 'Malone, John P None $250.00'

236-51st StreetCheck #1713 Des Moines, IA 50312

3/31/2004 Westergaard, Linda C None $100.00

4009 E . 23rd StreetCheck#13792 Des Moines, IA 50317

4/2/2004 Moss, Terry None $100.00

1746 Burr Oaks DriveCheck #'7317 West Des Moines, IA 50266


Committee Name


Status Filed

ContributionDate

ContributionCommittee ID




4/8/2004

4/15/2004


Page 16 of 16


4/2/2004 :~q,27.7

Check #

1234

Sheet metal Contractors of Iowa N/A

1454 30th StreetSuite 201

I West Des Moines, IA 50266-1312

$150.00

Total Regular Contributions $16,100.00Total Fundraiser Contributions $4,843 .00Grand Total All Contributions $20,943.00

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)


Reset Form

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATIONNUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGNDISCLOSURE 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 any person other than statutory political committees .

SUB-TOTAL

TOTAL (if lastpage of this schedule)

' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to thecommittee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by

4

4marriage) .

If surname of contributor is the same as candidate, but there is no

Page ------- of------familial relationship, enter "not applicable" in the relationship column .

(for Schedule A)

SCHEDULE

A MONETARY(Rev . 07/03) RECEIPTS

Q CHECKTHIS BOX IFAMENDING FORM

DATE PAC ID NUMBER NAME ANDADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-(MM/DD/YR) ANDPAC CHECK (if applicable) RAISER

NUMBER INCOMEID#

Fundraiser at Java Joes$150.003/16/04 CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#


Schedule B : Expenditures -- Money Spent From Committee AccountCommittee Name


Status

Filed

Committee Type Municipal Candidate - City_ f'_nmnril

Expenditure Expenditure

Expenditure Name & Address

PurposeDate Committee

3/8/2004

1 N/A

3/8/2004

,3/11/2004

3/16/2004

Check #

n/a

N/A

Check #

no #

N/A

Check #i no #

Carter Printing

N/A

(Java Joes

1739 East Grand Avenue


Carter Printing

1739 East Grand Avenue


Carter Printing

1739 East Grand AvenueCheck #

no #

Des Moines, IA 5031 6-

214 4th Street


04/16/2004 01 :15:06

Schedule BMonetary Expenditures

Statutory Due DateAdjusted Due DateFiled DateReceived Date

4/8/2004

4/15/2004

Amended Date

Printing & Reproduction

$375.24

invoice 79141letterhead, envelopes,cards


invoice 79125photocopies


invoice 79182yard signs, stickers,postcards

Fund-Raiser (Holding)

snacks, plates,napkings, cups andwater set-up for

Sch-B

ExpenditureAmount


04/16/2004 01 :15:06

Page 1 of 6

$29.68I'I

$1,398.14

$42.40



Committee Name


Status

Filed

Committee Type Municipal Candidate - City_ . Cnuncil

I

Check #no number

1165 Second Avenue


04/16/2004 01 :15 :06



4/8/2004

4/15/2004

Amended Date

Postage cost for mailer

T-


04/16/2004 01 :15:06

Page 2 of 6

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1(515) 281-4028

Expenditurei Date

toCommittee Expenditure Name &Address Purpose 'Expenditure

(Amount

3/16/2004 N/A Henry, Mitch Professional Fees $150.00

campaign managementfees

1900 MLK Jr . ParkwayCheck#

'cash Des Moines, IA 50314

3/17/2004 N/A Carter Printing Printing & Reproduction $222.60

invoice 79256

1739 East Grand Avenuecampaign cards

Check #no # Des Moines, IA 50316

3/18/2004 N/A 11 Mailtech, Inc Postage, Shipping,$1,027.71Delivery

Mail processing fee for"Let's Flip the Switch"

712 E. 2nd Street flyerCheck #

~no # Des Moines , IA 50309

3/18/2004 N/A I United States Postal Service Postage, Shipping,$2,346 .83 ;Delivery


Committee Name Committee ID 13303

14015 Muskogee AvenueCheck #no number


04/1612004 01 :15 :06


Statutory Due Date 4/8/2004

Reimbursement forpurchase of 23 centstamps for postcard


04/16/2004 01 :15:06

Page 3 of 6

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 i (515) 281-4028

~I Gayle Collins for City Council Adjusted Due DateFiled Date 4/15/2004Received Date

Status Filed Committee Type Municipal Candidate - City Amended Date_-Cnunnil

TExpenditure Expenditure

Expenditure Name & Address Purpose ExpenditureDate Committee 'Amount

3/23/2004 N/A Davitt Photo Alliance Photography $150.00

campaign photos1 1520 Walnut

Check #no # Des Moines, IA 50309

3/23/2004 N/A Henry, Mitch Professional Fees $237.00

campaign management

1900 MLK Jr. Parkwayfees

Check #

no number Des Moines, IA 50314

3/23/2004 N/A I111 TL &Associates Professional Fees $3,000.00

telemarketing services1100 Euclid Ave.

Check #

no number Des Moines, IA 50313

13/24/2004 N/A Curran, Mary K Postage, Shipping,$460 .00Delivery


Committee Name


Status

Filed

Committee Type Municipal Candidate - City__

-

Expenditure_Expenditure

Expenditure Name & Address

PurposeDate Committee

3/26/2004 N/A

3/28/2004

3/30/2004 N/A

3/31/2004

1 N/A

N/A

Dahl's Food Mart

Check #

1001

Check #

Henry, Mitch

1900 MLK Jr . ParkwayCheck #no #

Des Moines , IA 50314

!purchase of 23 centstamps for postcard

3425 Ingersoll Avenue

mailing


West Bank

PO Box 65020

Committee ID 13303

West Des Moines, IA 50265-0020

11739 East Grand AvenueCheck #

1003


04/16/2004 01 :15:06



Amended Date

4/8/2004

4/15/2004

Professional Fees

campaign managementfees

Advertising

Bank Charges

check printing charges

invoice 79300yard signs and wires

ExpenditureAmount

$150.00

$69.00 111

$15.50

Carter Printing


$1,050 .46


04/16/2004 01 :15:06

Page 4 of 6


Batch processed using the IEGDB Web Reporting System04/16/2004 01 :15:06



04/16/2004 01 :15:06

Page 5 of 6


Committee Name Committee ID 13303 Statutory Due Date 4/8/2_004Gayle Collins for City Council Adjusted Due Date

Filed Date 4/15/2004Received Date

', Statu s Filed Committee Type Municipal Candidate - City Amended Date

Expenditure ExpenditureExpenditure Name & Address Purpose Expenditure

Date Committee Amount

( 3/31/2004 1N/A Carter Printing Printing & Reproduction $262.88'

Iinvoice 79357

1739 East Grand Avenue4x6 cards - apr 13

Check #


4/1/2004 N/A ~TL & Associates Professional Fees

_

$3,000.00 I

I

( telemarketing fees100 Euclid Ave .

Check #


4/1/2004 N/A Jasnos, Jason Professional FeesI

_

$250.00

iPayment for email list

756 17th Street and blitz services

Check #


4/2/2004 N/A ( Carter Printing Printing & Reproduction j $169.60

:invoice 79417campaign cards

1739 East Grand Avenue 2/2-reorderCheck #1005 Des Moines, IA 50316

Batch processed using the IECDB Web Reporting System

04/16/2004 01 :15:06

Schedule B^^

Monetary Expenditures

,Committee Name

Committee ID 13303

IGayle Collins for City Council

Status

Filed

Committee Type Municipal Candidate - Cityrm,nnii

ExpenditureDate

ExpenditureCommittee Expenditure Name & Address


4/8/2004

4/15/2004

Amended Date

Purpose ExpenditureAmount _

Total Amount

-~-$1 4,407.04


04/16/2004 01 :15 :06

Page 6 of 6


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