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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)

SCHEDULE

A

(Rev. 07/03)

MONETARY

RECEIPTS

D CHECK THIS BOX IF AMENDING FORM

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.

CAUTION :

for any commercial purpose by any person other than statutory political committees .

Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or

DATE

RECEIVED

(MM/DD/YR)

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PAC ID NUMBER (ifapplicable) AND PAC CHECK NUMBER

NAME AND ADDRESS OF CONTRIBUTOR

ID# J

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RELATIONSHIP

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(if applicable)

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SUB-TOTAL

AMOUNT

RECEIVED

/6u~r

S

~J

e

~3-

J IF FOR FUND- RAISER INCOME

TOTAL (iflast page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the committee. Relationship must be shown 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

Page

I

of

-71

For Instructions, See Back of Form

CONTRIBUTIONS -- MONEY TAKEN IN (including candidate's personal funds)

Reset Fonn

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

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ti GV 1 N G

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SCHEDULE

A

MONETARY

(Rev . 07/03)

RECEIPTS

CHECK THIS BOX IF AMENDING FORM

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.

CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions or for any commercial purpose by any person other than statutory political committees.

DATE

RECEIVED

(MM/DD/YR)

(6 l 13 6

PAC ID NUMBER (if applicable) AND PAC CHECK NUMBER

ID#

CK#

Y"

O

`6

1v

1 - CK#

1.1

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ID#

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CK# `2 `) e8'

ID#

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ID#

NAME AND ADDRESS OF CONTRIBUTOR

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RELATIONSHIP

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(if applicable)

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SUB-TOTAL

TOTAL (if last page of this schedule)

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

marriage) .

familial relationship, enter "not applicable` III the relationship column .

Ifsurname of contributcK,i&the same as candidate, but there is no

Page

AMOUNT

RECEIVED

'~ vi>c'c

U

U

`''

o2

'X

of

(for Schedule A)

J IF FOR FUND- RAISER INCOME

SGa G

FOR INSTRUCTIONS, SEE BACK OF FORM

Reset Form

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

SCHEDULE

B MONETARY

(Rev.07/03)

EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

 

CANDIDATE

NAME AND ADDRESS TO WHOM

PURPOSE

AMOUNT

DATE

ID NUMBER

EXPENDITURE

(DESCRIBE TRANSACTION)

EXPENDED

EXPENDED (ifapplicable)

(MM/DD/YR)

AND PAC

CHECK

NUMBER

ID

C K# ~

CK#

C K#

ID#

at- fcst'

c 1

ID#

ID#

CK#

ID#

CK#

ID#

C K#

(Disbursement) WAS MADE

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1 22

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v

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rs .

S t s

 

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d, , . ~r fr'r

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SUB-TOTAL

TOTAL (iflast page of this schedule)

Yy

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on

Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on Schedule G instructions and Iowa Code 68A .402(3)(i) .)

behalf of the candidate's committee . (Refer to

Page

of_

(for Schedule B)

`r- r Madison

P

.O .

Box 329, Avenue G & 7th St Fort Iviaa isaii 1A

,

-

dw~7

www .fortmadisonbank .own email : bank@rfortmadisonbank .corn

978 00001 01

PAGE :

1

ACCOUNT :

4654544

10/21/2005

DOCUMENTS :

0

HELLING FOR MAYOR COMMITTEE JAMES G HELLING ROSIE D HELLING 3322 AVENUE H FORT MADISON IA 52627-3555

FREE CHECKING ACCOUNT 4654544

 

-

- -

-

-

-

P'RF #

.DATE

.AMOUNT

10/14

435 .00

 

-

- -

-

-

-

DATE

.BALANCE

10/14

435 .00

LAST STATEMENT 10/14/05

.00

2 CREDITS

575

.00

DEBITS

.00

THIS STATEMENT 10/21/05

575

.00

-

-

-

REF #

-

DATE

10/17

-

- DEPOSITS

 

-

-

 

-

-

-

-

.DATE

-

-

.AMOUNT

 

REF

 

#

10/17

140 .00

 

DAILY BALANCE

-

-

-

-

-

-

.BALANCE 575 .00

 

DATE

- END OF STATEMENT

-

-

-

-

.DATE

-

.AMOUNT

.BALANCE

NOTICE : SEE REVERSE SIDE FOR IMPORTANT INFORMATION

maciison

P .O . Box 329, Avenue G & 7th St ., Fort gthiEa isr~r~, Lri1. 52621 31 9-37'2-S y C :4

www.fortmadisonbzsni<.com

emaii : bank@fortmadisortbttrij

.

.coi .a

978 00001 01 ACCO DOCU

_~~

HELLING FOR MAYOR COMMITTEE JAMES G HELLING ROSIE D HELLING 3322 AVENUE H

52627-3555

FORT MADISON IA

F

I

N

A

L

S T A T E M E N T

4654544

0

PAGE :

11/21/2005

1

FREE CHECKING ACCOUNT 4654544

 

LAST STATEMENT 10/21/05

 

575

.00

 

3 CREDITS

 

215

.50

4 DEBITS

 

790

.50

 

-

-

-

-

-

-

-

THIS STATEMENT 11/21/05

- DEPOSITS

-

-

-

-

-

-

-

-

-

.00

REF ##

DATE

- - AMOUNT REF #

 

DATE

- AMOUNT REF #

 

DATE

AMOUNT

10/25

30 .00

10/27

150 .00

11/04

35 .50

 

-

- -

-

-

-

-

-

-

-

CHECKS

-

-

-

-

-

CHECK #

.

.DATE

.AMOUNT

CHECK #

.

.DATE

.AMOUNT

CHECK #

.

.DATE

.AMOUNT

*10/27

 

413 .02

 

*11/03

 

244 .80

11/09

128 .56

INDICATES A GAP IN CHECK NUMBER SEQUENCE

 
 

-

-

-

-

-

-

-

-

- OTHER DEBITS

 

-

-

-

-

-

-

-

-

-

DESCRIPTION

 

DATE

AMOUNT

CLOSING WITHDRAWAL

11/16

 

4 .12

 

-

-

-

-

-

-

-

-

DAILY BALANCE

 

-

-

-

-

-

-

-

-

DATE

.BALANCE

 

DATE

 

.BALANCE

 

DATE

 

.BALANCE

10/25

605

.00

11/03

 

97 .18

11/09

 

4 .12

10/27

341

.98

11/04

132 .68

11/16

.00

- END OF STATEMENT

-

NOTICE : SEE REVERSE SIOF FOR IMPORTANT (NFOEN1ATtON