Beruflich Dokumente
Kultur Dokumente
© Check rt this is final (termination) report and attach Notice of Dissolution Form DR-3. County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed,) which Election is held
"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) . . . ., . .
Attached?) YES NO
CONSULTANT BREAKDOWN (Schedule G
CANDIDATE CQMM1TTLK9 ONLY: 0.00
VALUE OF CAMPAIGN PROPERTY (From Schedule hl - Attach Schedule H)
STATE COMMITTEES : Submit a reconciled campaign account bank statement In January of each year.
Serft by : IOWA MED SOCIETY 515 223 0590 ; 10/18/06 5 :27PM ;JetraX #742 ;Page 3/11
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 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD,
CAUTION; Section 6BB.32A(6), 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 .
Diwloeum law requires candidate committees to dixelosee tha ralationehip of any relative making a contribution to the
committee. Relationship must be shown to 11to third degree of consanguinity (blood relatives) and affinity (relatives by 1
marriage) . If surname of eentributor is the same as candidate, but there is no Page of _~
tsmltl relationship, enter "not applirablo" in the relvtiont~hlp column . (for Schedule A)
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I
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Mustbe same as an Statement of Organization) AMENDING FORM
&TATE 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 AVAILACILE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD.
CAUTION: Section 68B,32A(6), 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
DIsclasure law requires candidate committees to disclose the rolationtihip of any rolafve making a contrlbuton to the
committee, Relationship must be shown to the third degree of ovnsanguinity (blood relatives) and affinity (relatives by
marriaae) . If surname of contributor is the same as candidate, but there is no Page of
tamilial relationship, enter "not .Ippllceblr" in t11a rdliltlonahlp column . (for Sc cdulo A)'~
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a
(Including candidate's pomnal funds)
CHECK THIS BOX IF
COMMITTEE NAME(Must be same as on Statement of Organization) AMENDING FORM
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM AASTATE PAC (POLITICAL ACTION COMMITTEE), LI6'r THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . LIST OF ID NUMBERS IS AVAILA13LE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.
NOTE: ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $760 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 68B,32A(6), prohlblts the use of information copied from reports and etatembnts for soliciting contributions or for any
commercial purpose by any person other than statutory political committees-
--DATE--- me IL.lrXlr~r ,tH aa.'J: -t~1~ 1,LL LI"7~~Z"I~YII U l"7 R GV\I IVIVSHIr' AMOUNT V IF FOR
RECEIVED (rf applicable) TO CANDIDATE' RECEIVED FIJND-
(MM/DD1YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
D . Michael Anderson 250,00
9/08/06 CK# 3774 20th Street
Grinnell 1A 50 .1 .12
" Disclosure law requires candidate committees to disclose tha relationship of any relative making a contribution to the
committee . Relutionship meet be shown DD tho third degree of consanguinity (blood relatives) and afflnlty (relatives by 3
marriage) . If surname of contributor Is the same as candidate, but there is no page '.,_._,. __ of -
farrliliel rblatlortrohip, anter'not applicable' in the relationship Column . (for Sehodulo A)
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STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECkIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND TFIF PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LI81 OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 6BB .32A(a), prohibits the use of information copied from reports and Statements for soliciting contributions or for any
commercial purposo by any person other than statutory political committees .
a
__
Ip#i
Anthony Davis Cousin 50 .00
9/20/06 CK# 1310 Cooledge Drive
An= TA 500 1 11
ID
Marianne Kramer 100.00
9/21106 CK# 313 5th Street
West Des Moines IA 50265
ID#
Brian Poindexter 100.00
9/21/06 CO 314 N. 16th Street
Inditlnola ., IA 50125
ID#
Mark Kcairnes 100.00
9122106 CK# 809 56th Streel
West Des Moines lA 50260
ID
Craig .l ohmon 100.00
9/22/06 CK# 822 Burr Oaks Drive
West Des Moines, IA 50266
lD#
Dale Hurniston 100.00
9/23/06 CK# 528 Champagne Road
Waukee .1A 50263
" Disclo.ure law requires candidate committees to disclose the rclationslilp or any relative making e contribution to the
committee . Relationship muel be shown 1o the thud degree of consanguinity (blood relatives) and affinity (relatives by 4
marriage) . If surname of conldbulor is the same as candidate, but there is no Page of 7
(for Schedule A)
familial relationship, enter 'not applicable" in the relationship column .
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STATE CANDIDATES NOTE : IF A GONfRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTF-F) . 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.
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY !-LAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 68B .32A(6), prohiNts 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,
ID#
Laurence Anderson 100 .00
9/25/06 CK# 1656 Burr Oaks Drive
West Des Moines . IA 50266
ID#
Dean Neese 100 .00
9125/06 CK# 4933 W . Park Drive
West Des Moines JA 50266
ID#
Cindy Sullivan 50 .00
9/20/06 CK# 2440 Windovcr
Anken lA 50021
I D#
Jeffrey Harsh 30 .00
9/21/06 CK# 1612 Aspen Drive
Adel, 1 A 50003-1970
ID#
Michael Grossmtn 40 .00
9/25106 CK# I I l l 66th Street
Windsor Hei hts IA S0311
IDA
Jonathan Narcisse 100 .00
9/26/06 CK# 1083 27th Street
Des Moines, IA 50311
S Ut3-TOTAL
Piaclosure law requires candidatecommittees to dlscloae the relationship of uny ralatlve making a ccnirlbution to the
commmee . Relationship must be shown to the two asgren ur cunsangulniry (bloou relatives) and amnlry (reiatrvns by 5
marriage) . 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)
Sent by : IOWA MED SOCIETY 515 223 0590 ; 10/18/06 5 :30PM ;JgtF
aX #742 ;Page 8/11
STATE CANDIDATES NOTE : Ir 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 NUMDER8 IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD .
NOTE : ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD .
CAUTION : Section 68B,32A(6), prohibits the use of information copied from report5 and statements for sollalling contributions or for any
commercial purpose by any person other than statutory political committees .
Disclosure law requiros oandtdate commitlnets to disclose the ralatlonshlp of any relative making a contribution to the
committee. Relationship must be shown to the lhlrd degree of consangulnlty (blood rekatlves) and affinity (relatives Dy 6 7
marriage) . 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 Schedules A)
Sent by :'IOWA MED SOCIETY 515 223 0590 ; 10/18/06 5 :30PM ;,JetFax #742 ;Page 9/11
STATE CANDIDATES NOTE= IF A CONTRI13UTION IS RECEIVED FROM A STATE PAC (POLII'ICAL 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.
NOTE: ANY PERSON, OTHER THAN AN INDIVIDUAL, THAT CONTRIBUTES MORE THAN $750 TO YOUR CAMPAIGN MAY HAVE FILING
RESPONSIBILITIES AND SHOULD IMMEDIATELY CONTACT THE BOARD,
CAUTION : Section 68B,32A(6), 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 .
. ,r
DATE PAC ID NUM BER i EU4W . RELATIONSHIP - - _ A:~daL. v IF FOR
RECEIVED (ifapplicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDNR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Worthin Grattan $50 .00
1 0/06/06 546 320th Avetiua
CK#
Grinnell, 1A 5011 .2
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
ID#
CK#
C K#
ID#
CK#
ID#
C K#
" Disclosure law requires candidato commlneas to disclos0 the relationship of any rulatlve making a contribution to the
committee . Relauonlinlp must be shown to the third dneree or consanvlnity (flood rniativea) and atrnlty (relatives ay
marriage) . If surname of contributor is the same as candidate, but there is no Page 7 of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
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- X #742 ;Page 10/11
Expenditures to personslentitles providing consulting, adverilslng, 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 personlentity on behalf of the candidate's committee. (Refer to
Schedule G Instructions and Iowa Code 58A .402(3)(i))
(for Schedule B)
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ID#
Wells Fargo Bank service chnrgcs
10/16/06 CK# 8301 Douglas Avenue 7 .42
Urbtindfle, IA 50322
1D#
C KO
ID#
C K#
ID#
C K#
IDf#
C K#
ID#
CK#
ID#
CK#
SUB-TOO. $ 57 .42
TOTAL (If last page of this schedule) $ 5,535,64
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 personientity on behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code 6BA,402(3)(1) .)
Page
(for Schedule B)