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PON : LOREtl CHIJPCH

FA ;: HO .

FOR INSTRUCTIONS, SEE BACK OF FORM

:

641 447 2644

DISCLOSURE SUMMARY PAGE

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

Church For Auditor

IMPORTANT:

Indicate by

# type of committee you are reporting for.

Sunding for Retention Candidate (2

F5 - 1

( 1 )Statewide/Leglgtative/Judge

)State PAC ( 3 )State Party

)County Central Committee ( S )County Candidate (

(4

Political

Subdivision Candidate (8

Subdivision PAC (11) Local Ballot issue

CANDIDATE COMMITTEES ONLY:

Candidate Name

6

)City Candidate ( 7 )School Board or Other

)County PAC (9 )City PAC ( 10 )School Board or Other Political

-

Political Party (if applicable)

Judv Church

. Democratic

Office Sought

' Clarke

County Auditor

District (if Senate or House)

Mar. 22 2005 11 :48Pf1

7

FORM

DR-2

(Rev. 07/2004)

;

DISCLOSURE

REPORT

P1

For OMCj Use Only

comm .it

76,-2 7

Logged in

Scanned

Computer

7"Z

Audited

Late reports are subject to

possible civil and criminal penalties .

TELEPHONE

DATE SIGNED

1 AM FILING A Final

(report date)

REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .

Indicate by #

EICHECK IF AMENDMENT TO REPORT DATED

Check if this is final (termination) report and attach Notioo of Dissolution Form DR-3 . (You must continue to file reports until a DR,3 is filed.)

Local Committees, enter Date of Election

November 2, 2004

County & Local Committees, enter County In

which Election is held

Clarie

STATEMENT OF CASH ON HAND

CASH 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 end of 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)

 

,.

Schedule F:

Loans Received total (Attach Schedule F)

Schedule H :

Total Sales of Campaign Property (Attach Schedule H)

,

,

,

-(Schedule H applies to Candidates' Committees Only)

5.19

-0-

-0-

 

SUB-TOTAL

 

$

5 .19

SUBTRACT TOTAL MONEY SPENT THIS PERIOD

 

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

 

Schedule F : Loan Repayments

total (Attach Schedule F)

5 .19

CASH ON HAND at the end of this reporting period (if final report balance must be zero Attach DR-3

 

-U-

"UNPAID BILLS (From Schedule D -Attach Schedule D)

,

,

., .,

,

.$

-0-

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E)

 

$

194.81

'OUTSTANDING LOANS (From Schedule F-Attach Schedule F)

 

., .,

,

.

,

,. ,., .,$

-0-

CANDIDATE COMMITTEES ONLY :

CONSULTANT BREAKDOWN (Schedule G Attached?)

 

® YES ENO

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

 

$

FOR 1NSTRUCTfONS, SEE BACK OF FORM

COMMITTEE NAME(Alust De seme as on Statement ol0rgonizaGlon)

Church For Auditor

NOTE ; This schedule reports money loaned to the committee which Is deposited In the commIltea accounl .

TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $ 200.00 _-

---~--

SCHEDULE

F

(Rev .07103)

LOANS

RECEIVED

6 REPAID

I CHECK THIS BOX IF AMENDING FORM

PART I- MONETARY LOANS RECEIVED _THIS REPORTING PERIOD (Odglnal source olfoan, such as a bank, must be shown If a third party is Involved . Include loans from cendkfato's personal funds .)

PART 11 - MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD (Loans forgiven must bo reported can Sehadula E - M,kfnd Conl4b0bns .)

DATE

NAME AND ADDRESS OF LENDER

RELATIONSHIP

 

AMOUNT

DATE PAID

RECEIVED

(Include Endorser's Name, 11 Apptirabla)

TO CANDIDATE

OF LOAN

(Mh11DDlYR)

Mh11DD/YR

If A

Ilcable'

 

S

 

211 1/05

 

TOTAL (FART0

S

NAME AND ADDRESS OF LENDER

RELATIONSHIP

AMOUNT

(Include Endorser's Name, it Applicable)

TO CANDIDATE'

EPAID

Judy Church

1699 140th Avenue

Murray, 1A 50174

It A

Self

TOTAL_ CASH REPAYMENTS (PART 11)

licah;a

$ 5.19

S

5,19

From Schedule E - TOTAL LOANS FORGIVEN

TO fAL OUTSTANDING LOANS END OF REPORT PERIOD

s 194 .81

£ .00

'Disclosure law requires candidate commlttses to dlscbose the relationship of any rotative making a contribution to the oommlttee . Retallonshlp musl be shown to the Third degree of consangutnlty (blood relatives) and affnlty (relatives by marriage). If surname of contributor Is the same as candidate, but there Is no famllIal relationship, enter "not applicable" In the retationshlp column when It applies .

Page 1

of

(for Schedule F)

)

COPJT IHUE FROM PREVIOUS PAGE

001

'Disclosure law requires

committee . Relationship must be shown to the

by marriage) .

familial relationship, enter "not appficeble' in the relationship column .

candidates to disclose the relationship

third degree

relative making an in kind contribution to the

of consanguinity (blood relatives) and affinity (relatives

of any

(See Page 2 of forms packet .) If surname of contributor

is the same as candidate, but there is no

Page

t

of (for Schedule E)

FROG : LOREN CHURCH

FAX NO .

: 541

Notice of Dissolution

447 2544

FORM

Mar . 22 2005 11 :51Ph1

DR-3

NOTICE OF

(Rev . 07103)

P1

Maul to :

 

DISSOLUTION

1ECDB

 

510

Last 12`x', Suite IA

For Office Use Only

Des

Moincs . Iowa 50319

 

Comm .

#

WHEN TO FILE :

Church For Auditor

1699 140th Avenue

Murray, IA 50174

I

COMMITTEE NAME

Official Name of Committee

Street

City, State, Zip Code

641

447-2644

L

1

Area

Telephone

Code

Indexed

Audited

Computer_

0 -

il 1' l

Certified Date of Dissolution

II

The Notice of Dissolution must be filed within thirty (30) days of completion of all the following:

1 . All debts, loans and obligations have been paid or transferred ; 2. All campaign funds have been spent;

3 . All campaign

4 . A final report disclosing all

property sold or transferred (candidates only); and

transactions closing the committee,

For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as possible if the bank statement is not available at the time the Notice of Dissolution is filed .

Candidate or Treasurer (if candidate's corn mittee)ISignature of Chair or Treasurer (if PAC)

Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM This form is not applicable to statutory political committees .