I

FOR INSTRUCTIONS, SEEBACK OFF ' FORM

' DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev. 12/2005) REPORT

For Office Use Only

Comm . #
IMPORTANT : Indicate by # type of committee you are reporting for: Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party
Scanned
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate (7 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political
ke,1R15
Computer
Subdivision PAC ( 11 ) Local Ballot Issue
Audited
CANDIDATE COMMITTEES ONLY ;
Candidate Name Political Party (if applicable) File with :
Iowa Ethics and Campaign
Disclosure Board
Office Sought District (if Senate or House) 510 E. 12`", Ste. 1A
Des Moines, Iowa 50319
Fax: 515-281-3701
Late reports are subject to possible civil and criminal penalties. Pursuant to Iowa Code section 68B .32A(7)
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is the
indMual responsible for filing tirtmelypnd'accurate reports.

SIGNATURE OF PERSON HUNG REPORT TELEPHONE DATE SIGNED

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

(report date) Indicate by #a
CHECK IF ANFJVDMENT TO REPORT DATED
PAICN Local Committees, enter Date of Election
I 1A F_ I F11CS & CABOARD
QuISCLOSURE
0 Check if this is final (termination) report and attach Notice of Di o tion Form DR-3 .
County & Local Committees, enter County in
(You must continue to file reports until a DR-3 is filed.)
NOV 2 0 2006 which Election is held

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)
SUB-TOTAL . . . . . . . . .. . . . .. . . . .. . . . $
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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

*"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . .'. . . . . . .. .. ..... ........... ... .. ..... . ....$
~
,
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule )C .1 .. . .. .. . :.~ . .). . . . . . .. . . . . . . . . . . . . . . . . . . . .

**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .; . . . . . . . . . . . .$

CONSULTANT BREAKDOWN (Schedule G Attached?)( ~e ..:-) G r I Gj , yvi, Y' C )Or - YES _ NO
~4

CANDIDATE COMMITTEES ONLY: .=1 ~j

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) ~L $ .--

STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .
 FOR INSTRUCTIONS, SEE BACK i ^ORM Reset'" j SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

B MONETARY
(Rev. 07/03) EXPENDITURES
STATE PAC COMMITTEES: NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER 1N 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 Statementof Organization)

Ann Fairchild for Iowa State House

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (ifapplicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID#
07/18/06 CK# Pit Stop Printing
103 North Mill
Lake Mills, L4 50450 641-592-2520
Payment for Campaign Flyers
$ 19 .65

ID#
08/16/06 CK# Staples
34404th Street SW
Mason City, IA 50401 641-423-4012
Payment for Campaign Flyers
65 .38

ID# Pit Stop Printing Payment for Campaign Flyers

08/18/06 103 North Mill 20 .76
CK# Lake Mills, IA 50450 641-592-2520
ID#
09/16/06 CK# Staples
3440 4th Street NW
Mason City, IA 50401 641-423-4012
Payment for Campaign Flyers
24.58

ID#
09/19/06 CK# Pit Stop Printing
103 North Mill
Lake Mills, IA 50450 641-592-2520
Payment for Campaign Flyers
85 .60

ID#
09/27/06 CK# Garner Leader & Signal
365 State Street
Garner, IA 50438 641-923-2684
Payment for Campaign Advertisement
for a publci meet and greet with the
candidate
32 .00

ID#
Staples Payment for Campaign Flyers
09/28/06 34404th Street SW 48 .11
CK# Mason City, IA 50401 641-423-4012

ID# Pit Stop Printing Payment for Campaign Flyers

09/29/06 103 North Mill 42 .80
CK# Lake Mills, IA 50450 641-592-2520

SUB-TOTAL $ 338.88
TOTAL (lf last page of tilt schedule) $

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 personslentities 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 expendthxe made by the personlenfty on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i).)

Vi1C suR BOWD

ajsC%o
(for Schedule B)
 FOR INSTRUCTIONS, SEE BACK OF FORM Resct Form' SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

EXPENDITURES
(Rev. 07/03)
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)

Ann Fairchld for Iowa State House
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (d applicable) (Disbursement) WAS MADE
(MM/00/YR) AND PAC
CHECK
NUMBER
ID#
Pit Stop Printing Payment for Yard Signs
10/12/06 CK# 103 North Mill $ 128.40
Lake Mills, 1A 50450 641-592-2520
ID#
Pit Stop Printing Payment for Yard Signs
10/23/06 CK# 103 North Mill 128.40
Lake Mills, IA 50450 641-592-2520
ID#

s- a 1s S
ID# f~~~Ac~t tr+PJ 6,9,vk1 f-Tw J- #k)111 - 74-~

1 106
c,U
gam .
CK# f'ar't_e,a~ , .T~wr9 SDV?,(o
9 1,5 , ca l- -d8 as
tD# 19Nfkd-arPs 6,4NK t-Tl -us
CK# ycres / C, ~/ : 1c.~.vf1 SZXI:jI:o
& I-sSS - ';q r S .~
ID# r
piU.~t C fu`
,~.f i8f)NK y-- Trua ,6A,I~

CK# 5z+Y3
4"V/ S$ - -~ ~S
'
fa vW ef l A-~0,e >10
Il I610(o 1 ~s 6'
I, qj-
ID#

CK#
L
SUB-TOTAL- $~ ? 4fo

TOTAL (If last page of this schedule) $

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 am , and date of each type of expenditure made by the personlentity on behalf of the candidate's committee . (Refer to
Schedule G i_rygtcyl~( P Code 68A .402(3)(1).) . ..
OlSGpSUFtE. 0V of
Page

2006

(for Schedule B)
 Printed using the IECDB Web porting System on 10/2412006 12 :59 :10 DR-2

FORM DR-2 : Disclosure Summary Page Statutory Due Date 10/19/2006

Status: Filed Adjusted Due Date
ID #: 1696 Received Date 10/17/2006
Postmark Date 10/16/2006
Committee : Ann Fairchild for Iowa State House
Amended 10/21/2006
Comm Type : State House
Date Due: 10/1912006
Report Year: 2006
Treasurer : Ann Fairchild
Primary Ph . (641)797-2221 Secondary Ph . (nul)Inu-null Gr ~~
Chair : r.

County : NA
Amended: 10/21/2006

Statement of Cash on Hand Cash on Hand at Start of Period $0.00

Schedule A: Cash contributions Total $630.00
Schedule F : Loans Received Total $0.00
Schedule H : Campaign Property Sales $0.00
SUB-TOTAL $630.00
Schedule B : Expenditure Total $1,063 .64
Schedule F: Cash Loan Repayments
(Cash on Hand At End of Period -433.64

Additional Assets and Liabilities

Loans in Place at Start of Period $0.00

Schedule D: Unpaid Bills $0.00
Schedule E: In-Kind Contributions $0 .00
Schedule F: Forgiven Loans
Schedule F : Outstanding Loans $0.00
Schedule G: Consultant Breakdown? No
(Schedule H : Campaign Property Value $0.00

FORM DR-2 : Ann Fairchild for Iowa State House

Printed using the IECDB Web Reporting System on 10/24/2006 12:59 :10 Page 1 of 1
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1510 EAST 12th, SUITE 1A I DES MOINES, IA 50319 I (515) 281-4028
Oct 21 06 09 :14a Librarian 641-797-2787 p .2

For Instructions, See Back of Form

Reset Form SCHEDULE
CONTRIBUTIONS -- MONEY TAKEN IN
A MONETARY
(Rev_ 07103) RECEIPTS
(Including candidate's personal funds)
© CHECK THIS BOX IF
COMMITTEE NAME(Must be same as on Statement of Organization) AMENDING FORM
~
!`tr) n Fa- >^c .I", ; 1j nr,~rA `;kA f>°_ Jdcx1 P
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 .

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.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

Al
14 `'~ 5'fs eer f~,1 .
$
(~o 7 i t~ . Swr`fe. "5'C?O
C K# f 00 of-'
.Y

Cl-
ID#
~VV~ V
'OJnCL' " c(;.IICL~ C'~,1~1"F"10( - r ~ .lt tl tCG I t.c;C ;F[~ f25

n " w,
V
CK# 9c0 c ec;en4) S-fr

' C ._ I ( I D#
,~O C27u. .c~-/y" IwJr~ C .fZc-c_ ,G 'Yi ,i'+7t if v..
(.t-"'v~ n e_ C2,..c, o GI z,_,L r,-4-V S care- r`"
CK# c.-
f ^rye (vQ~ 10 -) C«r)Cr~~ C~,urf i , r~e .t ~,'~ I
Cir_aq ._pc_r
ID#
t-k erl HCa1. r,
CK# P c~ 13c%uT

CK# ~-~ s L3 -41 o Sfcc<-- t

._
CK# s 8 T 10 ` t,re~f icy_
k-P )-, . e t. .~ _ 'c~<
I
De. r'rIc nc-b b
_ .5."

3%zs a_ l=o i -c~-S f- Cam; .. i e

CK#
ocf_ I uA Lt-, .4 y ., L7 -
ID#

CK# 3"A !vC'ej Gcal-a C_ ~;c=

-25-G(1

I D#
,~
-~s-cxc CK# ,~~~, Ce_r,'+e,r S-tre f) E . L.t .S . cle

.RD SUB-TOTAL
.. . ., . .. :

TOTAL (if last page of this schedule)

0rT

Page I of
(for Sched We A)
Oct 21 06 09 :14a Librarian 641-797-2787 p.3

For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN
A MONETARY
(Rev . 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
_ r~- L
.LI -n ra l r'C `l _ L!mr l A ,S1lv rr° A-S f
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 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-

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT CIF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND
(MMIDDIYR) AND PAC CHECK it applicable) RAISER
NUMBER INCOME
ID# $
CK# 3a 3Cr 3) -547 - qQ l
COIF C. fe_ _
ID# k' : c.h ¢rd i-k-, i 5fud
pin
CK# )4SS'T 1~:h~FIerLA_~c,~,d 2cxLd CcVI 3alt
No h - c: .u~+q SZxI S `f
ID# KaA PIj
CK#, P. C7 c. ~ ~n -ca:
C- a 4,
ID# 5p-ten 0 2l`
~h~l ion
01 -S ' CXF CK#
h ..tr- a
1D#

CK#

I D# .

CK#

ID#

C K#

ID#

CK#

ID#

C K#

ID#

CK# w---
.-E" :~h9 w
SUB-TOTAL

OCT f', k 20OG TOTAL (if last page of this schedule)

' Disclosure law require @tl6alp committees to dlsclose ~he relationship of any relative making a contribution to the
tc daa_tbiod.depr~¬iof consanguinity (blood relatives) and affinity (relatives by
committee . Relationship must be sho+knlathe
marriage) . If surname of contributor same as candidate, but there is no Page " `4~' of
familial relationship, enter'not applicable' in the relationship column . (for Schedule A)
 FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT

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)

.. ~ ,Lh~t/ -
f f -L -
1 j -EL I~ P- r~t` 7rti !} S TIT~ ~ ~CrC .t SC:
DATE
EXPENDED
CANDIDATE
ID NUMBER
(if applicable)
NAME AND ADDRESS TO WHOM
EXPENDITURE
(Disbursement) WAS MADE
PURPOSE
(DESCRIBE TRANSACTION) I AMOUNT
EXPENDED

(MM/DDIYR) AND PAC

CHECK
NUMBER
c
ID#

1A 7 C CK# ~ " TfiTE <T4ct

--T

red I ,rz
I D# . TT.~IJ~~
ivl-~ r y.
,
C K# F!- :l
~f',~C nl:GLS T/9 G
ID#
0

C K#

I D#
fW
C K# lo - ,
~X> !~9 zu 5; ~ 5~`-~sU
ID#
ia~~~'~~ U-4) ~
06 CK# '0AThl "yl i_L

ID# ~ 5-A c3 r
i TA?
C K#

I D# S'.

C K#
KE .M zLC_ 5 :~- SkiS-G
Ile ID#
j%2 .7_x() TZrL/6
7CK#
LZK.SL-,a ? LLL SI - :E~A Szv0
SUB-TOTAL $~ r
-i ID
TOTAL (if last page of this schedule) / $

THIS BOX APPLIES TO CANDIDATES' COM*n7EES ONLY :

Purchases of certain-een~aigmprsherl Wag. 0 or more must also be inventoried an Schedule H_ (Refer to Schedule H instructions .)

Expenditures to person s/entilies 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 behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)

(for Schedule B)

t,'d L8LZ -L(3L - 6V9 Ueueagi~ 1396 :60 90 2 100

 FOR INSTRUCTIONS, SEE BACK OF FORM I
Reset Form // SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev . 07/03)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D 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 Organizatfon)

A , '/v f - nrLCl-rZL G2 i q S
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) {Disbursement) WAS MADE
(MMIDD1YR) AND PAC
CHECK
NUMBER
ID#
/ f(~ ~ 7 44/0 L( J
'l
CK# c;TV M.4 sz'ro l
LO 3 q6 ' ,~Z
ID# jY',g l3L~ 5
t4 7-11 roz-,-

ID#

CK#
;~r~o Tl s r sr,~ 7
l li~i l `7 - L t: i .~t
I of -
~ rrt-~~ . E 5 _ .

cK# 3h'~to ~1 TJ , r SGV 1 J

/44
T T~ ;Ogev

S r f ~'~ -s
ID#

l .. i. -

1 r~ -
ID# r

_ _
! ID# laGCO
~cC
}~~1(G~c? h'' 1~t11r I ~ .~

/(t` f l
_ f ~(_7
SUB-TOTAL $ )C
TOTAL (ff lastpage ofthIs schedufe) $

THIS BOX APPLIES TO CANDIDATES' COM11ilITTEES ONLY:

Purchases of ce aLz~llpri Prop ' 00 or more must also be inventoried on Schedule H . (Referto Schedule H Instructions .)

Expenditures to personslenlities 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 personlentity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i).)

(for Schedule B) "

ueueagi~ 13 060 90 2 }0 4
~'d ZeZZ-Z6L- ~t9
 FOR INSTRUCTIONS, SEE BACK OF FORM I R F° SCHEDULE
B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT ` (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
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
D CHECK THIS BOX IF
AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

COMMITTEE NAME (Mustbe same as on Statement of Organization)

CANDIDATE NAME AND ADDRESS TO VVHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
~o - J_ r:to ID# Pr~~ f2a.r.~
Ict
CK# <' $
i- ~:. /- '/i - 1- c~ '

CK#
10C; `n-A- 0-7 tech .
-s-tis:-1
ID# J ~~:
I~aL L S -Z0 .

CK#
-f l-c yl - J - 2 Ll L
_C_ 47
4 L-Ll I - Sy cr &- 8
I D#

'7 c? 1 22
10#
D -7 -C.'(° CK# CI 1t~, h .u-J I C L0IZ14 1!" ;f
3~ '7 - S 7 7,?
Qom
s <A
ID# Lc)a .k
-1Cr -(-Cc CK# I S 1 J4 eh 5 . t-v .
Le 'l
e 'Q03-LA &2 71_p
ID# ~
J.P~ e~1 a1c A~'2~'_ C c~ ;~
_7-JS-U- CK# Kwq i CICI

SUB-TOTAL
TOTAL (iflast page of this schedule) $

THIS BOX APPLIEST6 CANDIDATES' COMMITTEES ONLY:

Purchases of c 1;tiimci~npaignwoper! 500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions.)

Expenditures to personslentities providing consultfng, 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 persoNentity on behalf of the candidate's committee- (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i) .)

(for Schedule B)

ueueagi-I a0Z :60 90 lZ 400

Zd L8LZ-L6L - I,t ,9
 FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form ( SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT

B MONETARY
(Rev. 07103) EXPENDITURES
STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES. LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D CHECK THIS BOX I F
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS S CAMPAIGN DISCLOSURE BOARD.

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

4tiILi P11 T f)~r, 14TLfl FG4- ~Ow/j 5 Tq Tr
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE IDNUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
I D# MU Q x'1-1y 6 .L G( 5~4 xiG ~`tC
l
CK#
`4o~t q `t_r-i
c -47Y ',
s sR-~~nI .,
1:~)
$ l~- ~~~

/a ID# r-It112PKY C~YC ~t~~ c~

.OG_CXP ~ ~ -'>
`i~,~l y ~ 4 T
CK# . L _
LI tl
ID# ~I u llrtih+'( v'~L C~5,9
s
~ C a~
LI oScf y T-J 5° r rn! 9)

ID#

CK#

ID#

CK#

ID#

CK#

10#

CK#

1D#

CK# li

SUB-TOTAL $ 5
TOTAL (iflast page ofthis schedule) $

THIS BOX APPLIES CAADIDIKT COMMITTEES ONLY :

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

Expenditures tospersanslentifiespr"dirig 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 personlentity on behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code 68A.402(3)(1) .)

(for Schedule B)

g'd ueueagi~ eOZ :60 90 2 100

L8LZ- L6L- 6t,9
 FOR INSTRUCTIONS, SEE BACK,. r=ORM I K-SCt i0rIri F SCHEDULE
MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07M3) I 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)

I
CANDIDATE NAME AND ADDRESS TO 1040M PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MMODIYR) AND PAC
CHECK
NUMBER
ID#
U X17 i ST Awkl
CK#
9Zr~z..~' ~ ~L

ID#

rf ,~f l,Io6, CK#

4 f,
06- /L%rtT-( .A1z~C
/1'1 Z-44 S, 24 5vtisc
~ra~Il ~~- . 3~rs >
Z-z -~.~
e- / .- C,-/V

.
(/L46
C K#
cr~lZ L r 5Gt1,~Cj
_CRS>t IS C ~:~ -
ID# Y J~~l.~lL S~G~Zi
,ZG2 (-r~IY f~,
)Oklac < <:f Q Z/-ICI:t z/r 5 ,e t" P.e) ~Ci. .~C.-(LLZ
CK#

ID# f"I i3T

o~ /~ lx CK#
tlr~~~i~ L I ~7Yr
ID#

CK#

1D#

CK#

iD#

CK#

SUB-TOTAL 1$ q
TOTAL (iffast page of this schedule) $

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 personslentifes providing consufthrg, 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 behalf of the candidate's committee . (Refer to
Schedule G Instructions and Iowa Code 68A.402(3)(t) .)

(for Schedule 8)

uelaeagl~ e060 90 2 300

t,-d L8LZ-L6L - ~ V9
 FOR INSTRUCTIONS, SEE BACK OF FORM I Reset Form i~ SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 07103) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, UST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE- A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA
D CHECK THIS BOX IF
AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

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

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DA7E ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIODNR) AND PAC
CHECK
NUMBER

iy - I ID# 5 ~ 79~,
'1c6q ~ c~
$ ~ >! _ h
CK# A)
GNP ° LF :~~-1, S
a,-ZZ . ~~~1
- C`~ __ ~ VE
_
ID# 1lu.tLyzh L~ ~ GfS J- . -p is 7 c>

S7 ~o
ID# (A SO ~' U -) S~
440 ~-D ci
_ ~_-- Y-~>
1 Lfl/ l -
ID#
y~L ~6 - (n_ USi -P (w79("

CK# 1-4gc:C i4' :-J1 S7ilC~~ ~- Lc1,

1D#
67 C~ CL

CK#
~ Cif -tea -s

Nosh ,st~~-6 s L <: y . v3

ma
' CK#
- --~ '
Y-22-0 2- 44a L
ID# jp
Vy)u
f ~!
CK# ~~0-y
~,C/1-I~a -s
ID# ek
`fhcz1L D1i/ O511) k(0-1Cl(o
C-~3 G
CK#
Lo L/ Ll -7 L~
SUB-TOTAL $

TOTAL (If last page of this schedule) $i 3 N

0~9

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 persorrslentities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amouni, purpose, and date of each type of expenditure made by the personrentity on behalf of the candidate's committee . (Refer to
Schedule G instructrone and Iowa Code 68A .402(3)(i) .)

(for Schedule 8)

ueueagi~ 8060 90 2 h 0
g'd Z2ZZ -Z6Z - 6ti9
A'"e--,,6-&- 7
Campaign Donations (check fo

Helen Hahn 20.00 9/24/06

P.O. box 91 Kensett, Iowa 50448
Chris Petersen 20.00 9/12/06
&James Berge
875 B 410th Street Kensett, Iowa 50448
James Berge 30.00 9/5/06
875 B 410th street Kensett, Iowa 50448
I.B .E . W. Educational Committee
200.00 9/29/06
International Brotherhood ofElectrical Workers
900 Seventh Street, N.W.
Washington, D .C . 20001
(Iowa agent)
Sandy Opstvedt 1435 N.E. 54th Avenue Des Moines, Iowa
All American PAC 100 .00 9/27/06
607 14th Street N. W. Suite 800
Washington, D.C. 20005
(Iowa agent)
Chris Hayler
811 Bur Oaks Drive #1207 W.
Des Moines, Iowa 50266
Winnebago County Democratic Committee
Wingding donation 50.00 10/11/06
Winnebago county treasurer
Jane Nagy 104 Sunland Court
Forest City, Iowa 50436
641-585-3443
Cash Donations
McNabb 25 .00 4/06

Lucas J. 45 .00 8/06

Riniker P. 20.00 8/06

Holstad R. 40.00 9/24/06

Brandstad K. 20.00 9/24/06

Spencer S . 5 .00 9/5/06

Tucker J. 45 .00 9/25/06

Lucas J. 10.00 9/25/06

GM
-THE &CRP
IA F
DISGLOSL'RE e0r>RD

OAT 1 7 21106

FILED,
 expenses

Garner Leader 32.00 9/27/06

Pit Stop Printing 128.40 10/12/06

Pit Stop Printing 42.80 9/19/06

42.80 9/29/06

42.80 9/19/06

21 .40 9/28/06

19.65 7/18/06

20.76 8/18/06

Staples 27.80 8/16/06

12.99 8/16/06

24.59 8/16/06

24.58 9/16/06

26 .71 9/28/06

Fertile Library 11 .00 8/14/06

Hobby Lobby 27 .10 6/08/06

Alco ( Nwer sip) 12 .32 10/08/06

Dollar Tree 9 .77 9/16/06

Dollar General 29 .78 9/16/06

Caseys General 19 .37 9/09/06

21 .20 10/10/06
 Caseys General gas 5 .00 7/25/06

Pronto gas 25 .00 10/08/06

Fareway Fnods potluck 76.98 10/07/06

walMart potluck 49.43 9/16/06

Murphy Oil gas 21 .03 6/01/06

27 .58 7/26/06

25 .00 8/19/06

14.98 8/26/06

20.83 9/02/06

9.02 9/04/06

15 .86 9/16/06

11 .47 9/23/06

19.14 10/01/06

21 .89 10/06/06

11 .68 10/13/06

1A ETHICS -& CANwA!GN

DISCLOSURE BOARD

OCT 1 h 2006

PILED
 Notice of r'ssolution FORM
DR-3
(Rev. 07103)

NOTICE OF
DISSOLUTION

For Office Use Only

Comm. #
Indexed
Audited
Computer
Certified Date of Dissolution

Ann Fairchild for Iowa State House

Official Name of Committee

3424 Dogwood Ave

Street
Fertile, Iowa, 50434

City, State, Zip Code

6#41 797-2221
Area Telephone
Code

WHEN TO FILE :
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 property sold or transferred (candidates only); and
4. A final report disclosing all 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 .

'ignature of Candidate or Treasurer (if candidate's committee)l5ignature of Chair or Treasurer (if PAC)

Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM

This form is not applicable to statutory political committees.