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10 15 004
09:08
FOR
INSTRUCTIONS,
SEEBACK
OF
FORM
DSCLOSURE
SUMMARY
PAGE
COMMTTEE
NAME
(Must
be
sam
as
on
Statemnt
of
Organization)
Mller
for
Iowa
Housc
IMPORTANT,
Indicate
by*
type
of
commtteeyou
are
reporting
for
:
 1
)Statewde/Legislative/Judge
Standing
for
Retention
Candidate
 
2
)State
PAC
 
3
)StateParty
(4
)County
Central
Commttee
 
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
Subdivision
P
AC
 
11
 
Local
 
allot
I
ss
ue
CANDDATE
COMMTTEESONLY
Political
Party
 if
appiicable)
Ronald
Mller
 
Demcrat
District
 if
Senate
or
House)
Canddate
Name
Ofice
Sought
OCT
Housc
Rcprcscnativc
 
-
 
21
SIGNATURE
O
PERSON
FILING
REPORT
I
AM
FILING
A
 
October
19
Dsclosure
CCHECK
IF
AMENDMENT
TO
REPORT
DATED
1319,832799
 
RFSkl
AtID
CO52004
31
q-a83°3a
.~d
TELEPHONE
(reportdate)
 
Indicate
by
D
Check
if
this
is
final
(termnation)report
and
attach
Notice
of
Dssolution
FormDR-3
(You
mst
continue
to
file
reports
until
a
DR-3
is
filed
.
STATEMENT
OF
CASH
ONHAND
REPORT
FOR
1)
ELECTION
l(2)NONELECTIONYEAR,
 
CASH
ON
HAND
at
the
beginning
of
the
reporting
period
.
(Total
of
all
funds
held
by
the
commttee,This
amunt
MUST
be
the
sam
asthecashon
hand
at
the
end
of
the
last
reporting
period
or
mst
bezero
if
this
isfirst
report
filed
.
....
 
.
 
.
 
...
 
.
 
.......
 
..
 
.
$
ADD
TOTAL
MONEY
TAKEN
IN
THS
PEROD
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
Camagn
Property
(Attach
Schedule
H)
 
.
 
....
 
..
 
..
 
....
 
..
 
..
 
.. 
e_dule
H
applies
to
Canddates'
Commttees
Ohl
SUB-TOTAL
.
.
...
S
 
10,513
.18
SUBTRACT
TOTAL
MONEY
SPENT
THS
PEROD
Schedule
5
Expenditures
total
(Attach
Schedule
13
( also
see
debts
and
loans
below
.
 
.
 
5,459
47
Schedule
F
:
Loan
Repaymnts
total
(Attach
Schedule
F)
.
 
.
 
.
 
.
 
..........
 
..
 
.
 
...
 
.
 
CASH
ON
HAND
at
the
end
of
this
reporting
period
 if
final
report
balance
mst
be
zero)(Attach
 
DR-3)
.
 
..
 
...
 
........
 
.
 
....................
 
..
 
.....
 
.
I ll
 
.......
 
.
 
.....
 
...
 
..
 
...
 
....
 
..
 
.
 
.,...
 
.
UNPAD
BLLS
(From
Schedule
D
-Attach
Schedule
D)
...
 
.......
.
...
 
..
 
..
 
..
 
......
 
....
 
.
 
..
 
..
 
..
 
.
 
.,
5
'IN
KIND
CONTRBUTIONS
(FrpmSchedule
E
-Attach
Schedule
E)
.......
 
...
 
.
 
..
 
...
 
..
 
....
 
...
 
..
 
.
' 'OUTSTANDNG
LOANS
(FromScheduleF-AtachSchedule
F)
.
 
.,
 ..
 
.....
 
.
 
.
 
_
.
CANDDATE
COMMTTEES
ONLYCONSULTANT
BREAKDOWN
Schedule
G
Atached?)
VALUE
OFCAMPAGN
PROPERTY
(From
Schedule
H
:
Attach
Schedule
H)
 
DSCLOSURE
REPORT
FORM
DR-2
(Rev
07/'2004)
For
Ofice
Use
Only
Comm
 
Logged
In
 ~L
ScannedComputer
Audited
Late
reports
are
subect
to
possible
civil
and
crimnal
penalties
.
Local
Commttees
.
enter
Date
of
Election
County
&
Local
Commttees,
enter
County
in
which
Election
is
held
3,748
.18
6,765
.00
5,053
.71
75
.00
2
.000.00
-15-0
DATESIGNED
PAGE
01
 
101151'2004
09
:08
 
13192832799
 
RFS J
Af1D
CO
 
PAGE
02
For
Instructions,
See
Back
of
Form
CONTRBUTIONS
--
MONEY
TAKEN
IN
(Including
candldaln spersonalfunds)
COMMTTEE
NAME
(Must
be
same
as
on
Statement
of
Organization)
Mller
for
Iowa
House
SCHEDULE
A
MONET RY
(Rev
07/03)
 
RECEPTS
CHECK
THS
BOX
IF
AMENDNGFORM
STATE
CANDDATES
NOTE
IF
A
CONTRBUTION
S
RECEVED
FROM
ASTATE
PAC
(POLITICAL
ACTION
COMMTTEE),
LIST
THEPAC
IDENTIFICATION
NUMBER
AND
THE
PACCHECK
NUMBER
IN
THE
DESIGNATEDCOLUMN
A
LIST
OF
ID
NUMBERS
IS
AVALABLE
FROM
THEIOWA
ETHICS
AND
CAMPAGNDSCLOSURE
BOARD
 
CAUTION
Section
 8B
.32A(6),
IowaCode,
prohibits
the
use
of
information
copied
from
reports
and
statements
for
soliciting
contributions
or
for
any
commercialpurposeby
any
person
other
than
statutory
political
commttees
 
SUB-TOTAL
~~1g5
TOTAL
(if
last
page
of
this
schedule)
S
Disclosure
law
requlrCs
candidate
commitees
to
disclose
the
relationship
of
any
relsltive
making
s
contribution
to
the
commttee
 
Reletlonship
must
be
shown
to
the
third
degree
O
consanguinity
(blood
rel tives
and
affinity
(relAllves
by
marriage)
 
If
surname
of
contributor
is
the
same
as
candidate,
but
there
 s
no
 
Page
 
f
famlial
relationship,
enter
 notapplicable
the
relationship
column
 
(for
Schedule
A)
DATEPAC
ID
NUMBER
NAME
AND
ADDRESSOF
CONTRIBUTOR
RELATIONSHP
 MOUNT
RECEIVED
(ifapplicable)
TO
CANDDATE
RECEVEC
(MMDDYR)
ANDPAC
CHECK
 if
applicable)
NUM ER
ID
John
Frost
 
100
00
-16-04
CK
410
Roxannc
Drive
4329
Fairbank,
Iowa
50629
ID
6129
HeavyHghway
PAC
7-19-04
CK
2415
Ingersoll
Ave
250
.00
1857
Des
Moines,
Iowa
50312-5233
 
D
Irma
Hopkins
7-21-04
CK
Box
668
15.00
2930
,Tesu
 
Iowa
 
50648
ID
6()84
Iowa
Suite
U W
7-26-04
CK
27005
River
Rd
500
.00
732
Dcs
Plaines
IL
60018
 
D
Bonita
Davis
7-26-04
CK
207
Allcrton
AveSw
25
.00
7543
Tndependence,Iowa
50644
 
D
Marry
Dodge
7-31-04
CK
307
TerraceDrive
20
.00
1472
Independence,
Iowa50644ID Debra
T3rase
7-29-04
CK
1217
110th
St
50
.00
4368
Fairbank,
Iowa
50629
 
D
Dick
Cameron
8-1-04
CK
1372
Otterville
Blvd
40
.00
cash
led
endenec,
Iowa
50644
 
D
Pass
thehat
8-1-01
CK
155
.00
cash
ID
Marry),
Klotzbech
5-1-04
CK
4013rd
Ave
SW
30
.00
7655Independ
encc,I
owa
50644
 
10 15/2004
09:08
 
13192832799
 
RF&4
AND
CO
 
PAGE
0
 3
For
Instructions,
See
Back
of
Form
CONTRIBUTIONS
--
MONEY
TAKEN
IN
 Including
candidate s
personal
funds)
COMMTTEE
NAM
(Must
be
sam
as
on
Statemnt
of
Organization)Mller
for
Iowa
Hou9e
SCHEDULE
A
 
MONETARY
(Rev
 
07/03)
 
RECEPTS
CHECK
THS
BOX
IF
AMENDNG
FORM
STATE
CANDDATESNOTE
IF
A
CONTRBUTON
S
RECEIVED
FROM
A
STATE
PAC
(POLITICAL
ACTION
COMMTTEE)
LIST
THE
PAC
IDENTIFICATION
NUMBER
ANDTHE
PAC
CHECK
NUMBER
IN
THE
DESIGNATED
COLUMN
A
LIST
OF
ID
NUN18ERS
IS
AVAILABLE
FROM
THE
IOWA
ETHCS
AND
CAMPAGNDSCLOSURE
BOARD
CAUTION
Section
68B
32A(6),
Iowa
Code,
prohibits
the
use
of
information
copiedfrom
reports
and
statements
for
solldtlngcontributions
or
for
any
commercialpurposebyany
person
other
than
statutory
political
commttees
 
SUB-TOTAL
TOTAL
 if
last
page
of
this
schedule)
Dsclosure
law
requires
candidate
commttees
to
disclose
the
relationship
of
any
relative
making
a
contrihution
to
the
commttee
 
Relationship
must
be
shown
to
the
third
degree
or
consanguinity
(blood
relatives)
end
aHinlly
 relatives
by
marriage)
 
If
surname
of
contributor
is
the
sam
as
candidate,
but
there
Is
no
 
Page
 
_
of
famlial
relationship,
enter
 riot
applicable
in
the
relationship
column
 
for
Schedule
A)
DATEPAC
10
NUMERNAM
ANDADDRESS
OF
CONTRBUTOR
RELATONSHP
AMOUNT
d
IF
FOR
RECEVED
 if
applicable)
TO
CANDDATE
RECEVED
FUND
(MMDDYR
AND
PAC
CHECK
 if
applicable)
RASER
NUMER
INCOME
ID*
Ed
Zmmr
 -I-04
CK
501
2ndAve
NE
15
.00
gT4g
Independence,
Iowa
50644
 
DO
Rchard
Shillinsglaw
ht
.A
 
8-1-04
CK
508
3rd
Ave
SE
100
00
418
Independence,
Iowa
50644
ID*
Lea
 
8-1-04
CK
417
3rd
Ave
NE
20
.00
 
3411
Independence,
Iowa
50644
ID David
Neil
8-1-04
CK
932413ishop
30
00
,/
1972
LaPorte
Citv,
Iowa
50651
10
Karen
Connell
8-1-04
CK
312
2ndAve
SW
20
.00
 
818
Independcncc,Iowa50644
ID
Jeanette
Randall -1-04
CK
706
3rdavc
Sw
15
.00
 
012
Independence,
Iowa
50644
1D
Wn
Reedy
8-1-04
CK
3046
Evcrly
Ave
50
.00
f
3939Brandon,
Iowa
52210
I
D
Marty
Mahoney
8-1-04
CK
8009
702
4th
St
NE
15,00
 
Independence,
Iowa
50644
I
D
Dane
Curry
8-1-04
CK
6102nd
St
 
40
00
 
1326
Ind
endence
Iowa50644
ID Gadys
Peters
5-1-04
CK
407
3rd
S1
30
00
,/
4962
Washburn
.Iowa50706

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