FOR INSTRUCTIONS, SEE BACK OF, RM DISCLOSURE S UMMARY PAGE CO M I E NAME (Mu e sam or 1 SPtement of Organization, C 1 6 2~~2 ens r- n T P 1'~ U IMPORTANT: Indicate type of committee you are reporting for: FTI (1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate ( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee ( 8 )Support Slate of Candidates - CANDIDATE COMMITTEES ONLY: Candidate Name D, & Q ught Routine Penalties Due For Late Filed Reports Range from $20 to $800 (report date) CHECK IF AMENDMENT TO REPORT DATED Poll ' f Part e v~ Distr t (if Senate or House) Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. (You must continue to file reports until a Notice of Dissolution is filed.) STATEMENT OF CASH ON HAND FORM DR-2 DISCLOSURE (Rev. 0512002) I REPORT For Office s Onl Comm . # __ Indexed -_ Audited --~! Computer ___W_ 'l~ i S%3 o Z7~-/ ~J oZ. /~ A a L TELEPHONE DOE SIGN#_D SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE: 1 AM FILING A REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR . Indicate one a Local Committees, enter Date of Election County & Local Committees, enter County in which Election is held CASH ON HAND at the beginning of the reporting period . (This is the total of all monies 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. . .. . . $ o~CJ t ~9 7, 6 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 jg& g be zero) (Attach DR-3) ... . . .. . . .... . .. . .. . . . .. . . .. . . ....... . ..... . .... . .. . .... . .... . .. . .... . .. . . . ....... . .. . . .. . . .... .. .... . . .. .$ 1 I **UNPAID BILLS (From Schedule D - Attach Schedule D) . . ..... . .... . .. . .... . ............ .......... . .. ..... . .... . .. . .... .$ ---- -------- *IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) .... . ....... . .... . .. . .... . .... . ................$ ~~0 0 a, "OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . .. . .. . .. .. . . . .. . . . .. . .. . . . .. . . .. . . .. . . . ..... . . . . . .$ "-'- CANDIDATE COMMITTEES ONLY : CONSULTANT BREAKDOWN (Schedule G Attached?) VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) YES v NO $ __ L_
16
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FORINSTRUCTIONS, RM FORM … · 31-Jul-01 Burtwin Day, P.O. Box293, Norway,IA 52318 25.0 X 31-Jul-011 _~ Andrew Christenson, 6454MerleRd,Johnston, IA 50131-1229 50.00 X
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FOR INSTRUCTIONS, SEEBACK OF,
RMDISCLOSURE SUMMARY PAGE
COM I
E NAME (Mu
esam
or1SPtement of Organization, C
1 6 2~~2ens r-
nT
P 1'~
UIMPORTANT: Indicate type of committee you are reporting for: FTI
Routine Penalties Due For Late Filed Reports Range from $20 to $800
(report date)
CHECK IF AMENDMENT TO REPORT DATED
Poll '
f Parte
v~Distr t (if Senate or House)
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3.(You must continue to file reports until a Notice of Dissolution is filed.)
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:1 AM FILING A
REPORT FORAN/A (1) ELECTION /(2)NON-ELECTION YEAR .
Indicate oneaLocal Committees, enter Date of Election
County & Local Committees, enter County inwhich Election is held
CASH ON HAND at the beginning of the reporting period . (This is the total of all monies heldby the committee. This amount MUST be the same as the cash on hand at the endof the last reporting period, or must be zero if this is first report filed .
ADDTOTAL MONEYTAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below)
'Disclosure law requires candidates to disclose themlstionsMp ofany relate making an in kind conkibutlonto the
pap.
I_of-Icommittee. RelaBomhip must be show to the third degree of consanguMlly (blood relatives) anda" (rslatkes
(for Schedule E)by marriage) . (See Page2 ofform packet .) If surname ofconhibutor is the same as candidate, but there is nofamilial relationship, enter -notapplicable' in the relationship coiurnn .
DATERECEIVEDMMIDDNR
NAMEANDADDRESSOF CONTRIBUTOR
RELATIONSHIPTO CANDIDATE' A
DESCRIPTIONOF IN KIND
CONiRBUTKNd
ESTIMATED-FAIR MARKET
VALUE
IF FORFUND4WSERCONTRIBUTION
JulPdtIt A6-44'1~4g:4
/4`101
mrf4A.p/O file d ~ G1 C,f,
a. -~B'A~,l
v.00
rte. . ...~.
.
Pin
of 4
FOR INSTRUCTIONS . SEE BACK C
DRM
1 AM FILING A
DISCLOSURE SUMMARY PAGE
CO
TT E NAME (Must
same as o Stat ment of Organization)01-` r
e7i%S
r
G~dIMPORTANT: Indicate type of committee you are reporting for: FLI( 1 )Statewide/Legislative Candidate (2
c se Committee ( 7 )County/City Central Committee(8
e e a '
f
E$SURER (or person filing this report)
Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:
/'5 j 76TELEPHONE
[]CHECK IF AMENDMENT TO REPORT DATED
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .(You must continue to file reports until a Notice of Dissolution is filed.)
REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR.
STATEMENT OF CASH ON HANDCASH ON HAND at the beginning of the reporting period . (This is the total
of all monies held by the committee . This amount MUST be thesame as the cash on hand at the end of the last reporting period,or must be zero if this is first report filed.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Mustbe
me as on Statement of Organization)
~!1f)117.-fo7u S
/'
/& 4" 1(0-;t-
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THEPAC IDENTIFICATIONNUMBER AND THE PACCHECKNUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGNDISCLOSURE BOARD.
CAUTION : Section 688.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor anycommercial purpose by any person other than statutory political committees .
SUB-TOTAL
TOTAL (if last page of thisschedule)
' Disclosure iaw requires candidate committees to disclose the relationship of any relative making a contribution to thecommittee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives bymarriage) (See Page 2 of forms packet.) . If surname of contributor is the same as candidate, but there is no
Page ~- ofJ__familial relationship, enter "not applicable" in the relationship column .
(for Scnedule A)
SCHEDULE
A MONETARY(Rev . 06/97) RECEIPTS
CHECK THIS BOX IFAMENDING FORM
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT v IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUNO-(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
CK# r~ r~5ID# -
CK# a-vID#-
1CK# S¢i
. ill ~jr
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
Contributions - Money Taken In
Citizens for Maddox
Schedule A [Attachment]
Prepared 1/18/02
A 4F~S'Vo
Page 1 of 8
tPAC t0fA'PAC
CSI and Address ofCM*bJtDrPtebbms*to Arnow
CW40191110 Red"x If t:1,a-
'~ 05-Jan-0 ~~ ransp . Pol . Ed . League PAC #8025, 14600 Detroit Av, Cleveland, OH 44107 500 .00
18-May-01 John & Judy Carlson, 9754 Sunset Ter, Clive, IA 50325 1 20 .00
I Homebuilders Association PAC #6146, 9001 Hickman Rd, Suite 210, Urbandale, IA j30-Jun-01'_ 50322 200 .00
24-Jul-01Ii
6070/2506I
Iowa Law PAC #6070, 521 E Locust, FI . 3rd, Des Moines, IA 50309-1939s i
250 .0
31-Jul-01i
David Brown, 803 Fleming Bldg, Des Moines, IA 50309-T 100 .00
02-Aug-01 Walt & Judy Tomenga, 7250 Hyperion Pointe, Johnston, IA 50131 25 .00 X
02-Aug-01' ' Porter & Beverly Williams, 5380 NW 71st PL, Johnston, IA 50131 50 .00 X02-Aug-01 Michael Carver, 4417 96th Ct, Urbandale, IA 50322
_25 .00_ X
02-Aug-01 John & Wanda Lewis, 2019 Crown Flair Dr, West Des Moines, IA 50 265 25 .00{ X
1 02-Aug-01 Ronald A . & Melba M . Fulton, 8804 Sunflower Cir, Urbandale, IA 50322 50.00 X .R 02-Aug-01 Charles Gabus, 3910 72nd St, Des Moines, IA 50322-2602 250.00 X
02-Aug-01 Richard Pope, 2905 Sherry Ln, Urban dale, IA 50322_ 25.00 XF~02-Aug-01 John & Pam Wharton, 13331 Hickory Av, Clive, IA 50325 50 .00 X
02-Aug-01 Jerry & Darlene Stanto n, 1835 NW 1 04th St, Clive, IA 50325 250 .00 X
02-Aug-01 Barb Beatty &John IA. Merriman, 13850 Lakeshore Dr ., Clive, 50325 50 .00 XI
02-Aug-01 David C or lone E Wilkens, 16 0 1 Buffalo Rd, West Des Moines, IA 5026 50 .00 X02-Aug-01 ~ ~
_John Pappajohn, 24 Foster Dr, Des Moines, IA 50312 100 .00
~^
~^X.
02-Aug-01 Laura & Conrad Githens, 8 211 Twana Dr, Urbandale, IA 50322 10.10_ XM
02-Aug-01 Dave Palmer, 213 SW Flynn Dr, Ankeny, IA 50021 100.00 X02-Aug-01 Ronald E . Cross, 4104 72nd St, Urbandale, IA 50322 50 .00 X
I~ 02-Aug-01 Richard Preston, 700 4 Jefferson, Windsor Hts ., IA 50322 100 .00 X
02-Aug-01 Jon F . & Patricia Crose, 4304 98th St, Urbandale, IA 50322i
_X._^._
02-Aug-011 Adam & Denise Obrecht, 1609 70th PI, Urbandale, IA 50322 50 .00 X
Contributions - Money Taken In
Citizens for Maddox
Schedule A [Attachment]
Prepared 1/18/02 Page 2 of 8
PAC tt*&PAC to Amowd x if Fun4l-Dam Receiued Ch" NameepdAd*89adCow' c RecWred MW tpcof
John Gilliland, 5853 Medow Valley Ct, West Des Moines, IA 50265
Patricia S Ward, 2092 NW 13 4th St, C live, IA 50325
4
Hobie & Dawn Bannister, 10639 Ridgeview Dr, Clive, IA 50325
Charles & Beatrice Moench, 8931 New York, Urbandale, IA 50322
Caroline V. & John Barzen, 3300 Crestmoor PI, Des Moines, IA 50310
E.J . Giovannetti, 3004 Melanie Dr, Urbandale, IA 50322t-_-_
Daryl & Karyl Henze, 4325 75th St, Urbandale, IA 50322
I owa Bev PAC #6098, 321 E. Walnut St, Ste 310, Des Moines, IA 50309
EMC Co. PAC #6033, 717 Mulberry St, Des Moines, IA 50309
Gus [R .L.F.] & Karen Skovgard, 4421 Bdnkwood Rd, Des Manes, IA 50310
Linda Shanks, 1680 NW 81st St, Clive, IA 50325
Bill & Marilyn C orwin, 10989 Hawthorne Drive, Clive, IA 50325-7040
Les & Sharon Aasheim, 8011 Northwest Dr., Clive, IA 50325
David & Sara Hawkins, 13193 Cedar Crest Ln, Clive, IA 50325-8751
Edene Veverka, 403 North Marshall, Prairie City, IA 50228
Bob Hamilton, 7730 Harbach, Clive, IA 50325
Jim & Susan Staudenmaier, 8709 Horton Cir, Urbandale, IA 50322
Timot hy D. Peterson, 9581 Lincoln Av, Clive, IA 50355
Arlo & Madeline McDowell, 181174th St, Windsor Heights, IA 50322
50.0
2 5.00
100 .00
75 .001 X
400 .00 X25 .oot:: X
_50 .00. ~_X25 .00 X
X
25.00 X50.00 X
50.00 X
25.00
25.001 X
100.0 X50 .001 X
50 .00 X
f, 7-) 0.00
Prepared 1/18/02
Page 5 of 8
Kim Schmett, 10141 Lincoln, Clive, IA 50325 25 .00 X
Joe Ellen Hill & Ted Sporer, 1475 NW 92nd St, Clive, IA 50325 50 .001 XMichael Carver, 4417 96th Ct, Urbandale, IA 50322 25 .00 X
Lind a Goeldner, 4038 Kingman Blvd, Des Moines, IA 50311 30 .00 X~.Dick & Pat Christian, 3509 82nd St, Urbandale, IA 50322 250.00 X
t
James D & Janet M Henter, 2182 NW 80th Ct, Clive, IA 50325 25.00 X
Contributions - Money Taken In
Citizens for Maddox
Schedule A [Attachment]
Prepared 1/18/02 Page 6 of 8
PACMW Raiiardtlpr10 x N FrxK-Date Recoived Chm NM SWAd*Wof Co or G*XkWe Reaetwd raiser lrorwie
04-Sep-01 Robert' Sharon Meisenheimer, 4208 74th St, Urbandale, IA 50322 50 .00 X _
10Seep-01 . Jon & Joyce Schneider, 3208 Mary Lynn Dr, Urbandale, IA 50322 T_~ - - 25 .00 .. ^Xd
I10-Sep-01 ArthurA & Judith A Andersen, 701 52nd St, West Des Moines, IA 50265 25 .00 X12-Sep-01 ' Diane Kutzko, 2026 5th Av, SE, Cedar Rapids, IA 52403 200 .00 X
23-Sep-01 ' Jane & James Clark, 9871 Lincoln Av, Clive, IA 50325 j 100.0 X(~ Q So Bankers Unite In Leg . Decision 6430, 418 6th Av, Ste 430, Des Moines, IA 50309- I
25-Sep-0143012517e2420 150 .00 X
j Independent Ins . Agents of Iowa PAC #6052, 4000 Westown Pkwy, West Des25-Sep-01 6052/2520 Moines, IA 50265 100 .0 X
! 1Meredith Corporation EE Fund PAC #6099, 1716 Locust St, Des Moines, IA 50309- j
25-Sep-0160991580 3023 150 .001 X
25-Sep-01 6070/2524 I ow a Law PAC #6070, 521 E Locust, FI 3rd, Des Manes, IA 50309 j 150 .00 X
I -~ ~ Iowa Certified Public Acc'tants PAC #6062, 950 Office Park Rd, Ste 300, West Des ~ I-~ j 25-Sep-01 6062/1315 Manes, IA 50265-2548 150 .00 ^_
Iowa Committee of Auto Retailer PAC #6059, 1111 Office Park Rd, West Des 1,
25-Sep-01 6059/2105 Moines, IA 50265 150 . X
{ 25-Sep-01 1 I Iowa Independent Bankers PAC #6160, 1623 22nd St, West Des Moines, IA 50266 250 .00 X
I ~ I PIowaTelecommunications Assoc . PAC #6087, 1601 22nd St, Suite 209, West Des25-Sep-01 6087/1120 Moines, IA 5026 6 250 .00 X
Iowa Optometric Association PAC #6118, 1454 30th St, Suite 204, West Des Manes,25-Sep-01 611811732 IA 50266 250.00 X
25-Sep-01 Carlos Jayne, 3523 SW 37th St, Des Moines, IA 50321 25.00 X
25-Sep-01 6077/1544 Iowa Pharmacy PAC #6077, 8515 Douglas, Ste 16, Des Moine s, IA 50322 150.00( X
25-Sep-01 6486/1050 Iowa Telecom PAC #6486,115 S 2nd Av, Newton, IA 50208 100.0 X
25-Sep-01 8025/1467 Transp. Pol . Ed . League PAC #80 25, 14600 Detroit Av, Clevel a nd, OH 44107 1 50 .00 X
26-Sep-01 6069/1836 Iowa Indus try PAC #6069, 904 Walnut, Suite 100, Des Moines, IA 50309-3503 {~ 100 .00 X
26-Sep-01 Joh n Shors, 2923 Fox Ru n, Des Moines, IA 50321 150.E ~- X _
{
26-Sep-01 635 1/1065 Petroleum Marketers of Iowa PAC #6351, 1303 50th St, West Des Moines, IA 50266 150 .0 X
Contributions - Money Taken In
Citizens for Maddox
Schedule A [Attachment]
6101/2131
6411/1130
i17-Oct-01
ITeresa A. Weis Preston, 7021 Sheridan Cir, Urbandale, IA 50322
50.00,17-Oct-0116107/3222
10west PAC #6107, 925 High St, 9S9, Des Moines, IA 50309
I
1
100 .00
623711386
29-Nov-0116038/0028
1Verizon Iowa State Good Govt CI PAC #6038, 111 1th Av, Grinnell, IA 50112
1
1
100.00
30-Sep-01
Steve & Dawn Roberts, 666 Walnut St, St 2500, Des Moines, IA 50309-3993
j
100.00
30-Sep-01
Susan Cameron, 2202 NW 140th St, Clive, IA 5 0325
10000'
X
01-Oct-01
06-Oct-01
18-Oct-01
23-Oct-011
IWarren Riekenberg, 3209 Melanie Dr, Urbandale, IA 50322
13-Nov-011
1Michelle Wood, 10055 Lincoln Av, Clive, IA 50325
1 3- Nov-6323/2482
Master Builders of Iowa PAC #6323, 221 Park St, Des Moines, IA 50303 .
14-Nov-011
Sandra Wilson, 10985 Lincoln Av, Clive, IA 50325
27-Nov-01
James Fox, 1707 Walnut St, P.O. Box 514, Dallas Center, IA 50063-0514
25.00
02-Dec-01
ILu A Cag in, 1 5 93 NW 103rd St, Clive, IA 50325
(
;
25.00'
02-Dec-011
+( Drew & Karla Tillotson, 1250 71st St, Windsor Heights, IA 5031102-Dec-011
PAC 09 &PAC p io MM* X rfFwnd-Dato awed Nomad`Addreaailfifia utoc 'C RWeVed raiWlnc"
28-Dec-01 6113/2519 AFSCME/Iowa Council 61 PAC #6113, 4320 NW 2nd Av, Des Moines, IA 50313 250.00
28-Dec-01 Dale & Mary Belknap, 6819 Oakwood Dr, Des Moines, IA 50322 25 .00
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :
Purchases of certain campaign property costing 5500 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/en'ity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(i) .)
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVECANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE [j CHECK THIS BOX IFPAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORMETHICS & CAMPAIGN DISCLOSURE BOARD .
COMMITTEE NAME (Must be same as on Statement of Organization)
CANDIDATECANDIDATE NAMENAME ANDAND ADDRESSADDRESS TOTO WHOMWHOM PURPOSEPURPOSE AMOUNTAMOUNTDATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE(MM/DD/YR) AND PAC
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the
Page
I- ofIcommittee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives
(for Schedule E)by marriage).
(See Page 2 of forms packet.) If sumame of contributor is the same as candidate, but there is nofamilial relationship, enter "not applicable" in the relationship column .
DATERECEIVED(MMIDDIYR)
NAME AND ADDRESSOF CONTRIBUTOR
RELATIONSHIPTO CANDIDATE" (if applicable)
DESCRIPTIONOF IN KIND
CONTRIBUTION
ESTIMATEDFAIR MARKET
VALUE
4 IF FORFUND-RAISERCONTRIBUTION
f 1265
/ f(a
FOR INSTRUCTIONS, SEE BACK OF FORM
THIS FORM IS USED BY CANDIDATES' COMMITTEES ONLY
COMMITTEE NAME (Must be same as on Statement of Organization)
r
-r'"n S
r auxPART I - ONGOING INVENTORY OF CAMPAIGN PROPERTY
PART II - SALES OR TRANSFERS OF CAMPAIGN PROPERTY "'
TOTAL VALUE CAMPAIGN PROPERTY THIS REPORT(TRANSFER TO SUMMARY PAGE) $
7 7
(TRANSFER TO SUMMARY PAGE) $
' If estimated, show est. beside figure .
"" PROPERTY SALES & TRANSFERS TOTAL
TOTALS
SCHEDULE
H I CAMPAIGN(Rev . 02/96)
PROPERTY
ATTACH SCHEDULE H TOEACH REPORT, MAKINGCHANGES AS REQUIRED .
CHECK THIS BOX IFAMENDING FORM
(Attach Additional Schedules if Needed)
Page
of
Pages(For Schedule H)
Date Purchased(Schedule B)
or Date Received(Schedule E)MM/DD/YR
Description of PropertyPurchase
Price or Est .Value WhenAcquired*
CurrentValue at FairMarket ThisRe rt
~x6 f4o
Date(MM/DD/YR)
Name and Address of Purchaser/Donee Description of Property Sold?YIN