PCLK CCCNTY DEMOCRATIC CENTRAL COMMITTEE · 19/05/2004 · 515-255-7696 April 23, 2005 SIGNATUREOFTREASURER(orpersonfiling this report) TELEPHONE DATESIGNED ... Computer I AMFILINGA

FORINSTRUCTIONS, SEE BACK OF FORM

DISCLOSURE SUMMARY PAGE

20F

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

,PCLK CCCNTY DEMOCRATIC CENTRAL COMMITTEE

IMPORTANT: Indicate type of committee you are reporting for:

( 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

515-255 -7696

April 23, 2005SIGNATURE OF TREASURER (or person filing this report)

TELEPHONE

DATE SIGNED

Penalties Due For Late Filed Reports Range from $10 to $400

SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE:

[NCHECK IF AMENDMENT TO REPORT DATED May

19,

2Q C /I

p 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

I DISCLOSURE(Rev . 09/97)

REPORT

For Office Use Only

Comm . #

915Indexed

AuditedComputer

I AM FILING A

REPORT FORAN/A (1) ELECTION /(2)NON-ELECTION YEAR .(report date)

Indicate one

Local Committees, enter Date of Election

County & Local Committees, enter County inwhich Election is hell

CASH ON HAND at the beginning of the reporting period . (This is the totalof all monies held by the committee. This amount MUST be the

(Schedule H applies to Candidates' Committees Only)

SUB-TOTAL .. . . . $

46661!A9

-~'SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B: Expenditures total (Attach Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1q!1. . . . . . . . . . . . . . . . . . . .Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .g1 . .~

23915-10249 1 .36

_R 3 .

~>

CASH ON HAND at the end of this reporting period (if final report, balance mustbe zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 20255-03

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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

CANDIDATE COMMITTEES ONLY:

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO

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

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

9137-15

Schedule A: Cash Contributions total (Attach Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44254-34Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 5 0C . 0 0Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For Instructions, See Back of Form

CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)


Polk County Democratic Central Committee

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD .

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person otherthan statutory political committees .

" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .

TOTAL (if last page of this schedule)

SUB-TOTAL

1 $

545.00

Page

1

of

4 0(for Schedule A)

SCHEDULEMONETARYRECEIPTS

(Rev. 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE- RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME

ID# Frederic S . LaCroix01/05/04 1128 45th St. $ 20.00

CK# 1144 Des Moines, IA 50311

ID# Marilyn Murphy01/05/04 1925 S.E . 82nd St . $ 150.00

CK# 8804 Runnells, IA 50237

ID# Ronald W. Nielsen01/05/04 6004 Terrace Dr. $ 25.00

CK# 6961 Johnston, IA 50131

ID# Lynn O'Hern01/05/04 6085 Greywood Circle $ 20.00


ID# Diane Krell01/05/04 1620 S . 43rd St . $ 100.00

CK# 1114 West Des Moines, IA 50265

ID# Lorraine M . Hackett01105/04 816 45th St. $ 20.00


ID# Gerald O . Ott01105/04 2854 Druid Hill $ 40.00


ID# Robert R . Waddill01/05/04 924 45th St . $ 50.00


ID# Robert E . Jester01/05/04 4201 Timberwood Dr . $ 100.00


ID# Daniel C . Aten01/05/04 5904 Dakota Drive $ 20.00





Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD .

CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees .

* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

I $

5,450.00

Page

2

of

4 0',(for Schedule A)

SCHEDULE

A MONETARYRECEIPTS(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Walter D . Felker

01/05/04 2701 N .E . Delaware Ave . $ 150.00CK# 5324 Ankeny,IA 50021

ID# Timothy J . Brien01/09/04 3919 Urbandale Avenue $ 100.00


ID# Rebecca McCreary01/09/04 5513 Kensington Circle $ 50.00


ID# Laura R . Belin01/14104 1705 Plaza Circle $ 25.00

CK# 1422 Windsor Heights, IA 50322

ID# Charles R . Montgomery01/14/04 940 45th Street $ 20.00


ID# James E . Wilson01/14/04 2813 Scenic Place $ 40.00


ID# A.D . Bachman01/14/04 1012 28th Street $ 20.00


ID# Taramattie Ganpat-Puffet01/14/04 5116 69th Street $ 20.00

CK# 4231 Urbandale,IA 50322

ID# Lori Burgess01/16/04 5134 68th Street $ 25.00

CK# 2081 Urbandale, IA 50322

ID# Jeffrey Krinsk01/16/04 567 Gage Lane $ 5,000.00

CK# 945 San Diego, CA 92106








SUB-TOTAL

I $

525.00'

Page

3

of

40(for Schedule A)

SCHEDULE MONETARYRECEIPTS

(Rev. 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Howard Hoy

01/19/04 2624 Boyd St. $ 250.00CK# 3978 Des Moines, IA 50317

ID# Sara Bisterfeldt01/19/04 1821 75th St. $ 50.00


ID# Jane E . Brown01/19/04 11646 121st St . $ 50.00

CK# 9352 Granger, IA 50109

ID# Maxine Grove01/19/04 608 N . James St . $ 25.00

CK# 9009 Granger, IA 50111

ID# Linda Newsom01/19/04 2637 S .E . 88th St. $ 25.00


ID# Steve Burch01/19/04 601 Grand Oaks Dr. $ 25.00


ID# Luann Johnson01/19/04 2818 36th St. $ 25.00


ID# Korpella Engineering01/19/04 1239 73rd St. $ 25.00


ID# Lisa Sandos01/19/04 3702 132nd Circle $ 25.00

CK# 1192 Urbandale, IA 50322

ID# Brian Millard01/19/04 3920 Lynner Drive $ 25.00






CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees.

Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

I $

250.00

Page

4

of

49(for Schedule A)

SCHEDULEA MONETARYRECEIPTS

(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Sheila Pottebaum

01/19/04 651 44th St . $ 25.00CK# 5316 Des Moines, IA 50312

ID# Robert Mannheimer01/19/04 3363 Grand Ave . $ 25.00


ID# Sherri Saul01/19/04 4310 Pleasant St . $ 25.00


ID# Colleen Jennings01/19/04 120849th St . $ 25.00


ID# Betty Brim-Hunter01/19/04 452 Wilmers Ave . $ 25.00


ID# Denise Tutty01/19/04 903 45th $ 25.00


ID# Harold Belken01/19/04 416 SE Gray $ 25.00


ID# Nancy Keunen01/19/04 416 SE Gray $ 25.00


ID# Jo Ellen McGrane01/19/04 3130 Beaver Ave . $ 25.00


ID# Alan Hutchison01/19/04 4328 New York Ave . $ 25.00









SUB-TOTAL

I $

215.00'

Page

5

of

4 9(for Schedule A)

SCHEDULE MONETARYA RECEIPTS(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# George Wells

01/19/04 3935 14th St . $ 25.00CK# 10172 Des Moines, IA 50313

ID# Ilo Stark01/19/04 1203 W. Euclid Ave . $ 25.00


ID# Renee Friend01/19/04 1264 NE 64th St . $ 25.00

CK# 1359 Altoona, IA 50009

ID# Marcia Nichols01/19/04 5917 Greendale Place $ 20.00


ID# Robert Galde01/19/04 1750 SE McKinley Ave . $ 20.00


ID# Vivian Givant01/19/04 4820 Elm St. $ 20.00


ID# Beverly Long01/19/04 4025 11th St . $ 20.00


ID# Carl Pierce01/19/04 7205 Jefferson Ave. $ 20.00


ID# Shirleen Erickson01/19/04 733 NE 9th St. $ 20.00

CK# 8064 Ankeny,IA 50021

ID# Suzanne Meyers01/19/04 4205 Walnut St . $ 20.00


For, Instructions, See Back of Form




STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.




SUB-TOTAL

I $

165.00 I /

Page

6

of

4 9(for Schedule A)

SCHEDULE

A MONETARYRECEIPTS(Rev. 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Kathryn Vasey

01/19/04 218 SW Herold $ 20.00CK# 5612 Des Moines, IA 50315

ID# Barbara Mentzer01/19/04 111 Kenyon $ 20.00


ID# Bonnie King01/19/04 2916 E . Tiftin Ave . $ 20.00


ID# Ellen Laws01/19/04 2415 E . 14th St. $ 20.00


ID# Elma Marquadt01/19/04 409 SE 9th ST . $ 20.00


ID# Frances Dailey01/19/04 4129 Beavercrest $ 20.00


ID# Lorraine Appell01/19/04 442 E . Hart Ave . $ 15.00


ID# David Schilling01/19/04 5135 SE 104th $ 10.00


ID# Ruth Davis01/19/04 711 Loomis $ 10.00


ID# Sharla Yeutsy01/19/04 4313 75th St . $ 10.00

'DICK# 4779 Urbandale, IA 50322




Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD .

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees .

Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationship''column .


SUB-TOTAL

1 $

100.001

Page 7 of 49(for Schedule A)


(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Bonnie Yazel

01/19/04 3950 52nd St . $ 10.00CK# 11406 Des Moines, IA 50310

ID# Krista Kulas01/19/04 5808 Crabapple Lane $ 10.00


ID# Craig Torkelson01/19/04 411 46th Place $ 10.00


ID# Polly Antonelli01/19/04 1807 6th St . $ 10.00


ID# Lesvia Lucas01/19/04 1124 Locust St . $ 10.00


ID# Teresa Jones01/19/04 733 26th St. $ 10.00


ID# Melissa Keeton01/19/04 1001 Frederick Ave. $ 10 .00


ID# Barbara Post-Althaus01/19/04 1510 Thompson Ave . $ 10 .00


ID# Karen Person01/19/04 203 5th St. $ 10.00

CK# 1274 Waverly, IA 50677

ID# David Beck01/19/04 1937 NW 89th St . $ 10.00

CK# 3601 Clive, IA 50325





STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD .




SUB-TOTAL

I $

50.00

Page

8

of

4 9(for Schedule A)

SCHEDULE MONETARYRECEIPTS

(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# Alecia Fry01/19/04 1644 Hull $ 5.00


ID# J . Drue Cavanaugh01/19/04 11281 NW Towner $ 5.00

CK# 7157 Grimes, IA 50111

ID# Christina Gonzalez01/19/04 2420 Maple St. $ 5 .00


ID# Eileen Kiess01/19/04 1056 56th St. $ 5 .00


ID# Janet Maldonado01/19/04 1110 Orchard Lane $ 5.00


ID# Mirsada Juhl01/19/04 2710 25th St . $ 5.00


ID# Rita Mason01/19/04 2744 Arnold Rd . $ 5.00


ID# Fuad Bejtovic01/19/04 2424 Payne Rd . $ 5.00


ID# Barbara Braak01/19/04 3829 82nd St . $ 5 .00


ID# Martha Raymond01/19/04 2571 Guthrie $ 5.00

1:]-CK# 4308 Des Moines, IA 50317


CONTRIBUTIONS -- MONEYTAKEN IN(Including candidate's personal funds)


Polk County Democratic Central CommitteeSTATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.




SUB-TOTAL

1 $

298.001,.-

Page

9

of

4 9(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Linda Russell

01/19/04 3821 13th St. $ 5.00CK# 1236 Des Moines, IA 50313

ID# Edith Munro01/19104 2015 68th St . $ 25.00


ID# Todd Russell01/19/04 6805 Timmons Dr . $ 20.00


ID# Carl McPherson01/19/04 1537 21 st St . $ 10 .00


ID# Jodi Bogue01/19/04 1700 38th St. $ 10.00


ID# Evelyn Christianson01/19/04 116 5th Ave . NW $ 3.00


ID# Carole Kavanaugh01/19/04 3000 Sylvania $ 100.00


ID# Marybeth Gardem01/19/04 1629 NW 102nd $ 50.00

CK# 3235 Clive, IA 50325

ID# Randy Hansen01/19/04 3400 Valdez Dr . $ 50 .00


ID# John Casper01/19/04 223 E . Court Ave. $ 25.00

CK# 5235 Winterset, IA 50273






CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees.

* Disclosure law requires candidate committees to disclose the relationship of -any relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationship

Page

1 0

of

4 4column .

(for Schedule A)



CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# Devonne Douglas01/19/04 5357 NW 66th Ave . $ 25.00


ID# Monica Moore01/19/04 6151 Country Ridge Lane $ 20.00


ID# Patricia Wengert01/19/04 4213 41st St. $ 10 .00


ID# Lora Rogerson01/19/04 3610 SW 36th $ 10.00

CK# 1156 Des Moines . IA 50321

ID# August Luthens01/19/04 8 W. Howard St. $ 10.00

CK# 2326 Colfax, IA 50054

ID# Grace L. Connell01/19/04 701 Morton Ave . $ 5 .00


ID# Michael Trier01/19/04 7640 NW 16th $ 100.00


ID# Cash contributions received at caucus "bucket pass"01/19/04 $ 16,706 .18

CK# CASH

ID# David Perret02/03/04 5321 Shriver Ave . $ 100.00


ID# David Van Sickel H02/03/04 509 57th Court $ 20.00CK# 8290 West Des Moines, IA 50266






* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

' $

450.00

Page 11 of 49(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# Marlene Alberigo

02/15/04 524 Sixth $ 250.00CK# 172 West Des Moines, IA 50265

ID# Sally Troxell03/12/04 701 54th St. $ 25.00


ID# Jerry Overman03/12/04 2118 Morton Ave . $ 25.00


ID# He Lives Ministry NSL03/13/04 1309 University Ave . $ 20.00


ID# Lark W . Roberts03/13/04 4904 W. Park Dr . $ 20.00


ID# Richard Bame03/13104 5821 Brentwood Circle $ 20.00


ID# Denise Mernka03/13/04 4328 New York Ave . $ 20.00


ID# R . Saffin Sams03/13/04 812 57th St . $ 25.00


ID# Susan A. Pohl03/13/04 8689 Sunny Hill Dr . $ 25.00


ID# Judie Horka03/13/04 704 62nd St . $ 20.00







* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

I $

240.00'

Page

1 2

of

4 9'(for Schedule A)

SCHEDULE MONETARYA RECEIPTS(Rev. 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Victoria Purcell

03/13/04 2019 68th StreetCK# 2215 Windsor Heights, IA 50322 20

ID# Alyssa Mowitz03/13/04 716 - 17th St .

CK# 654 Des Moines, Iowa 50314 20

ID# Dale A . Berry03/13/04 7039 Oak Brook Drive

CK# 8818 Urbandale, Iowa 50322 40

ID# Joyce A. Shackelford03/13/04 2011 E . 29th St.


ID# Lawrence P . Staunton03/13/04 5512 Dakota Dr .

CK# 6122 West Des Moines, Iowa 50266 20

ID# Paul E . Knupp, Jr.03/13/04 1804 - 44th Street


ID# Frank Affannato03/13/04 1128 22nd St .

CK# 2813 Des Moines, Iowa 50311-4412 20

ID# Mary P . Maloney03/13/04 3415 Witmer Pky.

CK# 10054 Des Moines, Iowa 50310-4434 20

ID# Emily Westergaard03/13/04 4009 E . 23rd St .


ID# John E . Kaiser03/13/04 5800 SE 2nd St.


For' Instructions, See Back of Form






* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity'(relatives by marriage). If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn.


Page

1 3

of- 49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# Marcia L . McFall03/13104 4333 Park Ridge Ave. #37

CK# 5783 Pleasant Hill, Iowa 50327 20

ID# Gary Thompson03/13/04 7209 SW 17th St.


ID# Sara Goul03/13/04 3220 Brinkwood


ID# Cathy M . Bienkowski03/13/04 9373 Lincoln Avenue

CK# 4407 Clive, Iowa 50325-6325 20

ID# Kyle J . Carlson03/13/04 7419 Canterbury Rd .

CK# 1533 Urbandale, Iowa 50322-4616 20

ID# Phyllis Blood03113104 3848 Beaver


ID# William A . Genzen03/13104 2335 E . 39th Street


ID# Deborah A . Baker03/13/04 1009 Grant Street S .

CK# 8880 Bondurant, Iowa 50035-2026 20

ID# Bonnie J . Davies03/13/04 1141 N.W . Prairie Ridge Dr.

CK# 5547 Ankeny, Iowa 50021 20

ID# Amy Fokuo03/13/04 2200 Prospect Avenue






CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees.

" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

I $

200.00'

Page

14

of

4 9(for Schedule A)


(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DDNY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Sally B . Bowzer

03/13/04 3209 86th Street, Apt . 215CK# 1100 Urbandale, Iowa 50322 20

ID# Leland Searles03/13/04 603 Little Beaver Drive S .

CK# 1245 Grimes, Iowa 50111 20

ID# Elisabeth M . Lewin03/13/04 1307 8th Street


ID# Daniel C . Aten03/13/04 5904 Dakota Drive


ID# Ray W . Peters03/13/04 405 NW . Irvinedale Dr .

CK# 4135 Ankeny, Iowa 50021-8962 20

ID# Nancy E . Kuenen03/13/04 359 NW 50th Place


ID# Carol L . Horner, D.O .03/13/04 1417 - 48th St .


ID# Samantha J . Keltner03/13/04 513 NE 15th Street


ID# Chris R . Acton03/13/04 1831 Fuller Rd ., Unit 16


ID# Michelle S . Wilcox03/13/04 5156 69th Street


For'Instructions, See Back of Form








SUB-TOTAL

I $

200.00

Page

1 5

of- 4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT q IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# Craig R . Leager03/13/04 6502 Lincoln Avenue

CK# 1216 Windsor Height, Iowa 50322 20

ID# Kyle A . Campos03/13/04 9344 Sandler Circle


ID# Kenneth E . Briggs, Jr .03/13/04 1433 NW 91st Street

CK# 5904 Clive, Iowa 50325 20

ID# Marilyn Y . Scott03/13/04 4325 NE 29th, NO 98


ID# Charlotte P . Hutchison03/13/04 1328 Birch Lane


ID# Michael J . Ferjak03/13/04 12057 NW 131st Court

CK# 2082 Madrid, Iowa 50156 20

ID# Sally Troxell03/13/04 701 54th Street


ID# Michael L . McGill03/13/04 802 SE 80th Avenue, Lot #42


ID# Timothy E . Runkel03/13104 731 Polk Blvd .


ID# Theresa M . Broussard03/13/04 1101 E . 36th Ct .








" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

I $

200.001 /

Page

1 6 of- 49(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# Christy Vangundy

03/13/04 2507 E . 16th St.CK# 2102 Des Moines, Iowa 50316 20

ID# John H . Edsill03/13/04 2610 E . 29th Ct.


ID# Lu Ann M . Pedrick03/13/04 3921 75th St.


ID# Charlene Teed03/13/04 2301 SW Oralabor Road, #97

CK# 4336 Ankeny,Iowa 50021 20

ID# Tamyra L. Wissmiller03/13/04 100 - 5th NW, Apt. 12

CK# 2546 Altoona, Iowa 50009 20

ID# Patience A . Dorr03/13/04 6425 NW 97th St .

CK# 3491 Johnston, Iowa 50131 20

ID# Timothy L . Hardy03/13/04 200 Center Avenue S .

CK# 2041 Mitchellville, Iowa 50169 20

ID# Shelley T . Wolfe03/13/04 6750 School St., #161

CK# 4829 Windsor Heights, Iowa 50311 20

ID# Lacey Jilek03/13/04 1315 E . 33rd Ct.


ID# John H . Middents, III03/13/04 1110 SE Mill Pond Ct.








' Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .

SUB-TOTAL


Page

1 7

o f-49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# John L. Creswell03/13/04 906 SE Wanda Dr .


ID# Jason Plunkett03/13/04 705 Linnwill PI .


ID# Mary Frances Reese03/13/04 3912 48th PI .


ID# Jenny A. Gustafson03/13/04 300 57th Ct .


ID# Mary A . O'Bannon03/13/04 5255 NW 55th


ID# Barbara E . B . Galloway03/13/04 4004 Fagen Drive


ID# Patricia L . W . Kinner03/13/04 5701 Waterbury Rd .


ID# Mary Beth Reiff03/13/04 1813 Hillside


ID# Sandy Weldon03/13/04 2827 Wolcott Ave .


ID# Christophe R . Kaler03/13/04 1005 22nd St .

CK# 237 West Des Moines, iowa 50265 20









SUB-TOTAL

I $

220.00'

Page

1 8

of

4 4(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DDIYY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Randel L . Vonnahme

03/13/04 1509 NW Wagner Blvd .CK# 6333 Ankeny, Iowa 50021 20

ID# Julius J . Satre03/13/04 4305 68th St .


ID# R.D . Bice03113/04 3210 Lindlavista Way


ID# Amanda C . Lundberg03/13/04 9339 Golden Valley Dr.

CK# 1506 Norwalk, Iowa 50211 20

ID# Joani Hollingsworth03/13/04 13903 Bryn Mawr Dr .


ID# Randall L . Stephenson03/13/04 460 NW 66th Place


ID# lone G . Shadduck03/13/04 3431 Brookview Dr .


ID# Nancy L . Steward03/13/04 1070 37th St.


ID# John Haan03/13/04 3804 - 11th St .


ID# Mykle Fallis03113/04 2741 Thompson


Fot Instructions, See Back of Form






Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If surname of contributor is the same as candidate,,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .


SUB-TOTAL

1 $

220.00

Page''

19

of

4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# Judy Kline03/13/04 6601 New York Circle


ID# Bruce Sullivan03113/04 1233 Prairie View Dr. 177


ID# Connie Boesen03113/04 3011 Don Lee Ct .


ID# Michael A . Espinosa03/13/04 706 27th Street


ID# Nancy Bobo03113/04 1146 - 38th St .


ID# G . Kay Bolton03/13/04 804 37th St .


ID# Brian R . Lynner03/13/04 1804 Woodland Ave .


ID# Jill Whitten03/13/04 217 Cedarwood Ct.


ID# Robert E . Jackson, Sr .03/13/04 3925 NE 48th St.


ID# Tanya H . Keith03/13/04 4556 50th St .


Foe Instructions, See Back of Form







SUB-TOTAL


Page 2 0

of

4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# Debra Storey Salowitz03/13/04 708 36th St.


ID# Gerald J . Szumski03/13/04 2705 - 39th St .


ID# David L. Stanley03/13/04 1924 E . 27th St .


ID# Terri A. Pollard03/13/04 1241 E . 33rd St .


ID# Steve Breeden03/13/04 1010 NE 8th Ct .


ID# Danielle K. Christensen03/13/04 3210 Be]-Afire Rd .


ID# Steven L . Greenquist03/13/04 7230 NW 21st St .


ID# Kathleen A. Fikenauer03/13/04 5921 Winwood Dr ., #310


ID# Virginia L . Campbell03/13/04 5344 NW 91st Court


ID# Joyce D . Giles03/13/04 6818 Mill Pond Dr .







CAUTION : Section 68B .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by ny person other than statutory political committees.

' Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity'(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .

SUB-TOTAL


Page 2 1

of

49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# Dennis E . Thompson03/13/04 P.O . Box 872


ID# Leanna L. Thornton03/13/04 10200 NE 76th Aveue

CK# 8573 Mitchellville, Iowa 50169 20

ID# Colleen A . Robinson03/13104 1014 Falcon Dr .


ID# Richard K . Bame03/13/04 5821 Brentwood Circle


ID# Karl B. McLain03/13/04 3811 Hillcrest Drive


ID# Dan Josephsen03/13/04 4611 Stonebridge Rd.


ID# Barbara L . Lemons03/13/04 2616 56th Street


ID# Sharon L . Yon03/13104 3904 Waveland Drive


ID# Kenneth C . Choquette03/13/04 1410 Pensylvania


ID# P.T . Ball03/13/04 3305 E . Aurora


Fo'r Instructions, See Back of Form






" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .

SUB-TOTAL


Page

22

of49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# James M . Cornick03/13/04 624 Glenview Dr .


ID# Brant W . Bruhn03/13/04 2102 York Street


ID# Ray M . Blase03/13/04 913 NE 34th Street


ID# A . C . Lubbert03/13104 3317 - 3rd St .


ID# Bonita Severson03/13/04 4530 Waveland Ct .


ID# Thomas g . Fisher, Jr.03/13/04 3239 Elmwood Drive


ID# Lauran M . Anderson03/13/04 1920 44th Street


ID# Dr . F . Dow Bates03/13/04 3706 E . 28th St .


ID# Alan W. Young03/13/04 169 Burr Oak Blvd .

CK# 3073 Pleasant Hill, Iowa 50327 20

ID# Jill Callahan Knoff03/13/04 1733 NW 122nd Ct .

CK# 9373 Clive, Iowa 50325 20









Page

2 3

of

49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT ~ IF FORRECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-(MM/DDIYY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# Diana Lynn Hansen03/13/04 3827 Lindlavista Way


ID# Michael A. Sadler03/13/04 9927 Hammontree Drive


ID# Clementine J . Karl03/13/04 1111 29th Street, #2


ID# Patricia K . Wengert03/13104 4213 41st Street


ID# R . Saffin Sams03/13/04 812 - 57th St .


ID# Carol S . Maddux03/13/04 302 NW Rockcreek Cir .


ID# M . Amjed03/13/04 12841 Sunset Ter .

CK# 9019 Clive, Iowa 50325 20

ID# Michel J . Pogge03,13/04 1033 NW Greenwood St .


ID# Hardin M . Whiteman03/13/04 1416 Thompson Ave .


ID# Eileen E . Bleskacek03/13/04 610 Oakhurst Dr .


Fo`r Instructions, See Back of Form







SUB-TOTAL

' $

200.00

Page'

2 4

of

49(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME

ID# Jamie Nelson03/13/04 4211 Beaver Crest Dr.


ID# Scott J . Saunders03/13/04 939 Leland Avenue


ID# Joann T . Muldoon03/13/04 1338 18th Street


ID# Catherine H . Engel03/13/04 907 - 27th St .


ID# John F . Rooney03/13/04 2212 - 51st St .


ID# Nancy Heimbaugh03/13/04 3923 29th Street


ID# Rodney H . Powell03/13/04 2717 71 st St .


ID# Rose M . Cordaro03/13/04 1628 E . Virginia Ave.


ID# Judith K . Lowe03/13/04 3418 Kingman Blvd .


ID# Janet L. Haselhoff03/13/04 3843 8th Pl .


Foi Instructions, See Back of Form








SUB-TOTAL

1 $

200.00 1 e,

Page

2 5

of

49(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# William J . Schadle03/13/04 P.O . Box 35983


ID# Barbara J . Miller03/13/04 669 61 st St.


ID# Joe Youngwirth03/13/04 3824 Lay St.


ID# Sarah Bolten03/13/04 626 SW 61st St.


ID# Robert E . Tucker03/13/04 3111 SW 24th Ct.


ID# Vince Bechtel03/13/04 305 SW State Street


ID# Dirk R . Bliss03/13/04 700 5th Avenue SW


ID# E . Copeland-Clark03/13/04 1410 Beaver Ave .


ID# Paula M . Thompson03/13/04 219 Plesantview Drive


ID# Paul A . Caligiuri03/13/04 3020 Stanton









SUB-TOTAL

I $

200.00 1,/

Page' 2 6

of

4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# John Pederson

03/13/04 1075 44th StreetCK# 1323 Des Moines, Iowa 50311 20

ID# Kent R . Ryan03/13/04 1314 Cummins Pky .


ID# Joshua T . Mandelbaum03/13/04 650 Polk Blvd ., Apt . 2


ID# Patricia D . Hollinger03/13104 7526 Barnsley Dr .


ID# Beverly D . Bunker03/13/04 2730 SE Leach


ID# Julie Rutz-Cota03113/04 7701 Hickman Rd ., #7


ID# Beth Myers03/13/04 1244 48th Street #A


ID# Rachel Paine03/13/04 1264 Office Park Dr #14


ID# Coby K . Koester03/13/04 4208 Adams Ave .


ID# Lark W . Roberts03/13/04 4904 W . Park Dr .









SUB-TOTAL

I $

220.001,/

Page

2 7

of

4 9(for Schedule A)


(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# Christa Addy

03/13/04 301 E . Bell AvenueCK# 1028 Des Moines, Iowa 50315 20

ID# Christine M . Drabek03/13/04 9810 SE Vandalia Dr .

CK# 4793 Runnells, Iowa 50237 40

ID# Danny C . Warren, Jr .03/13/04 3206 - 54th St .


ID# Jeffrey D . Goetz03/13/04 701 54th St.


ID# Marilyn Delay03/13/04 4024 Boulder Dr.


ID# Penni S . Guyler03113/04 323 E . Leach


ID# Chuck Lierman03/13/04 508 NW Beechwood


ID# Cindy Coppock03/13/04 719 - 47th St .


ID# Kathleen A . Richardson03/13/04 3917 Maquoketa Dr .


ID# Mrs . Marvin R . Briles03113/04 1015 Luster Lane







* Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationship'column .


SUB-TOTAL

I $

240.001,.-

Page 2 8

of

40,(for Schedule A)


(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# Dennis Beers

03/13/04 5505 Boulder DriveCK# 6602 West Des Moines, Iowa 50266 40

ID# Michael L. McCarthy03/13/04 2906 39th St.


ID# Susan E . Voss03/13/04 323 E . 5th Street


ID# Dallas J . Janssen03/13/04 520 - 35th St ., Suite 100


ID# William D . Thompson03/13/04 7500 SE Bloomfield Rd .


ID# Madith Burnett03/13/04 1422 Penn Ave . #8


ID# Matthew Ballard03/13/04 613 - 18th Ct. SW


ID# Kimberly J . Spitzig03/13/04 609 SW Southlawn Circle


ID# Arvid D . Oliver03/13/04 1709 NE Lowell Ct .


ID# Araceli Goode03/13104 7085 Bloomfield Rd., Lot 261


FoV Instructions, See Back of Form


COMMITTEE NAME (Must be same ason Statement of Organization)Polk County Democratic Central Committee





SUB-TOTAL 1 $ 220.001,,,

Page

2 9

of49(for Schedule A)

SCHEDULEMONETARYA RECEIPTS

(Rev . 07/03)

CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME

ID# Ben A . Hildebrandt03/13/04 2607 Emma Ave .


ID# Jesse F . Taylor03/13/04 1612 Lincoln Ave .


ID# Carl B . Brush03/13/04 1134 69th Street


ID# Janel R. Bellah03/13104 3117 Garden Avenue


ID# Marla P . Stidolph03/13/04 866 - 40th PI .


ID# Ken Rains03/13/04 4800 Euclid Ave .


ID# William L . Brauch03/13/04 3313 38th St .


ID# Linda S . Tossey03/13/04 3616 SW 26th St .


ID# John M . Forrest03/13/04 P.O . Box 65114


ID# Eugene M . Rittman03/13/04 407 SE Delaware Ave., 306






Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee. Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage). If sumame of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationshipcolumn .




SUB-TOTAL

I $

200.001/

Page

3 0

of

4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOMEID# Barbara L . Bernard

03/13/04 2 E . Wall AvenueCK# 1440 Des Moines, Iowa 50315 20

ID# Matthew J . Beedle03/13104 2720 Columbia St .


ID# Davon A . Hoye03/13/04 201 Motley St.


ID# JoAnn Hively03/13/04 3915 - 5th Avenue


ID# Mary L . McGee03/13/04 201 Locust, Apt. 341


ID# Berla J . Edsill03/13/04 2610 E . 39th Ct.


ID# Evelyn J . Christianson03/13/04 116 - 5 Avenue NW #2


ID# Marijean Sears03/13/04 4147 54th


ID# Colleen A. Jennings03/13/04 1208 49th Street #4


ID# Jack Hatch03/13/04 1623 Woodland Avenue








SUB-TOTAL


Page 3 1

of-4 9(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISERNUMBER INCOME

ID# Kristin Knudson Harris03/13/04 4038 Morton Avenue


ID# Steven R . Belieu03/13/04 816 E . 27th Ct.


ID# Stanley R. Pelts03/13/04 7004 Sheridan Cir.


ID# Ken A . Balduchi03/13/04 406 Plumwood Ct. SW


ID# Rose Mary Pratt03/13/04 4411 46th St.


ID# Steve Tasler03/13/04 4024 Adams Avenue


ID# Kristi Aney Smith03/13/04 358 Evergreen Avenue


ID# Jana Jongewaard03,13/04 1761 NW 99th Street


ID# Jeff Gronstal03/13/04 2710 - 34th St .


ID# Michael O'Deay03/13/04 1108 Park Ave .


Fob Instructions, See Back of Form






" Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the committee . Relationship must beshown to the third degree of consanguinity (blood relatives) and affinity(relatives by marriage) . If surname of contributor is the same as candidate,but there is no familial relationship, enter "not applicable" in the relationship

Page

32

of

49column .

(for Schedule A)



CHECK THIS BOX IF

AMENDING FORM

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT 4 IF FORRECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-(MM/DD/YY) AND PAC CHECK (if applicable) RAISER

NUMBER INCOME

ID# Ruth Michener03/13/04 10820 NE 78th Ct.

CK# 8229 Bondurant, Iowa 50035 40

ID# Irene H . Tan Creti03/13/04 3901 Western Hills Drive


ID# Patricia A . Cook03/13/04 1426 Pioneer Road


ID# Lory Nels Johnson03/13/04 909 SE Uehlamar Drive


ID# Todd A. McFadden03/13/04 3117 E . 43rd St.


ID# Mary K . Kelly03/13/04 2421 Pine Circle


ID# Musau Wakabongo03/13/04 1456 E . 17th Ct.


ID# Caroline Sondag03/13/04 1255 E . 35th St .


ID# Martha Anderson03/13/04 1717 Marella Trail


ID# Joe Kluepel03/13/04 3141 - 8th St .



CONTRIBUTIONS -- MONEY TAKEN IN(including candidate's personal funds)

COMMITTEE NAME (Mustbe same as on Statement of Organization)





SUB-TOTAL

1 $

200.00

Page 3 3'

of

49(for Schedule A)

SCHEDULE


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOMEID# Alba A . Bassett-Armijo

03/13/04 2803 Columbia St .CK# 5066 Des Moines, Iowa 50313 20

ID# William L . Strate03/13/04 7015 Sunset Terrace

CK# 2114 Winsor Heights, IA 50311 20

ID# Jeanette M . Ellington03/13/04 1003 E . Thornton Ave .


ID# Alan R. Koslow03/13/04 2716 Jordan Grove


ID# Christian D . Capaldo03/13/04 245 NE 142nd Ave .

CK# 2134 Alleman, Iowa 50007 20

ID# Thomas J . Griffin03/13/04 3404 Scott St .


ID# Matthew W . Russell03113/04 75333 Independence

CK# 2023 Anita, IA 50020 20

ID# Joseph H.Jongewaard03/13/04 4039 Ovid Ave .


ID# Natalie Burnham03/13/04 1910 74th St.

CK# 4703 Windsor Heights, Iowa 50322 20

ID# Sarah T . Fuller03/13/04 1607 Center St .








SUB-TOTAL

I $,


200 . 00

Page

3 4

of

4 9(for Schedule A)


CHECK THIS BOX IF

AMENDING FORM


NUMBER INCOME

ID# Deborah Kilgore03/13/04 3414 SW 35th St .


ID# David C . Huston03/13/04 1512 48th St .


ID# John Wenck03/13/04 3410 Aurora Avenue


ID# Patricia Lyman03/13/04 2305 Glenwood Dr.


ID# Karen S . Kelleher03/13/04 2304 - 2nd Street SW


ID# Tony G . Salem03/13/04 2623 Sherwood Dr.


ID# Lucille L . Krauss03/13/04 1005 - 45th St .


ID# Lila P.M . Starr03/13/04 1614 NW 99th Ct .

CK# 6774 Clive, Iowa 50325 20

ID# Bandstra Law Firm03/13/04 505 5th Avenue, Ste. 810


ID# Brian K . Schon03/13/04 295 NE 64th St .






STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PACIDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS IS AVAILABLE FROMTHE IOWA

PCLK CCCNTY DEMOCRATIC CENTRAL COMMITTEE · 19/05/2004 · 515-255-7696 April 23, 2005 SIGNATUREOFTREASURER(orpersonfiling this report) TELEPHONE DATESIGNED ... Computer I AMFILINGA

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