JAN-19-2005 15 :14 CHAMBER OF COMMERCE 1 319 752 6454 P .

02

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2
I
DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization)
(Rev. 07/2004) REPORT

For Office Use Only

Des Moines County Job and Business Opportunity Political Action committee Comm .
IMPORTANT: Indicate by #type of committee you are raportng for: Logged ln,r'
( 1 Statewide/Legislatlve/Judge Standing for Retention Candidate ( 2 )fate PAC ( 3 )State Party Scanned i
( 4 )CountyCentral Committee ( 5 )County Candidate ( 8 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC (9 )City PAC (10 )School Board or Other Political Computer -
Subdivision PAC Audited

Political Party (if applicable)

Late reports are subject to
possible civil and criminal
penalties.

~~i~o~ oo YY - - Z Xx's-117ejCS~
.
TELEPHONE DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR_

(report date) Indicate by #

(]CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

Ll Check if this Is final (termination) report and attach Notice of Dissolution Form DR-3- County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a DR-3 is filed_)

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 450.35
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) ..... ... .. 1,070.00
Schedule F; Loans Received total (Attach Schedule F) ................. ... .................... ... . ........... 350.00
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ...................... . ...........
(Schedule H anodes to Candidates' Committees Only)
SUB-TOTAL ..... $ 1,870.35
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below)___. 1,427.00
Schedule F: Loan Repayments total (Attach Schedule F) .......... ... ...... ... ..... . .............. .......... 350.00
CASH ON HAND at the end of this reporting period (iffinal report balance must
$ 93 .35
be zero Attach DR-3

"UNPAID BILLS (From Schedule D -Attach Schedule D) . ... .... ................_ .... ...............__.__.._ .._ .__.._ ....$
"IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) .......... ... ...... ......... ........... ... ... .. $ 7.
""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)
 JAN-19-2005 15 :14 CHAMBER OF COMMERCE 1 319 752 6454 P .03

For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS - MONEY TAKEN IN

A MONETARY
(Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS 90X IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
Des Moines County Job and Business Opportunity Political Action Committee

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 .

CAUTION : Section 68B .32A(6), Iowa Code, 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID# Michael Brouwer
10/15/2004 422 Washington Road $100 .0(1
CK# West Burlington, IA 52655

ID# Connie D. Reynolds

0/152004 CK9 2820 Lesylvia Street 80 .00
Burlington Town 52601
IDff
Don Henry
10/15/2004 1711Madison Avenue 100 .00
CK#
Burlington, lA 52601
ID#
Mark Richardson
10/25/2004 CK# 2700 Lochmoor Lane 100.00
Burlington Iowa 52601
ID# Thomas Greene
10/28/2004 5763 Hartman Road 50 .00
CK#
Burlington, Iowa 52601
ID# Jim Olson
10/25/2004 829 Easy Street 100_00
CK# Burlington, la 52601
ID#
Dennis }tinkle
10/26/2004 11941 42nd Street 100 .00
CK#
Burlington Iowa 52601
ID# Jim D . Elmer
10/29/2004 CK# 620 Iowa Street 40 .00
Burlington, IA 52601

Doug Martin
11/05/2004 14708 154 Avcnuc 100 .00
CK#
Burlington, [A 52601
_ _
ID# Jerry D Kraus
10800 Memorial Park Road 100,00
CKO
Burlington, Iowa 52601

SUB-TOTAL

TOTAL (if last page of this schedule)

* DIsclosure law requires candidate committees to disclose the relationship of Shy relative malting B contribution to the
committee . Retatronshlp must be Shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 1
marriage) . If surname of contributor is the same as candidate, but there is no Page of .-_~---.- . .
familial relationship, enter - not applicable' in the relationship column . (for Schedule A)
JAN-19-2005 15 :15 CHAMBER OF COMMERCE 1 319 752 6454 P .04

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
Des Moines County Job and Business Opportunity Political Action Committee

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 .

CAUTION : Section 68B .32A(6), Iowa Code, 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
ID# Charles E . Walsh
11/5/2004 CK# 1619 River $100 .00
Burlington, IA 52601

ID# Dave Walker

11/12/2004 708 Terrace Drive 100 .00
CK#
Burlington, TA 52601
10#

CK#

ID#

CK#

I D#

CK#

LM
ID#

CK#

ID#

CK#

10#

CK#

ID#

CK#

I D#

CK#

SUB-TOTAL $ 200 .00

TOTAL (If last page of this schedule) $ 1070.00

' Disclosure law requires candidate committees to disclose the relationship of any relative making B contribution to the
committee . Relationship must be shown to the third degree of consangulnlty (blood relatives) and affinity (relattves by 2 2
manlage) . If sumame of contributor is the same as candidate, but there is no Page -__- of -------
familial relationship, enter 'not applicable' in the relationship column . (for Schedule A)
JAN-19-2005 15 :15 CHAMBER OF COMMERCE 1 319 752 6454 P .05

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B

(Rev. 07103)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES : NOTE., FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFIGATION 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 an Statement of Organization)

Des Moines County Job Oporrunity and Business Opportunity Political Action Committee

CANDIDATE NAME AND ADOnSS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID# Committee to Elect Bob .Beck Campaign contribution
10/15/2004 19371 Roosevelt Street $ 250.00
CK# 1001 anville, Iowa 52623

1D# avid Miller for Supervisor Campaign contribution

10/15/2004 .0. Box 771 250,00
CK#1002 urlington, Iowa 52601

ID# urlington Hawkeye Advertising

10/29/2004 .0 . Box 10 927 .00
CK#1003 urlington, Iowa 52601

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUB-TOTAL $ 1427 .00

TOTAL (if last page of this schedule) $ 1427_00

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 personsfentlties 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/enfty on behalf of the candidate's committee, (Refer to
Schedule G Instructions and Iowa Code 68A.402(3)(i) .) - `

Page

(for Schedule 8)
FOR INSTRUCTIONS, SEE HACK OF FORM
SCHEDULE
COMMITTEE NAME(Must be same as on Statement of Organizellon) F LOANS
(Rev . 07103) RECEIVED
Des Moines County Job Oportunity and Business Opportunity Political Action Comr
ti REPAID

NOTE: This schedule reports money lowed to the committee which is deposited in the committee account. CHECK THIS BOX IF
AMENDING FORD)
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $

PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD PART It - MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD
(Origlnai source of loan, such as abank, must be sfrown if a third party is (Loans forgiven must be reported our Sct :aduie
E - in-kind ConWbuttans,)
involved. Include loans from candtdate'spwwnal finds,)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEi11ED (Include Endorsers Name, If Applicable) TO CANDIDATE OF LOAN (MWDDIYR) (Include Endorsers Name, If Applicable) TO CANDIDATE' REPAID
MMIDDfYR H 'pble' if Applicable)
Michael Brouwer 422 $ Michael Brouwer 422 $
Washington Road West Washington Road West
1012912004 Burlington, 1A 52655 Burlington, IA 52655
350 .00 350.00

TOTAL (PART 1) $350 .00 TOTAL CASH REPAYMENTS (PART il) $ 3 50 .00

From Schedule E -TOTAL LOANS FORGIVEN $

TOTAL OUTSTANDING LOANS END OF REPORT PERIOD $0

'Disclosure law requires candidate committees to disclose the relationship of any reta0ve
making a oonlribuban to the committee. Relationship must be shown to the third degree of
consanguinity (blood relatives) arrd affinity (relatives by marriage) . If surname of contributor is
the same as candidata, but there s no farrdlial relationship, enter not applicable in the
relationship column when It applies. Page 1 of
(for Schedule F)