Disclosure Summary Page - R : Possible Civil and Criminal
Disclosure Summary Page - R : Possible Civil and Criminal
Disclosure Summary Page - R : Possible Civil and Criminal
Schedule B : Expenditures total (Attach Schedule B) ('"also see debts and loans below).... 11
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) .. ..... .. . .. .................. ... ........... ... .. ............... .......... . . ..__....._.._. . ...._...... ... .S ,
"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?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) S
YES a NO
03-31-05 15 :29 COMMUNITY STATE BANK ID=563 942 3938 P04/06
M a r + h CeAar Kl IS
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
AND CAMPAIGN
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS
DISCLOSURE BOARD .
CAUTION: Section 68B.32A(6). Iowa Code, prohlbits 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
(if applicable) TO CANDIDATE' RECEIVED FUND-
RECEIVED
(MMIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
CK#
ID#
CK#
10#
CK#
ID#
CK#
ID#
CK#
I D#
CK#
ID#
CK#
1D#
CK#
ID#
CK#
SUB-TOTAL
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
commlnee . Relationship must be shown to the third degree of conaanguinity (blood relatives) and affinity (relatives by
marriage) . If surname of contributor is the same as candidate, but there is no Page ~~ of
(for Schedule A)
familial relationship, enter "not applicable" In the relationship column .
05-25-05 16 :45 COMMUNITY STATE BANK ID=563 942 3938 P04/05
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev, 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
North Ceda.r k1
STATE CANDIDATES NOTE: IF ACONTRIBUTION 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 683.32A(6), Iowa Code, prohlbits 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-
(MM/ODYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
=d QwnLCe
e.
t~- (-p5 CK#
30
r7 'o1-4J
C
C:1 at-~nce '~ S a t~
I D#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
1D#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
10#
CK#
SUB-TOTAL
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
commitco. Relationship must be ahown to the third degree of consanguinity (blood relatives) arsd affinity IralatiVCS by
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)
03-31-05 15 :29 COMMUNITY STATE BANK ID=563 942 3938 P05/06
CK#
ID#
CK# ..
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $
54-
TOTAL (iflast page of this schedule) $ 55lrl
(o
(for Schedule B)
D5-25-05 16 :45 COMMUNITY STATE BANK ID=563 942 3936 P05/05
W"A1R'1'TNWl
FOR INSTRUCTIONS, SEE BACK OF FORM il . SCHEDULE
North Cedar k I DS
CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Dlsbursemenp WAS MADE
(MWDDIYR) AND PAC
CHECK
NUMBER
ID#
y_i-a5 S,L~_ t~ea.e)S -4 AdverjtSer S,VIS,QT'fSIF!y QP'S
CK# :~c acx "m
$ 5a .a s
L_ow deJ, , xA s :lt z ss
ID#
_rip{on i^OhSer'v0
.~-1`~le
mt~t ~
L ri -o5 CK# ~~ Qn I r+ f~ t1UYr~'iSt
Ot u . ~0
XA
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $ rl~ .
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to personstentities 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(3xi),)
Page
(for Schedule B)
0-5-25-95 16 :44 COMMUNITY STATE BANK ID=563 942 3938 P03/05
a'v
Notice of Dissolution FORM
DR-3
(Rev . 07/03)
NOTICE OF
DISSOLUTION
Mail to .
IECDB
J
510 East 12`1', Suite 1A For Office Use Only
Des Moines, Iowa 50319
Comm. #
Indexed
Audited
Computer
Certified Date of Dissolution
COMMITTEE NAME
Nwrfih Ced.a..r K l DS
Official Name of Committee
PC
Street
(545 it' ga , 3 3y 14
Area Telephone
Code
WHEN TO FILE:
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following:
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 .
~d , A1
.-&-4
Signature f andidate or Treasure (if candidate's committee)ISignature of Chair or Treasurer (if PAC)
s-a4-OS
Date Signed