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FOR-INSTRUCTIONS, SEE BACK OF FORM

DISCLOSURE SUMMARY PAGECOMMITTEE NAME (Must be same as on Statement of Organization

Henry County Republican Women

IMPORTANT: I n d i c a t e b y # t y p e o f c o m m i t t e e y o u a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e P A C ( 3 ) S t a t e P a r t y

( 4 ) C o u n t y C e n t r a l C o m m i t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B o a r d o r O t h e r P o l i t i c a l

S u b d i v i s i o n C a n d i d a t e ( 8 )County PAC ( 9 ) C i t y P A C ( 1 0 S c h o o l B o a r d o r O t h e r P o l i t i c a l S u b d i v i s i o n P A C

( 1 1 ) L o c a l B a l l o t I s s u e

1 e LOSE BO i

r JCT 16 200S

CANDIDATE COMMITTE

Candidate Name P o l i t i c a l P a r t y ( i f a p p l i c a b l e )

Office SoughtF t r t 3

D i s t r i c t ( i f S e n a t e o r H o u s e )

FORM

DR-2 D I S C L O S U R E(Rev . 1 2 / 2 0 0 5 ) REPORT

F o r O f f i c e U s e O n l y

Comm . #

Logged I's

Scanned

Computer

A u d i t e d

q~ a 3 Ip

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l a n d c r i m i n a l p e n a l t i e s . Pursuant to Iowa Code section 68B . 3 2 A ( 7 ) t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o m m i t t e e ,

a n d t h e c h a i r p e r s o n , f o r a n y o t h e r t y p e o f c o m m i t t e e , i s t h e i n d i v i d u a l r e s p o n s i b l e f o r f i l i n g t i m e l y a n d a c c u r a t e r ep o r t s .

STATEMENT OF CASH ON HAND

CASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h ecomm ittee . This amount MUST be the same as the cash on hand at the end

o f t h e l a s t r e p o r t i n g p e r i o d o r m u s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) $

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A : Cash Contributions total (Attach Schedule A) (*also see i n - k i n d b e l o w ) Schedule F: Loans Received total (Attach Schedule F)

Schedule H : Total Sales of Campaig n Proper ty (Attach Schedule H)

(Schedule H applies to Candidates' Committees Only )

499 .10

SUB-TOTAL $ 733 .62SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B : Ex penditures total (Attach Schedule B) (**also see debts and loans below) ANEW 219 .8 6Schedule F : Loan Repayments total (Attach Schedule F)

CASH ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b a l a n c e m u s t

be zero) (Attach DR-3) $ 513 .76 * * U N P A I D B I L L S (From Schedule D -Attach Schedule D) $

*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) $

**OUTSTANDING LOANS (From Schedule F - Attach Schedule F) $

CONSULTANT BREAKDOWN (Schedule G A ttached?) YES NOCANDIDATE COMMITTEES ONLY:

VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Sch edule H) $

STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .

319-986-6101 October 13,2006IGNAT E OF PERSON FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A REPORT FOR (1 ) E L E C T I O N / (2 )NON- E L E C T I ON YEAR

( r e p o r t d a t e ) I n d i c a t e b y #

L o c a l C o m m i t t e e s , e n t e r D a t e o f E l e c t i o nDCHECK IF AMENDMENT TO REPORT DATED

o C h e c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h N o t i c e o f D i s s o l u t i o n Form DR-3 . C o u n t y & L o c a l C o m m i t t e e s , e n t e r C o u n t y i n( Y o u m u s t c o n t i n u e t o f i l e r e p o r t s u n t i l a D R - 3 i s f i l e d . )

w h i c h E l e c t i o n i s h e l d

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For Instructions, See Back of Form

CONTRIBUTIONS - - MONEY TAKEN IN( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )

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

Henry County Republican Women

SCHEDULE

A(Rev . 0 7 / 0 3 )

MONETARYRECEIPTS

[] CHECK THIS BOX IFAMENDING FORM

STATE CANDIDATES NOTE: IF A CONTRIBUTION IS RECEI VED FROM A STATE PAC (POLI TICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATIONNUMBER AND THE PA C CHEC K NUMBER IN THE DESIGNATED COLUMN . A L I S T O F I D N U M B E R S I S A V A I L A B L E FR O M THE I O W A ETH I C S A N D C A M P A I GN

DISCLOSURE BOARD.

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

SUB-TOTAL

TOTAL (if last page of this sch edule)

* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h e

committee . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y

marriage) . If surname of contributor is the same as candidate, but there is no Page off a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n (for Schedule A)

DATERECEIVED(MM/DD/YR)

PAC ID NUMBER( i f a p p l i c a b l e )

AND PAC CHECKNUMBER

NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIPTO CANDIDATE*

( i f a p p l i c a b l e )

AMOUNTRECEIVED

I I F F

FUND-RAISEINCOM

09-11-06

09-11-06

ID#

C K#tea cup donations

2 memberships

$ 1 6 . 77

24 .00

09-11-06

09-11-06

I D #

C K#

sale donations

donations

14 7 .75

15 .00

10-09-06

10-09-06

ID#

C K#

tea cup donations

donation

6 .00

2 5 . 00

I D #

C K #

I D #

C K #

I D #

C K #

I D #

C K #

I D #

C K #

I D #

C K #

I D #

C K #

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THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . ( R e f e r t o S c h e d u l e H i n s t r u c t i o n s . )

E x p e n d i t u r e s t o p e r s o n s / e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , m a n a g i n g , o r g a n i z i n g s e r v i c e s m u s t a l s o b e d e t a i l i t e m i z e d o n

Schedule G by the amount, purpose, and date of each type of exp enditure made by the person /entity on behalf of th e candidate's committee . ( R e f e r t o

Schedule G instructions and Iow a Code 68A .4 0 2( 3 )( i ), )

P a g e o f

( f o r S c h e d u l e B )

FOR INSTRUCTIONS, SEE BACK OF FORM

EXPENDITURES - - MONEY SPENT FROM COMMITTEE ACCOUNT

S C H E D U L E

B(Rev . 0 7 / 0 3 )

MONETARYEXPENDITURES

STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGIS LATIVECANDID ATES, LIST THE CANDIDATE ID ENTIFICATIO N NUMBER IN THE DESI GNATED COLUMN AND THE

PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILAB LE FROM THE IOWAE T H I C S & C A M P A I G N D I S C L O S U R E B O A R D .

CHECK THIS B OX IF

A M EN D I N G FORM

C OM M IT T E E N AM E (Must be same as on Statement of Org anization)

Henry County Republican Women

DATEEXPENDED(MM/DD /YR)

CANDIDATEID NUMBER( i f a p p l i c a b l e )

AND PACCHECKNUMBER

NAME AND ADDRESS TO WHOMEXPENDITURE

( D i s b u r s e m e n t ) WAS MADE

PURPOSE(DESCRIBE TRANSACTION)

AMOUNTEXPENDED

09-12-06

09-12-06

I D#

c k1 0 89

C K# 1090

Iowa Federation of Republican Women 3 dues

dues

$30 .00

$ 1 .05District Federation of Republican Women 3

09-12-06 I D # 1 091 David Heaton Iowa Rep Campaign 25 .00

0 9- 1 2- 0 6 C K # 1 09 2 Ana Lorber103 Cypress Circle, New Lcndon,

5 1 0 E . Wash Mt . Pleasant, is 52641

I a 52645 campaign donation 25 .00

0912096 I D# 1093 Darin Stater campaign donation 25 .00301 S . Walnut, Mt . Pleasan t, I a 52641

C K# 1094 Shirley Wandling campaign donation 25 .002585 Lexington Ave . Mt .P lE asan t, I a 52641

I D #

1095 Marc Lindeen campaign donation 25 .00

CK# 40 8 North Main, Mt . Pleasant, I a 52641

1096 Iowans for Leach . J im Tearh r n m p a i g n d n n a t i n n S f l - n nID# P . O . Bo x 2360, I ow a C ity , I a 52244

1097

CK#Iris Restaurant guest lunches 13 .81

I D #

C K #

I D#

C K #

I D#

CK#

SUB-TOTAL $

T OT A L ( i f l a s t p a g e o f t h i s s c h e d u l e ) $219 .86