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Transcript of Verizon Iowa State Good Government Club__6038__Scanned
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
http://slidepdf.com/reader/full/verizon-iowa-state-good-government-club6038scanned 1/97
FOR I NSTRUCT I ONS , SEF BACK OF FORM
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
I MPORTANT : I n d i c a t e t y p e o f c o mm 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 Ca n di d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) Co u n t y / L o c a l Ca n d i d a t e
( 5 ) Co u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e C o mmi t t e e ( 7 ) Co u nt y / C i t y C e n t r a l C ommi t t e e( 8 ) S u pp o f t S l a t e o f Ca n di d a t e s
J~Z~ w
SI GNATUP47M TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE DATE S I GNED
Ro u t i n e Pe n a l t i e s Du e F o r L a t e F i l e d Re po r t s R a n g e f r o m $ 2 0 t o $800
SEE I NSTRUCTI ONS ON BACK AND COMPLETE THE FOLLOWI NGSENTENCE :
I AM F I L I N G A OCT 1 9 , 2 0 0 4 REPOR T FOR AN / A ( 1 ) ELECT I ON / ( 2 ) NON - E LEC T I ON YEAR .
CI A I F AMENDMENT TO REPORT DATED
DISCLOSURESUMMARYPAGE
( r e p o r t d a t e ) I n d i c a t e o n e
OCT 1 9 , 2004
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 F o r m DR- 3 .( Y o u must 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 N o t i c e o f D i s s o l u t i o n i s f i l e d . )
STATEMENT OF CASH ON HAND
eL o c a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o n
C o u n t y & L o c a l C o mmi t t e e s , e n t e r C o u n t y iw h i c h e l e c t i o n i s h e l d
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 h i s i s t h e t o t a lo f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s amoun t MUST b e t h es ame a s t h e c a s h o n h a n d a t t h e e n d 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 mus t b e z e r o i f t h i s i s t h e f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5 , 8 51 . 4 1
ADDTOTAL MONEY TAKEN I N T HI S PERI OD
Sc h e du l e A : C a s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 , 6 9 2 . 6 8
Sc h e du l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
Sc h e du l e H : T o t a l S a l e s o f C amp a i g n P r o p e r t y ( A t t a c h Sc h e d u l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
( S c h e d u l e H a p p l i e s t o C a n d i d a t e s ' Co mmi t t e e s o n l y )SUB- TO TAL . . . . . . . . $ 3 , 6 92 . 6 8
SUBTRACT TOTAL MONEY SPENT T HI S PERI OD
Sc h e du l e B : E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 , 5 5 0 . 0 0
Sc h e du l e F : L o a n Re p a yme n t s t o t a l ( A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
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 mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 5 , 9 9 4 . 0 9
UNPAI D BI L LS ( F r o m Sc h e du l e D - A t t a c h Sc h e du l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
I N KI ND CON T RI BU T I ON S ( F r o m Sc h e d u l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
OUTSTANDI NG LOANS ( F r o m Sc h e du l e F - A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
CANDI DATE COMMI TTEES ONLY :
CONSULTANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? ) YE S NO
VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h ed u l e H - A t t a c h Sc h e du l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA S TA TE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMM I T T E E ) , L I ST T HE PAC I DE NT I F I C AT I ONNUMBER ANDTHE PAC CHECK NUMBER
I N THHE DES I GNATED COLUMN.A L I ST OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I $ 26 . 00
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) 1 $
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 1 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
.~X CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E RNUMBER I NCOME
0 7 / 23 / 04 I D# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 06 / 04 I n# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0/ 0 4 I D# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 0 3 / 0 4 I D# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Uh i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 0 4 I D# Rodney D. Ande r s o n 5 . 001 6 5 4 F i s h e r Av e
CK# New S h ar o n , I a 5 0 2 0 7
0 8 / 06 / 04 I D# Rodney D. Ande r s o n 5 . 001 6 5 4 Fi s h er Av e
CK# New S h ar o n , I a 5 0 20 7
0 8 / 20 / 04 I D# Ander s o n1 6 5 4 F i s h er
5 . 00
CK#Av
New S h ar o n , l a 5 0 20 7
0 9 / 0 3 / 0 4 I D#R
D . An d e r s o n 5 . 001 6 5 4 F i s h e r Av e
CK# New S h ar o n , I a 5 0 2 0 7
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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Fo r I n s t r u c t i o n s , See Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DE S I GNAT ED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA' ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
' D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 2 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
MX CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 1 7 / 0 4 I D# Rod n e yD . An d e r s o n 5 . 001 6 5 4 F i s h e r Av e
CK# New S h ar o n , I a 5 0 20 7
1 0 / 0 1 / 0 4 I D# Rodney D . An d e r s o n 5 . 001 6 5 4 F i s h e r Av e
CK# New S h ar o n , I a 5 0 20 7
0 7 / 2 3 / 0 4 m# Mi c h e l l e R . Bar man 2 . 5 01 5 1 5 Re ed S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Mi c h e l l e R . Ba r n t mm 2 . 5 01 5 1 5 Re ed S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 20 / 04 I D# Mi c h e l l e R . Bar man 2 . 5 01 5 1 5 Re ed S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 03 / 04 I D# Mi c h e l l e R . Ba r n t mr < 2 . 5 0
1 5 1 5 R e e d StCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Mi c h e l l e R . Bar man 2 . 5 01 5 1 5 Reed St
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Mi c h e l l e R . Ba r n um 2 . 5 01 5 1 5 Reed S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 23 / 04 I D# Ro n a l d D . Br own 2 . 5 0PO Bo x 2 2 6
CK# New S h ar o n , l a 5 0 20 7
0 8 / 06 / 04 I D# Ro n a l d D . Br own 2 . 5 0PO Bo x 2 2 6
I
CK#
INew S h ar o n , I a 5 0 20 7
I I I I
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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Fo r I n s t r u c t i o n s , S e e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g an i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN.A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI C S ANDCAMPAI GNDI SCLOSURE BOARD.
CAUT I ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t page o f t h i s s c h e d u l e )
` D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 3 o f 44
( f o r S c h e du l e A)
SCHEDULE
A MONETARY
( Re v . b 6 / 9 7 ) RECEI PTS
F CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
0 8 / 20 / 04 I D# Ro n a l d D . Br own 2 . 5 0PO Bo x 2 2 6
CK# New S h ar o n , l a 5 0 20 7
0 9 / 0 3 / 0 4 I D# Ro n a l d D . Br own 2 . 5 0PO Bo x 2 2 6
CK# New S h ar o n , l a 5 0 20 7
0 9 / 1 7 / 04 I D# Ro n a l d D . Br own 2 . 5 0PO Bo x 2 2 6
CK# New S h ar o n , I a 5 0 20 7
1 0 / 01 / 04 I D# Ro n a l d D . Br awn 2 . 5 0PO Bo x 2 2 6
CK# New S h ar o n , I a 5 0 20 7
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0/ 0 4 I D# Un i t e aa i z ed Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
S TA TE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I S T OF I D NUMBERS I S AVA I LABLEFROM THE
I OWA ETHI C S AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p must 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 4 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI P T S
RX CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CON T RI BU T OR RELAT I ON SHI P AMOUNT f I F FORRECE I VED ( i f a p p l i c a b l e ) T O CANDI DAT E * RECE I VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI S ER
NUMBER I N COME
0 7 / 23 / 04 I D# Ch e r y l A . Ch r i s t i n s o n 2 . 5 01 4 2 8 Reed S t r e e t
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Ch e r y l A . Ch r i s t i n so n 2 . 5 01 4 2 8 Reed S t r e e t
CK# Gr i n ne l l , l a 5 0 1 1 2
0 8 / 2 0/ 0 4 m# Ch e r y l A . Ch r i s t i n s o n 2 . 5 01 4 2 8 Reed S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Ch e r y l A . Ch r i s t i n s o n 2 . 5 01 42 8 Re e d S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Ch e r y l A . Ch r i s t i n s o n 2 . 5 01 42 8 Re e d St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Ch e r y l A. Ch r i s t i n s o n 2 . 5 01 4 2 8 R e e d St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 23 / 04 I D# C y n t h i a S . Cl o y e d 5 . 001 2 2 1 Pr i n c e S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 06 / 04 I D# C y n t h i a S . Cl o y e d 5 . 0 01 1 2 1 Pr i n c e S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 2 0 / 0 4 I D# C y n t h i a S . Cl o y e d 5 . 0 01 1 2 1 Pr i n c e S t r e e t
CK# Gr i n n e l l , l a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# C y n t h i a S . Cl o y e d 5 . 0 01 2 2 1 Pr i n c e S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THHE DE S I GNAT ED COLUMN . A L I S T
OF I D NUMBERS I S AVA I LABLEFROM THE
I OWA ETHI C S AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL 1 $ 3 0 . 00
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) J $
" 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 5 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
~X CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E RNUMBER
I NCOME
09 / 1 7 / 04 I D# Cy n t h i a S . Cl o y e d 5 . 0 01 21 Pr i n c e S t r e e t
CK# Gr i n n e l l , I a 5 01 1 2
1 0/ 01 / 04 I D# Cy n t h i a S . Cl o y e d 5 . 0 01 1 -21 Pr i n c e S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
07 / 23 / 04 I D# Un i t e a i z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
09 / 03 / 04 I D# Un i t e n i z e d Re c e i p t 2 . 5 0
CK#
09 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0/ 01 / 04 I D# Un i t a mi z e d Re c e i p t 2 . 5 0
CK#
07 / 23 / 04 m# J a y M. Ct n i n gs 2 . 5 0140 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
08 / 06 / 0 4 I D# J a y M. C3m~n i ngs
1 4 0 8 Ol d 6d2 . 5 0
CK# Ma l c o m, l a 5 0 1 5 7
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
S T AT E C ANDI DAT E S N OT E : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE
I OWAETHI C S AND
CAMPAI GNDI SCLOSURE BOARD
CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 1 9 . 0 0
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) 1 $
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e shown t o t h e t h i r d d e g r e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 6 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI P T S
M CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ON SHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I N COME
0 8 / 2 0 / 0 4 I D# J a y M . ~mmi ns 2 . 5 01 4 0 8 Ol d 6 Rd -.
CK# Ma l c o m, I a 5 0 1 5 7
0 9 / 03 / 0 4 I D# J a y M . Cu ma i n g s 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, l a 5 0 1 5 7
0 9 / 1 7 / 0 4 I D# J a y M . CL ; mmr i nrgs 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
1 0 / 01 / 0 4 I D# J a y M . Cummngs 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
0 8 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
0 8 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
09 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
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Fo r I n s t r u c t i o n s , See Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
S TATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL AC T I ON C OMMI T T EE ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND T HE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T
OF I DNUMBERS I S
AVA I LABLEFROM
T HE I OWA ETHI CSAND
CAMPAI GNDI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TO TAL I $ 1 6 . 8 0
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 7 o f 4 4
( f o r Sc h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
0 CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SERNUMBER I NCOME
0 7 / 23 / 0 4 I D# Ana l De v i l d e r 2 . 3 61 4 1 4 3 50 t h Av e
C R C # Br o o k l y n , I a 5 2 2 1 1
0 8/ 0 6 / 0 4 I D# An n a De v i l d er 2 . 3 61 4 1 4 3 50 t h Av e
CK# Br o o k l y n , I a 5 2 2 1 1
0 8 / 2 0/ 0 4 I D# An n a De v i l d e r 2 . 3 61 4 1 4 3 50 t h Av e
CK# Br o o k l y n , I a 5 2 2 1 1
0 9 / 0 3 / 0 4 I D# An n a De v i l d e r 2 . 3 61 4 1 4 3 50 t h Av e
CK# Br o o k l y n , I a 5 2 2 1 1
0 9 / 1 7 / 0 4 I D# A n n a De v i l d e r 2 . 3 61 4 1 4 3 50 t h Av e
CK# Br o o k l y n , I a 5 2 2 1 1
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 0 3 / 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
S TA TE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DE S I GNAT ED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI C S ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL 1 $ 4 0 . 00
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y I r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa ge 8 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI P T S
~ X CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ON SHI P AMOUNT A/ I F FORRECE I VED ( i f a p p l i c a b l e ) T O CANDI DATE* RECEI VED FUND-
( MM/ DDI YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I N COME
1 0/ 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
07 / 23 / 04 I D# S u s a n M. Ed e l e n 4 . 0 03 6 3 0 9 0 t h S t
CK# Gr i n n e l l , l a 5 0 1 1 2
08 / 06 / 0 4 I D# S u s a n M. Ed e l e n 4 . 0 03 6 3 0 9 0 t h S t
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 20 / 0 4 I D# S u s a n M. Ed e l e n 4 . 0 03 6 3 0 9 0t h S t
CK# Gr i n n e l l , I a 5 0 1 1 2
09 / 03 / 04 I D# S u s a n M. Ed e l e n 4 . 0 03 6 3 0 9 0t h S t
CK# Gr i n n e l l , I a 5 0 1 1 2
09 / 1 7 / 04 I D# S u s a n M. Ed e l e n 4 . 0 03 6 3 0 9 0t h S tCK# Gr i n n e l l , I a 5 0 1 1 2
1 0/ 01 / 04 I D# S u s a n M. Ed e l e n 4 . 003 6 3 0 9 0t h S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Roma i n e K . F e n n e r 5 . 0 0423 4 20 t h s t r e e t
C S C # Gr i n n e l l , l a 5 0 1 1 2
0 8/ 0 6/ 0 4 I D# Rr ma i n o K , Fe n n e r 5 . 0 0423 4 20 t h S t r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 2 0/ 0 4 I D# Roma i n e K. F e n n e r 5 . 0 042 3 4 20 t h S t r e e t
CK# Gr i n n e l l , I a 5 01 1 2
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME / Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n /
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
S T AT E C ANDI DAT E S NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N T HHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE
I OWA ETHI C S ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 3 3 . 50
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 9 o f 4 4
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI P T S
n X CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CON T RI BU T OR RELAT I ON SHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) T O CANDI DAT E * RECE I VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I N COME
0 9 / 0 3 / 0 4 I D# Rr mw i n p K . Fenne r 5 . 0 04 2 3 4 2 0t h St r e et
CK# Gr i n ne l l , I s . 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Rcma n e K . Fenne r 5 . 0 04 2 3 4 2 0 t h s t r ee t
C 3 C # Gr i n ne l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Rc a i n e K . Fa r mer 5 . 004 2 3 4 2 0t h s t r ee t
CK# Gr i n ne l l , l a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
C S C #
08 / 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
C 3 C #
0 9 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
07 / 23 / 04 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1 s t
CK# W. Des Mo i n e s , l a 5 0 2 6 5
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA S T A T E GOODGOVERNMENT CLUB
S TA TE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I ST THE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBERI N THHE DES I GNATED COLUMN
. AL I S T
OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 sa n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
Pa ge 1 0 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECE I P T S
R CHECK T HI S BOXAMENDI NG FORM
DAT E PAC I D NUMBER NAME AND ADDRESS OF CON T RI BU T OR RELAT I ON SHI P AMOUNT J I F FOR
RECE I VED ( i f a p p l i c a b l e ) T O CANDI DAT E * RECE I VED FUND-
( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I N COME
08 / 06 / 04 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1 s t
C 3 C # W. De s Mo i n e s , I a 5 0 2 6 5
08 / 2 0 / 0 4 I D# J o h n S . F l a nn e r y 1 2 . 5 01 0 2 4 21s t
C S C # W. De s Mo i n e s , I a 5 0 2 6 5
0 9 / 0 3 / 0 4 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 21s t
CK# W. De s Moues , I s 5 0 2 6 5
0 9 / 1 7 / 0 4 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1 s t
CK# W. Des Mo i n e s , I a 5 0 26 5
1 0 / 0 1 / 0 4 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1 s t
CK# W. Des Mo i n e s , I s . 5 0 2 6 5
0 7 / 2 3 / 0 4 m# Pa t r i c i a A . Go s s el i n k 2 . 5 0
1 5 3 4 6 S 8 4 t h Av e ECK# Gr i n n e l l , I s . 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Pa t r i c i a A . Go s s el i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n n e l l , l a 5 0 1 1 2
0 8 / 20 / 04 I D# Pa t r i c i a A . Go s s el i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Pa t r i c i a A . Go s s e l i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n ne l l , l a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Pa t r i c i a A. Go s s e l i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n ne l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t be s ame a s o n St a t eme n t o f Or g a n i z a t i o n )
VERI ZON I OWA S T A T E GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C AL ACTI ON COMMI TTEE) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUT I ON : S e c t i o n 68B . 3 2A( 6 ) , I o wa Co d e, p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r om r e p or t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o ns o r
f o r an y c omme r c i a l p ur p o s e by a ny p er s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t page o f t h i s s c h e d u l e )
* Di s c l o s u r e l a w r e q ui r e s c an d i d a t e c o mmi 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 any r e l a t i v e ma k i n g a c on t r i b ut i o n t o t h e
c o mmi t t e e . Re l a t i o ns h i p mu s t b e shown t o t h e t h i r d d e g r e e o f c o ns an g u i n i t y ( b l o od r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S ee P a g e 2 o f f o r ms p ac k e t ) . I f s u r n a me o f c o nt r i b u t o r i s t h e sa me a s c an d i d at e , b u t t h e r e i s n of 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 pp l i c a bl e ' i n t h e r e l a t i o ns h i p c o l u mn .
Page . 1 1 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
F X CHECK T HI S BOX
AMENDI NGFORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT , / I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a b l e ) R AI S E R
NUMBER I NCOME
1 0/ 01 / 04 I D# Pa t r i c i a A . Go s s e l i n k 2 . 5 01 5 3 4 6 S 8 4t h Av e E
CK# Gr i n n el l , l a 5 0 1 1 2
07 / 23 / 04 I D# El l e n T . Gr a f f 4 . 0 07 00 Ga r f i e l d S t
CK# Tama, I a 5 2 3 3 9
08 / 06 / 0 4 I D# El l e n T . Gr a f f 4 . 0 07 00 Ga r f i e l d S t
CK# Tama, I a 5 2 3 3 9
08 / 20 / 0 4 I D# El l e n T . Gr a f f 4 . 0 07 00 Ga r f i e l d S t
CK# Tama, I a 5 2 3 3 9
09 / 03 / 04 I D# El l e n T . Gr a f f 4 . 0 07 00 Ga r f i e l d S t
CK# Tama, l a 5 23 3 9
09 / 1 7 / 04 I D# El l e n T . Gr a f f 4 . 0 0
7 00 Ga r f i e l d S tCK# Tama, I a 5 2 3 3 9
1 0/ 01 / 04 I D# El l e n T . Gr a f f 4 . 007 00 Ga r f i e l d S t
CK# Tama, l a 5 2 3 3 9
07 / 23 / 04 I D# An d r e w J . Gr o s e n b a c h 5 . 001 1 1 6 Re e d S t Ap t 1 01
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6/ 0 4 I D# An d r e w J . Gr o s e n b a c h 5 . 0 01 1 1 6 Re e d S t Ap t 1 01
CK# Gr i n n e l l , I a 5 01 1 2
0 8/ 2 0/ 0 4 I D# An d r e w J . Gr o s e n b a c h 5 . 0 01 1 1 6 Re e d S t Ap t 1 01
CK# Gr i n n e l l , I a 5 01 1 2
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEENAME ( Mu s t b e same a s o n S t a t e me n t o f Or g a n i z at i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : i F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I S T OF I D NUMBERS I S AVA I LABLEFROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) . I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 sa n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
Page_ 1 2 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 0 3 / 0 4 I D# And r ew J . Gr o s e n b a c h 5 . 001 1 1 6 Re e d S t Ap t 1 0 1
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# And r ew J . Gr o s e n b a c h 5 . 001 1 1 6 Re e d S t Ap t 1 0 1
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# And r ew J . Gr ose nbach 5 . 0 01 1 1 6 Reed St Ap t 1 0 1
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 m# J e n n i f e r Gu n d e r s o n 2 . 5 040 9 Cl a y S t
CK# Ma l c o m, l a 5 0 1 5 7
08 / 0 6 / 0 4 I D# J e n n i f e r Gu n d e r s o n 2 . 5 04 0 9 Cl a y S t
CK# Ma l c om, I a 5 0 1 5 7
0 8 / 2 0/ 0 4 I D# J e n n i f e r Gu n d e r s o n 2 . 5 0
4 0 9 Cl a y S tCK# Ma l c o m, I a 5 0 1 5 7
0 9 / 0 3 / 0 4 I D# J e n n i f e r Gu n d e r s o n 2 . 5 04 0 9 Cl a y S t
CK# Ma l e = , I a 5 0 1 5 7
0 9 / 1 7 / 0 4 I D# J e n n i f e r Gu n d e r s o n 2 . 5 040 9 Cl a y S t
CK# Ma l c o m, I a 5 0 1 5 7
1 0 / 0 1 / 0 4 m# J e n n i f e r Gu n d e r s o n 2 . 5 0409 Cl a y S t
CK# Ma l c o m, I a 5 0 1 5 7
0 7 / 2 3 / 0 4 I D# T r a c i A . Gu t h r i e 8 . 001 2 1 Ad a i r S t
CK# Ke l l o g g , I a 5 0 1 3 5
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA
ETHI C S ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 4 4 . 5 0
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) 1 $
' D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Pag e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b ut t h e r e i s n of 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 mn .
P a g e 1 4 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
~ X CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E RNUMBER I NCOME
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
C3C#
0 7 / 23 / 04 I D# Ann M . Ra n s s e n 6 . 00PO Bo x 2 4 6
CK# Ke l l o g g , I a 5 0 1 3 5
0 8 / 0 6 / 0 4 I D# Ann M . H a n s s e n 6 . 0 0PO Bo x 2 46
CK# Ke l l o g g , I a 5 0 1 3 5
0 8 / 2 0/ 0 4 I D# Ana M . H a n s s e n 6 . 00PO Bo x 2 46
CK# Ke l l o g g , I a 5 0 1 3 5
0 9 / 0 3 / 0 4 I D# Ana M. H a n s s e n 6 . 00PO Bo x 2 4 6
CK# Ke l l o g g , l a 5 0 1 3 5
0 9 / 1 7 / 04 I D# Ann M . H a n s s e n 6 . 00
PO Bo x 2 4 6C2C# Ke l l o g g , l a 5 0 1 3 5
1 0 / 0 1 / 0 4 I D# Ana M . H a n s s e n 6 . 0 0PO Bo x 2 4 6
CK# Ke l l o g g , I a 5 0 1 3 5
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
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CK#
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N T HHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
P a g e 1 5 o f 44
( f o r S c h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
. 0 CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SER
NUMBER I NCOME
0 9 / 03 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 01 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CC#
0 7 / 23 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 03 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CC#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CC#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
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0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
I
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I I I I
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Fo r I n s t r u c t i o n s , S e e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DE S I GNAT ED COLUMN. A
L I S T OF I D NUMBERS I SAVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TO TAL
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .Page 1 6 o f 44
( f o r Sc h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
MX CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E R
NUMBER I NCOME
0 8 / 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
08 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
1 0 / 01 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
! I I j ~
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI B UT I ON I S RECE I VED FROM A S T A T E PAC ( P OL I T I C AL ACT I ON COMM I T T E E ) , L I ST T HE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I S T OF I D NUMBERS I SAVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s
TOTAL ( i f l a s t page o f t h i s s c h e d u l e )
" D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 sa n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .Pa ge 1 7 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap pl i c ab l e ) R AI S E R
NUMBERI NCOME
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 7 / 2 3 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 22 9 t h Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 1 1 3 Avenue
CK# Gr i n ne l l , l a 5 0 1 1 2
0 8 / 20 / 04 I D# Peggy A. J a n t z e n 2 . 5 0
5 22 9 t h Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 03 / 04 I D# Peggy A . J a n t z e n 2 . 5 0
5 22 9 t h Avenue
CK# Gr i n n e l l , l a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
CK# Gr i n n e l l , l a 5 0 1 1 2
0 7 / 23 / 04 I D# Di a n e J . Ke e n a n 2 . 5 0
1 2 2 8 Wes t S tCK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 06 / 04 I D# Di ane J . Keenan 2 . 5 0
1 2 2 8 Wes t S tCK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 I D# Di ane J . Keenan 2 . 5 0
1 2 2 8 Wes t S tCK# Gr i n ne l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA S T A T E GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I ST THE PAC I DE NT I F I C AT I ON
NUMBERAND
THE PAC CHECKNUMBER I N THHE DES I GNATED COLUMN
. A
L I S T OFI D NUMBERS
I SAVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .
TOTAL ( i f l a s t p ag e o f t h i s s c h ed u l e )
Page 1 8 o f 44
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
. ~CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P ' AMOUNT ( I F FOR
RECEI VED ( i f a pp l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 03 / 04 I D# Di ane J . Keenan 2 . 5 01 2 2 8 Wes t St
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 04 I D# Di ane J . Keenan 2 . 5 01 2 2 8 Wes t St
CK# Gr i n n e l l , l a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Di ane J . Keenan 2 . 5 01 2 2 8 We s t S t
CK# Gr i n n e l l , l a 5 0 1 1 2
0 7 / 23 / 04 I D# Pame l a L . Ke s s l e r 5 . 002 5 5 42 0t h Av e
CK# Gr i n ne l l , I a 5 0 1 1 2
08 / 06 / 04 I D# Pame l a L . Ke s s l e r 5 . 002 5 5 42 0t h Av e
CK# Gr i n ne l l , l a 5 0 1 1 2
0 8 / 2 0/ 0 4 I D# Pmne l a L . Ke s s l e r 5 . 00
2 5 5 42 0t h Av eCK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 002 5 5 4 20 t h Av e
CK# Gr i n ne l l , I s 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 002 5 5 4 20 t h Av e
CK# Gr i n ne l l , l a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 02 5 5 42 0 t h Av e
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
S T A T E CANDI DA T E S NOTE : I F A CON T RI B UT I ON I S RECE I VED FROM A S T A T E PAC ( P OL I T I C AL AC T I ON C OMMI T T EE ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND T HE PAC CHECK NUMBER I N T HHE DES I GNATED COLUMN A L I S T OF I DNUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b ut t h e r e i s n o
f 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 mn .Pa g e 1 9 o f 4 4
( f o r S c h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) REC EI P T S
r X CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CON T RI BU T OR RELAT I ON SHI P AMOUNT / I F FOR
RECE I VED ( i f a p p l i c a b l e ) T O CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I N COME
08 / 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 1 7 / 0 4 I D# U n i t e mmi z e d Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
C 3 C #
0 7 / 2 3 / 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 0
6 1 6 Ma i n S tCK# Br o o k l y n , l a 5 2 2 1 1
0 8 / 06 / 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 0
6 1 6 Ma i n S tCK# Br o o k l y n , l a . 5 2 2 1 1
0 8 / 20 / 04 I D# Ki mbe r l y K . Kr i e g e l 2 . 5 06 1 6 Ma i n S t
CK# Br o o k l y n , l a 5 2 2 1 1
0 9 / 0 3 / 0 4 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 1 6 Ma i n S t
CK# Br o o k l y n , I a 5 2 2 1 1
0 9 / 1 7 / 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 1 6 Ma i n S t
CK# Br o o k l y n , I a 5 2 2 1 1
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s a m e a s o n S t a t e m e n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER
ANDTHE PAC CHECK
NUMBER I N THHE DES I GNATED COLUMN.A L I S T OF I D NUMBERS
I SAVA I LABLE
FROM THEI OWA ETHI C S
ANDCAMPAI GNDI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
" D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 2 0 o f 4 4
( f o r S c h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
MX CHECK T HI S BOXAMENDI NGFORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE " RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E R
NUMBER I NCOME
1 0 / 0 1 / 0 4 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 1 6 Ma i n S t
CK# Br o o k l y n , I a 5 2 2 1 1
07 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 0 6/ 0 4 m# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
08 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
09 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
09 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
1 0 / 01 / 04 I D# u hi t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 23 / 04 I D# Sha r o n L . Kr t mm 2 . 5 01 5 4 1 5 N 7 5 t h Av e E
CK# Gr i n ne l l , I a 5 0 1 1 2
08 / 06 / 04 I D# Sha r o n L . Kx l amn 2 . 5 01 5 4 1 5 N 7 5 t h Av e E
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 m# Sha r o n L . Kr t mm 2 . 5 01 5 4 1 5 N 7 5 t h Av e E
CK# Gr i n ne l l , l a 5 0 1 1 2
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Fo r I n s t r u c t i o n s , S e e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I ST OF I DNUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .Page 21 o f 44
( f o r Sc h e du l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
n X CHECK T HI S BOX I FAMENDI NG FORM
DAT E PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ON SHI P AMOUNT J I F FOR
RECE I VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 0 3 / 0 4 I D# Sha r o n L . Kr man 2 . 5 01 5 4 1 5 N 7 5t h Av e E
CK# Gr i n ne l l , l a 5 0 1 1 2
0 9 / 1 7 / 04 I D# S h a r o n L . Kx1af 2 . 5 0
1 5 4 1 5 N 7 5 t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Sha r o n L . Kr t n n n 2 . 5 0
1 5 4 1 5 N 7 5t h Av e Ec K# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 03 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 23 / 04 I D# Debr a E . Lewi s 5 . 00
1 2 0 2 El m S t r e e tCK# Gr i n n e l l , l a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
C ON T RI BU T I ON S - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA S T A T E GOODGOVERNMENT CLUB
S TA TE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I ST T HE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I ST OF I D NUMBERS I S AVA I LABLE FROMTHE
I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 2 2 o f 4 4
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( R e v . 0 6/ 9 7 ) RE CE I P T S
EX CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CON T RI BU T OR RELAT I ON SHI P AMOUNT J I F FORRECE I VED ( i f a p p l i c a b l e ) T O CANDI DAT E * RECEI VED FUND-
( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I N COME
08 / 0 6/ 0 4 m# Debr a E . L e wi s 5 . 0 01 2 0 2 El m St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 20 / 04 I D# Debr a E . Le wi s 5 . 0 01 2 0 2 El m St r e et
CK# Gr i n n e l l , l a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Debr a E . Le wi s 5 . 001 2 0 2 El m St r e et
CK# Gr i m 1 1 , I a 5 0 1 1 2
0 9 / 1 7 / 04 I D# Debr a E . Le wi s 5 . 001 2 0 2 El m S t r e e t
CK# Gr i n n e l l , l a 5 0 1 1 2
1 0 / 01 / 04 I D# Debr a E . L e w i s 5 . 001 2 0 2 El m S t r e e t
CK# Gr i n n e l l , I s 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
Y0 9 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e: a i z e d Re c e i p t 2 . 5 0
CK#
07 / 2 3 / 0 4 I D# S u s a n J . Mc Ca i n 2 . 5 0
CK#4 3 7 0Ma l c o m, g Ih a 5 01 5 ' 7
6 3 Bo x8
08 / 0 6 / 0 4 I D# S u s a n J . Mc Ca i n 2 . 5 04 3 7 0 6 3 Bo x
8CK# Ma l c o m, I s 5 01 5 ' 7
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Fo r I n s t r u c t i o n s , S e e Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED
COLUMN. A L I S T
OFI D NUMBERS
I SAVA I LABLE FROM T HE
I OWAETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 2 3 o f 44
( f o r Sc h e du l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
n CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
0 8 / 2 0 / 0 4 I D# S u s a n J . Mc Ca i n 2 . 5 04 3 7 0 Hi g h w ay 6 3 , Ha a s 8
CK# Ma l c c m, l a 5 0 1 5 7
0 9 / 03 / 04 I D# S u s a n J . Mc Ca i n 2 . 5 04 3 7 0 Hi g h wa y 6 3 , Bo x 8
CK# Ma l c am, I a 5 0 1 5 7
0 9 / 1 7 / 0 4 I D# Susan J . Mc Ca i n 2 . 5 04 3 7 0 Hi g h wa y 6 3 , Bo x 8
CK# Ma l c am, l a 5 0 1 5 7
1 0 / 0 1 / 0 4 m# Susan J . Mc r a i n 2 . 5 04 3 7 0 Hi ghway 6 3 , Bo x 8
CK# Ma l c am, I a 5 0 1 5 7
0 7 / 2 3 / 0 4 m# Un i t e o i z e d Re c e i p t 1 . 00
CK#
0 8 / 0 6 / 0 4 I D# Un i t e a i z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0/ 0 4 I D# Un i t e o i z e d Re c e i p t 1 . 00
CK#
09 / 0 3 / 0 4 I D# Un i t e a i z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Un i t e a i z e d Re c e i p t 1 . 00
CK#
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON TR I BUT I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND T HE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 2 4 o f 4 4
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 m# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
C 3 C #
0 7 / 2 3 / 0 4 I D# Rhonda R . Mayes 5 . 003 02 2 nd Av e
C 3 C # Gr i n n e l l , l a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Rhonda R . Mayes 5 . 003 02 2 nd Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e same a s o n S t a t e me n t o f Or g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e shown t o t h e t h i r d d e g r e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Pa g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL AC T I ON C OMMI T T EE ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h e d u l e )
Page 25 o f 4 4
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
I CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT % f I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SER
NUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Rho n d a R . May es 5 . 0 03 0 2 2n d Av e
CK # Gr i m 1 1 , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Rho n d a R . May es 5 . 0 03 0 2 2n d Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Rho n d a R . May es 5 . 0 03 0 2 2n d Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Rho n d a R . Moy es 5 . 0 03 0 2 2n d Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 5 0
CK #
0 8 / 0 6 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 5 0
CK #
0 8 / 2 0 / 0 4 I D# Un i t a a i z e d Re c e i p t 2 . 5 0
CK #
0 9 / 0 3 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 5 0
CK #
0 9 / 1 7 / 0 4 m# Un i t e mi z ed Re c e i p t 2 . 5 0
CK #
1 0 / 0 1 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 5 0
CK #
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Fo r I n s t r u c t i o n s , S e e Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON TR I BUT I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMM I T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND T HE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b ut t h e r e i s n of 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 mn .
Pa g e 26 o f 44
( f o r Sc h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
. ~ CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
0 7 / 2 3 / 0 4 I D# R e b e c c a L . No r t h c u t t 2 . 5 07 0 5 E F l o od S t Bo x 8 1 9
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 8 / 0 6 / 0 4 I D# R e b e c c a L . No r t h c u t t 2 . 5 07 0 5 E Wood S t Bo x 8 1 9
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 8 / 2 0/ 0 4 I D# Re b e c c a L . No r t h c u t t 2 . 5 07 0 5 E Wood S t Bo x 8 1 9
CK# Mo n t e z u ma , l a 5 0 1 7 1
09 / 0 3 / 0 4 I D# R e b e c c a L . No r t h c u t t 2 . 5 07 0 5 E Wood S t Bo x 8 1 9
CK# Mo n t e z u ma , l a 5 0 1 7 1
0 9 / 1 7 / 04 I D# R e b e c c a L . No r t h c u t t 2 . 5 07 0 5 E Wood S t Bo x 8 1 9
CK# Mo n t e z u ma , I a 5 0 1 7 1
1 0 / 01 / 04 I D# R e b e c c a L . No r t h c u t t 2 . 5 0
7 0 5 E Wood St Bo x 8 1 9CK# Mo n t e z u ma , l a 5 0 1 7 1
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
08 / 06 / 04 I D# Un i t ea i z ed Re c e i p t 1 . 0 0
CK#
08 / 20 / 04 I D# Un i t e t L i z ed Re c e i p t 1 . 0 0
CK#
09 / 0 3 / 0 4 I D# Un i t ea i z ed Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z at i o n )
VER I ZON I OWA S T A T E GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI B UT I ON I S RECE I VED FROM A S T A T E PAC ( P OL I T I C AL ACT I ON COMM I T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N T HHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn
P a g e 2 7 o f 44
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT , / I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) AND PAC CHECK ( i f a pp l i c a b l e ) R AI S E RNUMBER I NCOME
0 9 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
08 / 06 / 04 I D# Un i t e t t i z e d Re c e i p t 2 . 5 0
CK#
08 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
09 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
09 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 01 / 04 I D# Un i t ea i z ed Re c e i p t 2 . 5 0
CK#
07 / 2 3 / 0 4 I D# Mi c h a e l D. Pa wl o ws k i 5 . 009 0 2 H a n o v e r Dr i v e
CK# So u t h L a k e , T x 7 60 9 2
08 / 0 6/ 0 4 I D# Mi c h a e l D. Pa wl o ws k i 5 . 009 02 Ha n o v e r Dr i v e
CK# So u t h L a k e , T S c 7 6 0 9 2
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F o r I n s t r u c t i o n s . S e e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBERAND
THE PAC CHECKNUMBER I N THHE DES I GNATED COLUMN
. AL I S T OF I D NUMBERS I S AVA I LABLE
FROM THE I OWAETHI C S AND
CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
` 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d eg 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 ) a n d a f f i n i t y I r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p ag e o f t h i s s c h e d u l e )
Page 28 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . ' 06 / 9 7 ) RECEI PTS
EX CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - I I F FORRECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Mi c h a e l D . Pa wl o w s k i 5 . 009 02 H a n o v e r Dr i v e
CC# So u t h L a k e , T S c 7 6 0 9 2
0 9 / 0 3 / 0 4 I D# Mi c h a e l D . Pa w l o w s k i 5 . 009 02 H a n o v e r Dr i v e
CK# S o u t h L a k e , T x 7 60 9 2
0 9 / 1 7 / 0 4 I D# Mi c h a e l D . Pa wl o ws k i 5 . 009 02 H a n o v e r Dr i v e
CK# So u t h L a k e , T x 7 6 0 9 2
1 0 / 01 / 04 I D# Mi c h a e l D. Pa wl o ws k i 5 . 009 02 H a n o v e r Dr i v e
CK# So u t h L a k e , T x 7 60 9 2
0 7 / 2 3 / 0 4 I D# Li n da M . P e a c e 5 . 001 1 0 8 S u mme r S t
C E C # Gr i n n e l l , l a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Li n da M . P e a s e 5 . 00
1 1 0 8 S u mme r S tCK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 I D# Li n da M . P e a s e 5 . 001 1 0 8 s u mme r S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Li n da M . Pease 5 . 001 1 0 8 S u mme r S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Li n da M. Pease 5 . 0 01 1 0 8 S u mme r S t
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Li n da M. Peace 5 . 0 01 1 0 8 S u mme r S t
CK# Gr i n n e l l , I a 5 0 1 1 2
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Fo r I n s t r u c t i o n s , S e e Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g an i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
S TATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBERAND
THE PAC CHECKNUMBER I N THHE DES I GNATED COLUMN
. A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
" 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 2 9 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
~ X CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 41 I F FOR
RECEI VED ( i f a p p l i c a b l e ) T O CANDI DATE" RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E R
NUMBER I NCOME
0 7 / 2 3 / 0 4 I D# J ame s R . Ph e l p s 2 . 5 01 6 0 2 1 0 t h Avenue Pl a c e
C t # Gr i m 1 1 , I a 5 0 1 1 2
08 / 0 6/ 0 4 I D# J ame s R . Ph e l p s 2 . 5 01 6 0 2 1 0 t h Avenue Pl a c e
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 20 / 04 I D# James R . Ph e l p s 2 . 5 01 6 0 2 1 0 t h Avenue Pl a c e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 03 / 04 I D# James R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Avenue Pl a c e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# J a me s R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Avenue Pl a c e
CK# Gr i n n e l l , l a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# J mn e s R . Ph e l p s 2 . 5 0
1 6 0 2 1 0t h Avenue Pl a c eCK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# J a n K . P o p e 5 . 006 0 3 Va n Ho r n e C i r
CK# Gr i n ne l l , I a 5 0 1 1 2
08 / 0 6 / 0 4 I D# J a n K . P o p e 5 . 006 0 3 Va n Bo r n e C i r
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 I D# J a n K . P o p e 5 . 006 0 3 Va n Home Ci r
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# J a n K . P o p e 5 . 006 0 3 Va n Ho r n e Ci r
CK# Gr i m 1 1 , l a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CON TRI BU T I ON S - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S TATE PAC ( POL I T I C AL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
Page 3 0 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
M CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - I I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E RNUMBER I NCOME
0 9 / 1 7 / 0 4 I D# J a n K . Gape 5 . 006 0 3 Va n Home Ci r
CK# Gr i n n e l l , l a . 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# J a n K . Pope 5 . 006 0 3 Va n Ho r n e C i r
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 23 / 0 4 I D# Un i t mi z e d Re c e i p t 1 . 00
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 1 7 / 0 4 I n # Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
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Fo r I n s t r u c t i o n s , See Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMM I T T E E ) , L I ST THE PAC I DE NT I F I C AT I ONNUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS ANDCAMPAI GNDI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I $ 1 0 . 0 0
TOTAL ( i f l a s t page o f t h i s s c h e d u l e ) 1 $
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y I r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn
Pa g e 3 1 o f 44
( f o r Sc h e du l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
. ~ CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E RNUMBER I NCOME
0 8 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
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F o r I n s t r u c t i o n s , S e e Bac k o f F o r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBERAND
THE PAC CHECKNUMBER I N THHE
DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA . ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD .CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page - 3 2 o f 4 4
( f o r S c h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
RX CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 7 / 2 3 / 0 4 I D# Ba r b a r a J . S c h u l t z 2 . 5 0
5 1 0 Pe a r l S tCK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Ba r b a r a J . S c h u l t z 2 . 5 0
5 1 0 Pe a r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 m# Ba r b a r a J . S c h u l t z 2 . 5 0
5 1 0 Pe a r l S tCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Ba r b a r a J . S c h u l t z 2 . 5 05 1 0 Pe a r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 04 I D# Ba r b a r a J . S c h u l t z 2 . 5 05 1 0 Pe a r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Ba r b a r a J . S c h u l t z 2 . 5 0
5 1 0 Pe a r l S tCK# Gr i n n e l l , l a 5 0 1 1 2
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 03 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
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Fo r I n s t r u c t i o n s , S e e Ba c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
STATE CANDI DATES NOTE : I F A CON T RI B UT I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMM I T T E E ) , L I ST T HE PAC I DE NT I F I C AT I ON
NUMBERANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
Page 3 3 o f 4 4
( f o r Sc h e du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
M CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT , ' I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap pl i c ab l e ) R AI S E R
NUMBER I NCOME
0 9 / 1 7 / 0 4 m# U n i t e m i z e d R e c e i p t 1 . 0 0
C K #
1 0 / 0 1 / 0 4 m# U n i t e m i z e d R e c e i p t 1 . 0 0
C K #
0 7 / 2 3 / 0 4 m# U n i t e m i z e d R e c e i p t 2 . 5 0
C K #
0 8 / 0 6 / 0 4 m# U n i t e mi z e d R e c e i p t 2 . 5 0
C K #
0 8 / 2 0 / 0 4 m# U n i t e m i z e d R e c e i p t 2 . 5 0
CK#
0 9 / 0 3 / 0 4 m# U n i t e m i z e d R e c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 m# U n i t e mi z e d R e c e i p t 2 . 5 0
C K #
1 0 / 0 1 / 0 4 m# U n i t e m i z e d R e c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 m# U n i t e m i z e d R e c e i p t 1 . 2 5
C K #
0 8 / 0 6 / 0 4 m# U n i t e m i z e d R e c e i p t 1 . 2 5
C K #
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Fo r I n s t r u c t i o n s , S e e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND T HE PAC CHECK NUMBER I N T HHE DES I GNATED COLUMN. A
L I S T OF I D NUMBERSI S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s
" D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus t b e shown 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 ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Pa g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
Page 3 4 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
M CHECK T HI S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - I I F FOR
RECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 8 / 2 0/ 0 4 I D# Un i t e a i z e d Re c e i p t 1 . 2 5
CK#
0 9 / 0 3 / 0 4 I D# Un i t e oi z ed Re c e i p t 1 . 25
CK#
0 9 / 1 7 / 0 4 I D# Un i t e ai z ed Re c e i p t 1 . 25
CK#
1 0 / 01 / 04 I D# Un i t ea i z ed Re c e i p t 1 . 2 5
CK#
07 / 23 / 04 I D# Mi c h e l e L . S i s s o n 3 . 00
1 4 2 1 4 t h Av e
CK# Gr i - e l l , I a 5 0 1 1 2
08 / 06 / 04 I D# Mi c h e l e L . S i s s o n 3 . 00
1 4 2 1 4 t h Av eCK# Gr i n ne l l , l a 5 0 1 1 2
0 8 / 2 0/ 0 4 I n # Mi c he l e L . S i s s o n 3 . 0 01 4 2 1 4 t h Av e
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 03 / 0 4 I D# Mi c h e l e L . S i s s o n 3 . 00
1 4 2 1 4 t h Av eCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 m# Mi c h e l e L . S i s s o n 3 . 00
1 4 2 1 4 t h Av eCK# Gr i n ne l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Mi c he l e L . S i s s o n 3 . 001 4 2 1 4 t h Av e
CK# Gr i n ne l l , I a 5 0 1 1 2
I I I I I ~
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN.A L I S T OF I D NUMBERS I S AVA I LABLE
FROM THE I OWAETHI C S
AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s . '
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 5 o f 4 4
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
~ X CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 7 / 2 3 / 0 4 I D # U n i t e m i z e d R e c e i p t 2 . 5 0
C K #
0 8 / 0 6 / 0 4 I D # U n i t e m i z e d R e c e i p t 2 . 5 0
C K #
0 8 / 2 0 / 0 4 I D # U n i t e m i z e d R e c e i p t 2 . 5 0
C K #
0 9 / 0 3 / 0 4 m# U n i t e mi z e d R e c e i p t 2 . 5 0
C K #
0 9 / 1 7 / 0 4 I D # U n i t e mi z e d R e c e i p t 2 . 5 0
C K #
1 0 / 0 1 / 0 4 I D # U n i t e mi z e d R e c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 I D # K a t h y V . S t a n e k 2 . 5 0PO B o o t 9 2 6
C K # Gr i m 1 1 , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D # K a t h y V . S t a n e k 2 . 5 0P O B o x 9 2 6
CK# G r i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D # K a t h y V . S t a n e k 2 . 5 0P O Bo x 9 2 6
C K # G r i n n e l l , l a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D # K a t h y V . S t a n e k 2 . 5 0P O Bo x 9 2 6
C K # G r i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 sa n gu i n i t y I b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON COMMI T T E E ) , L I S T T HE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A
L I S T OF I DNUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
Page 3 6 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v 0 6/ 9 7 ) RECEI PTS
F CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v1 I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E R
NUMBER I NCOME
0 9 / 1 7 / 0 4 I D# Ka t h y V . St a n e k 2 . 5 0
PO Bo x 9 2 6CK# Gr i me 1 1 , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Ka t h y V . St a n e k 2 . 5 0
PO B o a t 9 26
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 23 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CZ#
0 8 / 2 0/ 0 4 m# Un i t e a i z e d Re c e i p t 1 . 0 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 1 7 / 0 4 I D# Un i t en i z ed Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Un i t e a i z e d Re c e i p t 1 . 00
C a t #
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
Ca t #
0 8 / 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CZ#
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON TR I BUT I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA' ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 sa n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 3 7 o f 44
( f o r S c he d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
FX CHECK T HI S BOX
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E R
NUMBER I NCOME
0 8 / 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
09 / 0 3 / 0 4 I D# Un i t ea i z ed Re c e i p t 2 . 5 0
CK#
09 / 1 7 / 0 4 I D# Un i t emd z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t ea i z ed Re c e i p t 2 . 5 0
CK#
07 / 2 3 / 0 4 I D# Ma r c i a T a r v i n 2 . 5 05 0 2 7 Hwy 6 3
CC# Mo n t e m- , i s 5 0 1 7 1
0 8/ 06 / 0 4 I D# Ma r c i a Ta r v i n 2 . 5 0
5 0 2 7 Hwy 6 3CK# Mo l n t e z t a n a , I a 5 0 1 7 1 .
0 8 / 2 0/ 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 02 7 Hwy 6 3
CC# Mo n t e z t ml a , I a 5 0 1 7 1
0 9 / 0 3 / 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 02 7 Hwy 6 3
CK# Mon t e z uma , I a 5 0 1 7 1
0 9 / 1 7 / 0 4 I D# Ma r c i a Ta n n i n 2 . 5 05 02 7 Hwy 6 3
CC# Mo n t e z t mi a , I a 5 0 1 7 1
1 0 / 0 1 / 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
1
CC# Mo n t e z t ml a , I a 5 0 1 7 1
I I I
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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DE S I GN ATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page _ 3 8 - o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
F RI CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E R
NUMBER I NCOME
0 7 / 2 3 / 0 4 I D# Ka r en Va n So e l e n 2 . 5 01 2 6 9 5 S 92nd Av e E
CK# S u l l y , I a 5 0 25 1
0 8 / 06 / 04 I D# Ka r en Va n So e l e n 2 . 5 0
1 2 6 9 5 S 92nd Av e ECK# S u l l y , I a 5 0 2 5 1
0 8 / 20 / 04 I D# Ka r en Va n So e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e E
CK# S u l l y , I a 5 0 2 5 1
0 9 / 03 / 04 I D# Ka r e n Va n So e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e E
CK# S u l l y , l a 5 0 2 5 1
0 9 / 1 7 / 04 I D# Ka r e n Va n S o e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e E
CK# S u l l y , I a 5 0 2 5 1
1 0 / 0 1 / 0 4 I D# Ka r e n Va n So e l e n 2 . 5 0
1 2 6 9 5 S 92n d Av e ECK# S u l l y , I a 5 0 2 5 1
07 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK# .
08 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 2 0/ 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON TR I BUT I ON I S RECE I VED FROM A STATE PAC ( POL I T I CAL AC T I ON C OMMI T T EE ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND T HE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 9 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
. ~ CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT , / I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 1 7 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 01 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 0 4 I D# Mar l i s R . Va n Za n t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , l a 5 0 1 5 3
0 8 / 0 6 / 0 4 m# Mar l i s R . Va n Za n t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
0 8 / 20 / 04 I D# Mar l i s R . Va n Za n t e 2 . 5 0E 1 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
t 0 9 / 03 / 04 I D# Mar l i s R . Va n Za n t e 2 . 5 0
1 4 0 1 7 Ewy F - 6 2 ECK# L y n n v i l l e , l a 5 0 1 5 3
0 9 / 1 7 / 0 4 m# Mar l i s R . Va n Za n t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
1 0 / 01 / 04 I D# Mar l i s R . Va n Za n t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
0 7 / 23 / 04 I D# Ka r l a L . Va n d e r l e e s t 2 . 001 5 2 7 0 N 75t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Ka r l a L . Va n d e r l e e s t 2 . 001 5 2 7 0 N 75t h Av e E
CK# Gr i n ne l l , I a 5 0 1 1 2
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4 k
Fo r I n s t r u c t i o n s , S e e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e same a s o n S t a t e me n t o f Or g an i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMM I T T E E ) , L I ST THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND
CAMPAI GNDI SCLOSURE BOARD.CAUT I ON : Se c t i o n 68 B . 3 2 A( 6 ) . I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TO TAL I S . 2 , 5 2 7 . 9 2
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e ) J $
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Pa g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 4 0 o f 4 4
( f o r Sc h e d u l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
~X CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) R AI S E RNUMBER I NCOME
0 8 / 20 / 04 I D# Ka r l a L . Va n d e r l e e s t 2 . 001 5 2 7 0 N 75t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 03 / 04 I D# Ka r l a L . Va n d e r l e e s t 2 . 001 5 2 7 0 N 75t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 04 I D# Ka r l a L . Va n d e r l e e s t 2 . 001 5 2 7 0 N 75t h Av e E
CK# Gr i n ne l l , I s . 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Ka r l a L . Va n de r l e es t 2 . 0 01 5 2 7 0 N 7 5t h Av e E
CK# Gr i n ne l l , l a 5 0 1 1 2
0 7 / 2 7 / 04 I D# Ve r i z o n Good Go v e r n me n t C l u b - T S [ 1 , 2 5 0 . 008 1 6 Co n g r e s s Av e . , S u i t e 1 5 0 0
CK# Au s t i n , T 5 c 7 8 7 0 1
1 0 / 1 2 / 0 4 I D# Ve r i z o n Good Go v e r n me n t C l u b - T X 1 , 2 50 . 00
C 3 C # 8 1 6x 7 8 7 0 1
S u i t e 1 5 0 0Au s t i n
0 7 / 2 3 / 0 4 I D# Debor ah D. Wal ke r 4 . 9 82 3 8 Ho r s e s h o e Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 8/ 0 6 / 0 4 I D# Debor ah D . Wal ke r 4 . 9 823 8 Ho r s e s h o e Dr
C 3 C # Mo n t e z u ma , I a 5 0 1 7 1
0 8 / 20 / 04 I D# De b o r a h D . Wal ke r 4 . 9 82 3 8 Ho r s e s h o e Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 9 / 0 3 / 0 4 I D# De b o r a h D . Wal ke r 4 . 9 82 3 8 Ho r s e s h o e Dr
IC 3 C #
IMo n t e z u ma , l a 5 0 1 7 1
I I I
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CONTRI BU T I ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z at i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S TATE PAC ( POL I T I C AL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON: Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
` D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 4 1 o f 44
( f o r S c h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - / I F FOR
RECEI VED ( i f ap pl i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a pp l i c a b l e ) R AI S E R
NUMBER I NCOME
0 9 / 1 7 / 0 4 I D# De b o r a h D . Wal ke r 4 . 9 82 3 8 Ho r s e s h o e Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
1 0 / 01 / 0 4 I D# De b o r a h D . Wal ke r 4 . 9 8
2 3 8 Ho r s e s h o e Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 7 / 23 / 0 4 I D# Dav i d L . Wea v er 2 . 5 0
1 7 9 Wal nu t Ro a dCK# Gr i n n e l l , I s . 5 0 1 1 2
0 8 / 06 / 04 I D# Dav i d L . Wea v er 2 . 5 01 7 9 Wal nu t Ro a d
CK# Gr i n n e l l , I s 5 0 1 1 2
0 8 / 20 / 04 I D# Dav i d L . Wea v er 2 . 5 01 7 9 Wal nut Ro a d
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Dav i d L . Wea v er 2 . 5 0
1 7 9 Wal nut RoadCK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Dav i d L . Wea v er 2 . 5 01 7 9 Wal nut Road
CK# Gr i n ne l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Dav i d L . Wea v er 2 . 5 01 7 9 Wal nut Road
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 23 / 04 I D# J o a n n L . We l l s 5 . 0 025 6 Newbu r g Ro a d
CK# Gr i n ne l l , I s , 5 0 1 1 2
0 8 / 06 / 04 I D# J o a n n L . We l l s 5 . 0025 6 Newbu r g Ro a d
1
CK# Gr i n ne l l , I s . 5 0 1 1 2
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F o r I n s t r u c t i o n s , S e e Bac k o f Fo r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DE S I GNAT ED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S AND CAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o n t r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t page o f t h i s s c h ed u l e )
' 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e shown t o t h e t h i r d d e g r e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( Se e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Pa g e 4 2 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT % I I F FORRECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f ap p l i c ab l e ) R AI S E RNUMBER I NCOME
0 8 / 2 0/ 0 4 I D# J o a n n L . We l l s 5 . 0025 6 Ne wb u r g Road
CK# Gr i n ne l l , l a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# J o a n n L . We l l s 5 . 0025 6 Ne wb u r g Road
CK# Gr i n ne l l , l a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# J o a n n L . We l l s 5 . 0025 6 Ne wb u r g Road
CK# Gr i n ne l l , l a , 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# J o a n n L . We l l s 5 . 0025 6 Ne wb u r g Road
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 0 3 / 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
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F o r I n s t r u c t i o n s , S e e Bac k o f F o r m
CON TR I BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
" 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S T A T E PAC ( POL I T I C AL AC T I ON C OMMI T T EE ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM T HE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD
CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
Pa g e 4 3 o f 44
( f o r S c h ed u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
EX CHECK T HI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f ap p l i c ab l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S E R
NUMBER I NCOME
0 7 / 23 / 04 I D# Li n da J . Wi n c h e l l 2 . 5 0
3 1 5 2n d Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Li n da J . Wi n c h e l l 2 . 5 0
3 1 5 2n d Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0/ 0 4 I D# Li n da J . Wi n c h e l l 2 . 5 0
3 1 5 2 n d AvenueCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# L i n d a J . Wi n c h e l l 2 . 5 0
3 1 5 2n d Avenue
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 1 7 / 04 I D# L i n d a J . Wi n c h e l l 2 . 5 0
3 1 5 2n d Avenue
CK# Gr i n ne l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 0
3 1 5 2n d AvenueCK# Gr i n ne l l , l a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 20 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 0 3 / 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
~# I 1 1
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F o r I n s t r u c t i o n s , Se e Bac k o f Fo r m
CON TRI BU T I ON S - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g an i z at i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CON T RI BU T I ON I S RECE I VED FROM A S TATE PAC ( POL I T I C AL AC T I ON COMMI T T E E ) , L I S T THE PAC I DE NT I F I C AT I ON
NUMBERAND
THE PAC CHECKNUMBER
I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI C S ANDCAMPAI GN
DI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68 B . 3 2A( 6 ) , I o wa Co d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d eg r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
m a r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o
f 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 mn .Pa g e 4 4 o f 4 4
( f o r S c he d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
0 CHECK T HI S BOX I
AMENDI NG FORM
DATERECEI VED
( MM/ DD/ YR)
PAC I D NUMBER( i f a pp l i c a b l e )ANDPAC CHECK
NUMBER
NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P
TO CANDI DATE*( i f a pp l i c a b l e )
AMOUNT
RECEI VED
J I F FOR
FUND-
RAI SER
I NCOME
0 9 / 1 7 / 0 4 I D#
CK#
Un i t e mi z e d Re c e i p t 1 . 00
1 0 / 0 1 / 0 4 I D#
CK#
Un i t e n i z e d Re c e i p t 1 . 00
1 I ~ l i
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FOR I N ST RU CT I ON S, SEE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNT
STATE PAC COMMI TTEES : NOTE : FOR CON T R I B UT I ON S MADE T O STATEWI DE OR LEGI S LAT I V E
CANDI DATES , L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DES I GNATED COLUMN ANDTHE
PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA
ETHI C S & CAMPAI GN DI SCLOSURE BOARD .
COMMI TTEENAME ( Mus t b e s ame a s o n St a t eme n t o f Or g an i z at i o n )
VER I ZON I OWA S T A T E GOODGOVERNMENT CLUB
a 0 #0 0 1 2 4
r h y d ' a , AE 6 8 5 0 8 P o l i t i c a l . Omi t r i b u t i m
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $
SUB- TOTAL 1 $ 1 , 5 00 . 0
THI S BOXAPPL I ES TOCANDI DATES' COMMI TT EES ONLY :
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $500 o r mo r e must a l s o b e i n v e n t o r i e d o n S c he d u l e H . ( R e f e r t o S c he 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 , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o n
S c he d u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p en d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
S c he d u l e G i n s t r u c t i o n s a n d I o wa Co de 5 6 . 6 1 3 ) ( i ) . )
Page 1 o f 4
( f o r Sc h e d u l e B)
SCHEDULE
B MONETARY
( Re v . 0 9 / 9 7 ) EXPENDI TURE
0CHECK T HI S BOX I F
AMENDI NG FORM
DATE
EXPENDED
( MM/ DD/ YR)
CANDI DATE
I D NUMBER
( i f a p p l i c a b l e )
ANDPAC
CHECK
NUMBER
NAME ANDADDRESS TOWHOM
EXPENDI TURE
( Di s b u r s e me n t ) WASMADE
PURPOSE
( DESCRI BE TRANSACTI ON)
AMOUNT
EXPENDED
0 9 / 1 4 / 0 4 1 D I #
1 1
Bc V l e Pt i a l i c S e r v i c e 0a u d s s i m 5 0 0 . 0 0
4 2 04 2 0 S . 1 1 t h S t r e e t Gmer a l 2 0 0 4 / n ea 0 # 1 ~ E 6 8 5 0 8 P o l i t i c a l 0 a l t r i bu t m
0 0 1 2 5( O u t s ,
0 9 / 1 4 / 0 4 n i i t u mas d a c p e c > I d i t me 5 0 0 . 0 0 -
a 0 #
0 9 / 1 7 / 0 4 7 b e a x x a u Oo s mt b e e s t a t e x ~ n ~ i , A f i , . , e J ~P 2 0 0 . 0 0
DMVc 1 1 1 3 M 1 i Gi a l i ma l 2 0 0 4 / i aa 0 # 2 44 4 00 F b l i t i a a a 0 3 3 t d b u t i m
0 0 1 2 8 ll , L a 5 0 1 1 2
0 8 / 2 6 / 0 4 I D* Dau n t f o r s o u s e S t a t e H w s e , / l e g i s l a b l a e l r e p 5 0 . 0 0
2 + I q r I c D e t v i t t G l a l e r a l 2 0 0 4 / i d 7 4
a 0 # 6 1 1 WAsWaA ( 7 3 1 - r i b u t i m
0 0 1 2 3 I I e r t i a m d a , i s 5 0 1 2 5
0 9 / 1 4 / 0 4 Z D * Demdm f m S t a t e S wa t s Q 3 M I L t b e e S t a t e 9 a r l a t e 5 0 . 0 0
3 1 1 3 Ki MWA a l = > l e ame r a l 2 0 0 4 / i aQ0 De s M o i n e s , La 5 0 3 0 9 w i ; t i aa l . 03 3 b i b r i m
0 0 1 . 2 6
0 9 / 1 7 / 0 4 F f a i s e f r r S amt e S t a t e s e n a t e 2 0 0 . 0 06 0 3 8 MFYai se G a l i e l i s l 2 0 0 4 / s c i 5 0
a 0 # Rt . 1 Pd L t i c a l O > r i t r i b u t i m
0 0 1 3 4 F t . M3 d i sm, I a 5 2 6 2 1
0 9 / 1 7 / 0 4 1 1 D 1 # F Y i r a r l s f o r Di x S t ~ b e Aa wa / h eg i s l a t 3 r %/ r W 5 0 0 . 0 0
P O H o s c 2 2 0 G a l e t r a l 2 0 0 4 / i aC# Ro d , I a 5 0 6 7 0 PbU t L a i l 0 3 3 t r i b l _ = a l t
0 0 1 3 7S h e 1 1
0 9 / 1 4 / 0 4 3 1 * Ge r a l d V a p - p u t a 7 i c s wi m a = d s a k m e r B i l b i ; ~ S e i r v i c e Oomd s Wam 5 0 0 . 0 0
1 2 0 0 Nx t h S t r e e t coal 2 00 4 / m
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FOR I N S T RU CT I ON S , SEE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNT
STATE PAC COMMI T T E E S : NOTE : FOR CON T R I B UT I ON S MADE T O STATEWI DE OR LEGI S LAT I V E
CANDI DATES , L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DES I GNATED COLUMN ANDTHE
PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA
ETHI C S & CAMPAI GN DI SCLOSURE BOARD .
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me nt o f O r g a n i z a t i o n )
VERI ZON I OWA S T A T E GOODGOVERNMENT CLUB
CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE
TOTAL ( i f l a s t page o f t h i s s c h ed u l e ) 1 $
AMOUNT
SUB- TOTAL 1 $ 1 , 0 50 . 0 0
T HI S BOX APPL I E S TO CANDI DATES' COMMI TTEES ONLY :
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $500 o r mo r e must a l s o b e i n v e n t o r i e d o n S c he d u l e H . ( R e f e r t o S c h ed 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 , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o n
S c h ed u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p en d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
S c h ed u l e G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( i ) . )
Pa g e 2 o f 4
( f o r Sc h e d u l e B )
SCHEDULE
B MONETARY
( Re v . 0 9/ 9 7 ) EXPENDI T URE
El CHECK T HI S BOX I F
AMENDI NG FORM
DATE
EXPENDED( MM/ DD/ YR)
I D NUMBER( i f a p p l i c a b l e )AND PACCHECKNUMBER
EXPENDI TURE( D i s b u r s e m e n t ) WAS MADE
( DESCRI BE TRANSACT I ON ) EXPENDED
09 / 1 4 / 04 I I # L h i b md z e d bme 5 0 0 . 0 0 -
Qd 1
09 / 1 7 / 0 4 l D l l Gi p p f r r a t i v e Wmat t ee St a t e 1 3 o us e / l e g i s l a t t a q / x e p 200 . 0 0
5 8 6 I C 3 j c k Gi p p Gaul 2004/ ~ a 0 3 1Po1 i t i Ml 03 3 t r i b , r i m
00 1 33 P e a c i i w h , I a 52101
09 / 1 7 / 0 4 Ci t i z e ns £ c c Gk =B t a St a t e 200 . 0 0
Gr c n s t a l Ge ne r a l 2004/ i a -
220 H e a 3 1 e t t A9 e Ad i t y c a l Ct n t x i b at i r n
0 0 1 3 2 Oo i x mi l Shams, I a 5 1 90 3
08 / 26 / 04 3 D# Hs er f x r S t a t e Ae p r e e s t a t i v e S t a t e Ha ; I S Q / l r e c p s l a t u a ' e / x v 5 0 . 0 0
Ge r i Pl y Gwe c a l 20 04 / i i
r 3 K 1 ~ 2 1 3 7 t h s t r e e t N4 C b r Ax i b i t i r n
00121 I A l t o o a a , I a 50009
1 0 / 0 4/ 0 4 l a wn Dwmxa t i c Pe t t y S t a t e Po l i t a r wl Pa t t y 5 00 . 0 0
9 0 9 8 3 4 5 V i d t Me r P o s y Gaul 2 00 4/ i a
Qd k DEB M3 d n e s , I a 5 0 3 1 0 P a l i t d r c a l r tmt x i b , t i m
00 1 38
0 9/ 1 7 / 0 4 l D* I NVr e m f o r S t a t e S e na t e 200 . 0 0S t e we x t l v e r s m G~ a ~ ~ u ~ ~ l ~ , 2 ~ 0 0 4 / i a 0 0 5
3020 Dow- L V i l l i s r e n I t a d Po l i t i c al s t i r 00 1 30 Don s , I a 500 7 1
1 0 / ] . 1 / 0 4 1 1 3 ~ J a r ~ 2 ' ~ s Ommi t t e e S t a t e x e p 20 0 . 0 0
1 8 0 8 5 8t h S t r e e t Ga i e c a l 2004/ i aWe s t De s M o d n e s , l a 5 2 3 3 9 Pa l i t i c al a 2 i t r i b , t i m
00 1 39
09 / 1 7 / 0 4 K d b b d e f i c r r Sa t e S t a t e S e na t e 20 0 . 0 0
P O Hc x 1 9 0 Gex a l 2 0 0 4 / s r p 1 4
PJ ml e t d a g , I a 50 5 36 P o l i t i c a l Or t x i b u t i m
00129
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FOR I N ST RU CT I ON S, SEEBACKOF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNT
STATE PAC COMMI T T E E S : NOTE : FOR CON T RI BU T I ON S MADE T O STATEWI DE OR LEGI S LAT I V E
CANDI DATES , L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N T HE DES I GNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA
ETHI CS &CAMPAI GN DI SCLOSURE BOARD.
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA S T A T E GOOD GOVERNMENT CLUB
NAME AND ADDRESS T OWHOMCANDI DATE PURPOSE
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $
AMOUNT
SUB- TOTAL I S 1 , 1 0 0 . 0 0
T HI S BOX A PP L I E S T O CANDI DATES' COMMI T T EES ONLY :
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $500 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n S c he d u l e H . ( R e f e r t o S c h ed 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 , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o n
S c h ed u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
S c h ed u l e G i n s t r u c t i o n s a n d I o wa C o d e 5 6 . 6 ( 3 ) ( i ) . )
P a g e 3 o f 4
( f o r S c h e d u l e B )
SCHEDULE
B MONETARY
( R e v . 0 9 / 9 7 ) EXPENDI TURE
0 CHECK T H I S BOX I FAMENDI NG FORM
0 7 / 2 7 / 0 4 1
0 9 / 1 7 / 0 4
1 1 I #
C I O /0 0 ] 1 8
M l a p t y f i c c S t a r v e R P. I r e s s u t a t i v eP a t r i c k MmTW1 5 3 N Gr o a d v i e t y A v e .u u e , 7 a 5 2 0 0 1
P e l u e z f o r S t a t e P e P r e s e o d a t i v e
S t a t e H n u a a i t l a J x f l - A n r e l / zWG w e a a l 2004/ i i =C l o n t r i b k i m
1 0 0 . 0 0
5 0 . 0 01 1 4 F i r s t Am. E Gau l 2 0 0 4 / i iC d c a L o o s a , l a 5 0 6 3 5 P t a 1 i t i o d l 0 3 3 L x i i b u t i m
0 0 1 3 6
0 7 / z 7 / o 4 3 1 * P a u l B e l l f o r S t a t e R4: 1 r e e a l i t a t i v e S t a t e T 3 L 7 1 / l e g+ ' a l a t ,m. ~ZW 1 0 0 . 0 0
6 1 1 E . 1 7 t h S t . N . Ge n e r a l 2 0 0 4 / i aQ0 Ne w t = l a 5 0 2 0 8 C t a 3 t r i b t i m
0 0 1 1 9
0 9 / 1 7 / 0 4 P u t n e y f o r S e r r a t e S t a t e 1 0 0 . 0 0J d a z P u b i e y G e u e a a l 2 0 0 4 / s d 2 0
QK I 1 3 6 5 1 7 0 t h S t r e e t Po l i t i c a l a3 2 -- r b u t i m0 0 1 3 5 GI z d a o d c , I a 5 0 6 3 5
0 9 / 1 7 / 0 4 1 D # , l i e u . , P a t t y o f l o m s t a t e P o l i t i c a l P a r t y 5 0 0 . 0 05 2 1 E . l o c u s t s t r e e t Ga u l 2 0 0 4 / i a
Qc # D e s N b d n e s , I a 5 0 3 0 9 P o l i t i c a l Omr i k u t i m0 0 1 3 1
0 9 / 1 4 / 0 4 I I * A n d J o h n s o n P u b l i c S e r v i c e C b md e s i a n 1 0 0 . 0 01 2 0 0 N o r t h S t r e e t Ge c r a l 200; / / e
C 1 0 k Ca h e , N B 6 8 5 0 8 P o l i t i c a l C o r i t r b u t i m0 0 1 2 7
DATEEXPENDED
( M M / D D / Y R )
I D NUMBER( i f a p p l i c a b l e )AND PACCHECKNUMBER
E X P EN D I T U R E( D i s b u r s e m e n t ) WAS MADE
( D ES CR I B E TRANSACT I ON) EXPENDED
0 8 / 2 6 / 0 4 1 1 * I r a d v &r h u l a S e ~ + t e S t a t e S s c a t e 5 0 . 0 0G a r r a l 2 0 0 4 / i a
P O B o x 5 6 3 f } 0 l 3 t r i b u t r n
0 0 1 2 2 I A 5 2 3 0 2
0 8 / 1 8 / 0 4 Go d t t e e t o E l e c t N 3 t t M o [ b y S t a t e 9 e o a t e 1 0 0 . 0 0
M 3 t t b e w M o O p y Gwaa l 2 0 0 4 / s M l4 7 2 0 P b o d i a n d A v e . P o l i t i c a l C fo n t r i b u t i m
0 0 1 2 0 D e s M o d n e s , I a 5 0 3 2 0
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FOR I N ST RU CT I ON S, S EE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TT EE ACCOUNT
STATE PAC COMMI T T E E S : NOTE : FOR CON T R I B UT I ON S MADE T O ST ATEWI DE OR LEGI S LAT I V E
CANDI DATES , L I S T THE CANDI DATE I DE NT I F I C AT I ON NUMBER I N THE DES I GNATED COLUMN AND T HE
PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA
ETHI CS &CAMPAI GN DI SCLOSURE BOARD.
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA S TA TE GOOD GOVERNMENT CLUB
CANDI DATE
I D NUMBER
( i f a p p l i c a b l e )AND PAC
CHECK
NUMBER
NAME ANDADDRESS TOWHOM
EXPENDI TURE
( Di s b u r s e me n t ) WASMADE
TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )
THI S BOXAPPL I ES TOCANDI DATES' COMMI TTEES ONLY :
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $500 o r mo r e mus t a l s o b e i n v e n t o r i e d o n S c h ed u l e H . ( R e f e r t o S c h ed u l e H i n s t r u c t i o n s . )
Ex p e nd 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 , man a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o n
S c h ed u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e ac h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
S c h ed u l e G i n s t r u c t i o n s a n d I o wa Co d e 5 6 . 6 ( 3 ) ( 1 ) . )
Page 4 o f
( f o r Sc h e d u l e B)
SCHEDULE
B MONETARY
( Re v . 0 9 / 9 7 ) EXPENDI TURE
DCHECK T HI S BOX I F
AMENDI NG FORM
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FOR I N S T RU CT I ON S , SEE BACK OF FORM
I AM F I L I NG A
CASH
DI SCLOSURE SUMMARY PAGE
COMMI TT EE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOODGOVERNMENT CLUB
I MPORTANT : I n d i c a t e t y p e o f c o mmi 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 C a n d i d a t e ( 2 ) S t a t e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e( 5 ) C o u n t y PAC ( 6 ) B a l l o t I s s u e / F r a n c h i s e Co mmi t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mm i t t e e( 8 ) S u p p o r t S l a t e o f C a n d i d a t e s
SI GNATURE TREASURER ( o r p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE
Ro u t i n e Pe na l t i e s Du e F o r La t e F i l e d Re po r t s R a n g e f r o m $ 2 0 t o $800
SEE I NSTRUCTI ONS ONBACKANDCOMPLETE THE FOLL OWI NG SENTENCE :
OCT 1 9 , 2 0 0 4 - REPORT FOR AN/ A ( 1 ) ELECTI ON / ( 2 ) NON- ELECTI ON YEAR .
( r e p o r t d a t e )
CHECK I F AMENDMENT TO REPORT DATED
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 No t i c e o f Di s s o l u t i o n F o r m DR - 3 .( Yo u mus t c o n t i n ue t o f i l e r e p o r t s u n t i l a No t i c e o f D i s s o l u t i o n i s f i l e d . )
STATEMENT OF CASH ON HAND
I n d i c a t e o n e e
ON HAND a t t h e b eg i n n i n g o f t h e r e po r t i n g p e r i o d . ( T h i s i s t h e t o t a l -o f a l l mo n i e s h e l d b y t h e c o mmi t t e e . T h i s amount MUST b e t h es ame a s t h e c as h o n h a n d a t t h e e n d 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 mu s t b e z e r o i f t h i s i s t h e f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
FORM
DR - 2 DI SCLOSURE
( R e v . 0 1 / 9 8 ) REPORT
Comm . #
I n d ex ed
Au d i t e d
C o mp u t e r
i D - / ? - D 4 /DATE SI GNED
L o c a l Commi t t e e s , e n t e r Da t e o f E l e c t i o n
Co u n t y & L o c a l C ommi t t e e s , e n t e r Co u n t y i nwh i c h e l e c t i o n i s h e l d
5 , 8 5 1 . 4 1
ADD TOTAL MONEY TAKEN I N T HI S PERI OD
S c h ed u l e A : C a s h Co nt r i b u t i o ns t o t a l ( At t a c h S c h ed u l e A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , 4 42 . 6 8
S c h ed u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
S c h ed u l e H : T o t a l S al e s o f C amp a i g n Pr o pe r t y ( At t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
( S c h e d u l e H a pp l i e s t o Ca n d i d a t e s ' Co mmi t t e e s o n l y )- SUB- TOTAL . . . . . . . . $ 2 , 4 42 . 6 8
SUBTRACT TOTAL MONEY SPENT T HI S PERI OD
S c h ed u l e B : Ex p en d i t u r e s t o t a l ( A t t a c h S c h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 , 6 5 0 . 0 0
S c h ed u l e F : L o a n Re p a y me n t s t o t a l ( At t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 . 0 0
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 al a nc e mu s t
b e z e r o ) ( A t t a c h DR - 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 3 , 6 44 . 0 9
UNPAI D BI L L S ( F r o m Sc h e d u l e D - At t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
I N KI ND CONTRI BUTI ONS ( F r o m S c h ed u l e E - At t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
OUTSTANDI NG LOANS ( F r o m S c he d u l e F - At t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
CANDI DATE COMMI TTEES ONLY :
CONSULT ANT BREAKDOWN ( S c h ed u l e G At t a c h ed ? ) YES NO
VALUE OF CAMPAI GN PROPERTY ( F r o m S c he d u l e H - At t a c h S c h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 . 0 0
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 6 8 8 . 3 2 A ( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o rf o r a ny c omme r c i a l p u r p o se by any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e R e l a t i o n s h i p mus 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 ns a ng ui ni t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s nof 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 mn
TOTAL ( i f l a s t page o f t h i s s c h ed ul e )
Page 1 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6/ 9 7 ) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
- DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT % I I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p pl i c a bl e ) RA I SERNUMBER I NCOME
0 7 / 2 3 / 0 4 I D# Un i t e mi z ed Re ce i pt 1 . 0 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t e mi z ed Re ce i pt 1 . 0 0
CK#
s
0 8 / 2 0 / 0 4 I D# - Un i t ea i z ed Rec ei pt 1 . 0 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z ed Re ce i pt 1 . 0 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z ed Re ce i pt 1 . 0 0
CK# -
1 0 / 0 1 / 0 4 m# Un i t e mi z e d Rece i p t 1 . 0 0
CK#
0 7 / 2 3 / 0 4 m# Rodney D . An d e r s o n 5 . 0 01 6 5 4 F i s h e r Av e
CK# New S h a r o n , l a 5 0 2 0 7
0 8 / 0 6 / 0 4 I D# Rodney D . An d e r s o n 5 . 0 01 6 5 4 Fi s h er Av e
CK# New S h a r o n , I a 5 0 2 0 7
0 8 / 2 0 / 0 4 I D# Rodney D . An d e r s o n 5 . 0 01 6 5 4 Fi s h er Av e
CK# New S h a r o n , l a 5 0 2 0 7
0 9 / 0 3 / 0 4 m# Rodney D . An d e r s o n 5 . 0 01 6 5 4 Fi s h er Av e
CK# New S h a r o n , l a 5 0 2 0 7
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F o r I n s t r u c t i o n s , Se e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : . I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a n di d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mu s t b e s h o w n t o t h e t h i r d d eg r e e o f c on s a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
SUB- TOTAL
Page 2 o f 4 4
( f o r Sch edu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
` r AT E - "- - PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT d I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RA I SER
NUMBER I NCOME
0 9/ 1 7/ 0 4 I D# -RodneyD. An d e r s o n 5 . 0 01 6 5 4 F i s h e r Av e
CK# New Sh a r o n , I a 5 0 207
1 0 / 01 / 04 I D# RodneyD . An d e r s o n 5 . 0 01 6 5 4 F i s h e r Av e
CK# Ne w Sh a r o n , I a 5 0 207
a
0 7/ 2 3 / 0 4 I D# - Mi c h e l l e R . B r n u m 2 . 501 51 5 Re e d St
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Mi c h e l l e R. Ba r n t mi 2 . 5 01 5 1 5 Reed St
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# Mi c h e l l e R. ' Ba r n u r m 2 . 5 01 5 1 5 Reed St
CK# Gr i n n e l l , I a 501 1 2 -
09 / 0 3 / 04 I D# Mi c h e l l e R. Ba r n t mt 2 . 501 5 1 5 Reed St
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 1 7 / 0 4 I D# Mi c h e l l e R . Ba r n t mt 2 . 5 01 5 1 5 Reed St
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0/ 0 1/ 0 4 I D# Mi c h e l l e R . Ba r nu m 2 . 5 01 5 1 5 Reed St
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# Ro n a l d D . B r o wn 2 . 50PO Bo x 2 2 6
CK# Ne w Sh a r o n , I a 5 0 207
0 8/ 0 6/ 0 4 I D# Ro n a l d D.B r a wn 2 . 5 0PO Bo x 2 2 6
C a t # Ne w Sh a r o n , I a 5 0 207
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i bu t i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must 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 ns a ng ui n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
. _
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c abl e ) RA I SER
NUMBER I NCOME
0 8 / 2 0 / 04 I D# Rona l d D . Br o o m 2 . 5 0
PO B o o t 2 2 6CK# New Sh a r o n , I a 5 0 2 0 7
0 9 / 0 3 / 0 4 I D# Rona l d D . Br o o m 2 . 5 0
PO B o o t 2 2 6
CK#New
Sh a r o n , I a 5 0 2 0 7 a
0 9/ 1 7/ 0 4 I D# Rona l d D . B r o wn 2 . 5 0
PO Bo x 2 2 6CK# New Sh a r o n , l a 5 0 2 0 7
1 0 / 0 1 / 04 I D# Rona l d D . B r o wn 2 . 5 0
PO Bo x 2 2 6CK# New Sh a r o n , I a 5 0 2 0 7
0 7/ 2 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t e l a i z e d Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7 / 0 4 I D# Un i t en i z ed Re c e i p t 1 . 0 0
CK#
1 0/ 0 1/ 0 4 I D# Un i t e ai z ed Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I C AL ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r any c o mme r c i a l p ur p o s e by an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . .
TOTAL ( i f f a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must b e s h own 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 ) a nd a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
P a g e 4 o f - 4 4
( f o r S c h e d u l e A )
SCHEDULE
A MONET ARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT d I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a bl e ) RA I S ER
NUMBER I NCOME
07 / 2 3 / 04 I D# Ch e r y l A . Ch r i s t i ns on 2 . 5 01 4 2 8 Reed St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
08 / 0 6/ 04 I D# Ch e r y l A . Ch r i s t i ns om 2 . 5 01 4 2 8 Reed St r e e t
CK # Gr i m 1 1 ,I a 5 0 1 1 2
s
0 8 / 2 0 / 0 4 I D# Ch e r y l A . Ch r i s t i n e + 2 . 5 01 4 2 8 Reed St r e e t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 03 / 04 I D# Ch e r y l A . Ch r i s t i ns on 2 " 5 01 4 2 8 Reed S t r e e t
CK # Gr i m 1 1 , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D # Ch e r y l A . C h r i s t " n n 2 . 5 01 4 2 8 Reed St r e et _
CK # Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D # Ch e r y l A . Ch r i s t i ns on 2 . 5 0
1 4 2 8 Reed St r e etCK # Gr i n n e l l , I a 5 0 1 1 2
07/ 2 3 / 0 4 I D # Cy nt h i a S . Cl o y e d 5 . 0 01 1 2 1 Pr i nc e St r e et
CK # Gr i n a e l l , l a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Cy nt h i a S . Cl o y e d 5 . 0 01 2 2 1 Pr i nc e St mt
C K # Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D # Cy nt h i a S . Cl o y e d 5 . 0 01 2 2 1 Pr i nc e St r e et
CK # Gr i n a e l l , I a 5 0 1 1 2
09 / 0 3 / 04 I D # Cy nt h i a S . Cl o y e d 5 . 0 01 2 2 1 Pr i nc e S t r e e t
C K # Gr i n n e l l , l a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME / Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n/
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u se o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o rf o r a ny c o mme r c i a l p ur p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d eg r e e o f c on s a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 5 o f 44
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
0 9 / 1 7 / 0 4 I D# Cy n t h i a S . Cl o y ed 5 . 0 01 2 2 1 Pr i n c e St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Cy n t h i a S . Cl o y ed 5 . 0 01 2 2 1 Pr i n ce St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e t i i z e d Re c e i p t 2 . 5 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t eai z ed Rece i p t 2 . 5 0
CK#
0 8 / 2 0 / 0 4 I D# Un i t eai z ed . Re ce i p t 2 . 5 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t en i z ed Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t eai z ed Re c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 I D# J ay M. Ct mmi n g s 2 . 5 01 4 0 8 Ol d 6 Rd .
CC# Ma l c o m, I a 5 0 1 5 7
0 8 / 0 6 / 0 4 I D# J ay M. Comi ngs 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, l a 5 0 1 5 7
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t be s ame a s o n St a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c on t r i bu t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e by a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es . -
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e es 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s nof 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
Page 6 o f 4 4
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
FI CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE` RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c abl e ) RAI SER
NUMBER I NCOME
0 8/ 2 0 / 0 4 I D# J oy M. s emi n g s 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
0 9 / 0 3 / 0 4 I D# J oy M. i n r n a 2 . 5 0
1 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
0 9 / 17 / 04 I D# J ay M. i n gs 2 . 5 01 4 0 8 Ol d 6 Rd .
C : K# Ma l c o m, I a 5 0 1 5 7
1 0 / 01 / 04 I D# J oy M. i n g s 2 . 5 01 4 0 8 Ol d 6 Rd .
CK# Ma l c o m, I a 5 0 1 5 7
0 7/ 2 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 5 0
C a t #
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
Cs t #
0 8 / 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t - 1 . 5 0
CK#
0 9 / 17 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 5 0
C a t #
1 0 / 01 / 0 4 I D# Un i t e mi z e d Re c e i p tx
1 . 5 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER ANDTHE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A VA I L A B L E FROM THE I OWA ETHI CS ANDCAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2A ( 6 ) . I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o r
f o r an y c o mme r c i a l p ur p o se b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a n gu i n i t y Wood r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c ke t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 7 o f - - 4 4
( f o r Schedul e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
FI CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 7/ 2 3 / 0 4 I D# An na Dev i l der 2 . 3 6
1 4 1 4 3 50 t h Av eCK# B r o o k l y n , I a 5 2 2 1 1
0 8/ 0 6 / 0 4 I D# Anna De v i l d er 2 . 3 6
1 4 1 4 3 50 t h Av e
CK# B r o o k l y n , I a 5 2 2 1 1 z
0 8/ 2 0 / 0 4 I D# Anna De v i l d er 2 . 3 61 4 1 4 3 50 t h A v e
CK# B r o o k l y n , I a 5 2 2 1 1
0 9/ 0 3 / 0 4 I D# Anna De v i l d er 2 . 3 61 4 1 4 3 50 t h Av e
CK# B r o o k l y n , I a 5 2 2 1 1
0 9/ 1 7/ 0 4 I D# An n a Dev i l de r 2 . 3 61 4 1 4 3 50 t h Av e -
CK# B r o o k l y n , I a 5 2 2 1 1
0 7/ 2 3 / 0 4 I D# Un i t emi z e d Recei pt 1 . 00
CK#
0 8 / 0 6 / 0 4 I D# Un i t emi z ed Rec ei p t 1 . 00
CK#
0 8/ 2 0 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 9/ 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 1 7/ 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n /
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE ) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L A B L E FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o rf o r an y c o mme r c i a l p ur p o se b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )
" D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ns a n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 8 o f 4 4
( f o r Schedu l e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SERNUMBER I NCOME
1 0/ 0 1/ 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
07 / 2 3 / 0 4 I D# Susan M. Ed e l e n 4 . 003 6 3 0 9 0t h S t
CK# Gr i n ne l l , I a 5 0 1 1 2
08 / 0 6 / 0 4 I D# Susan M. Ede l e n 4 . 003 6 3 0 90 t h S t
C a t # Gr i n ne l l , I a 5 0 1 1 2
08 / 2 0 / 0 4 I D# Susan M. Ede l e n 4 . 003 6 3 0 90 t h S t
CK# Gr i n ne l l , I a 5 0 1 1 2
09 / 0 3 / 0 4 I D# S u s a n M. Ede l e n 4 . 003 6 3 0 90 t h S t -
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 17 / 04 I D# Susan M. Ede l e n 4 . 00
3 6 3 0 90 t h S tCK# Gr i n ne l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Susan M. Ede l e n 4 . 003 6 3 0 90 t h S t
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 2 3 / 04 I D# Rr . ~ RB i n p K . Fenne r, . 5 . 00
4 2 3 4 2 0 t h s t r ee tCK# Gr i m 11 , I a 5 0 1 1 2
0 8 / 06 / 04 I D# Rr ma i n e K . Fenne r 5 . 004 2 3 4 2 0t h St r e et
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 2 0 / 04 I D# Rcma i n s a K . Fenne r 5 . 004 23 4 2 0 t h s t r ee t
C a t # Gr i n ne l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p or t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r any c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s . -
SUB- TOTAL 1 $ 3 3 . 5 0
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) 1 $' 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k et ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 9 o f 4 4
( f o r Schedu l e A)
SCHEDULEA MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME
0 9 / 0 3 / 0 4 I D# Ro ma i n e K . F e n n e r 5 . 0 04 2 3 4 20 t h St r eet
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7/ 0 4 I D# Rc ma i n p K . F enne r 5 . 0 04 2 3 4 2 0t h s t r e e t
C( # Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Rc ma i n p K . F e n n e r 5 . 0 04 2 3 4 2 0t h s t r e e t
CK# Gr i n a e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t mi z ed Re c e i p t 1 . 0 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t ml i z ed Re c e i p t 1 . 0 0
CC#
0 8 / 2 0 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
C( #
0 9 / 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9 / 1 7 / 0 4 I n # Un i t emi z e d Re c e i p t 1 . 0 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
C( #
0 7 / 2 3 / 0 4 I D# J o h n S . F l a n n e r y 12 . 5 01 0 2 4 2 1 s t
CK# W. De s Mo i n e s , I a 5 0 2 6 5
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a nd s t a t e me n t s f o r s o l i c i t i n g c o nt r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . ,
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h ow n t o t h e t h i r d d e g r e e o f c o ns a n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t l . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h er e i s n of 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 mn .
Page 1 0 o f 44
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 8/ 0 6 / 0 4 I D# John S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1 s t
CK# W. De s Mo i n e s , I a 5 0 2 6 5
0 8 / 2 0 / 0 4 I D# John S . F l a n n e r y 1 2 . 5 0
1 0 2 4 2 1 s t
CK# W. Des Mo i n e s , I a 5 0 2 6 5
0 9/ 0 3 / 0 4 I D# John S . Fl a n n ex y 1 2 . 5 0
1 0 2 4 21 s tCK# W. Des Mo i n e s , I a 5 0 2 6 5
0 9/ 1 7 / 0 4 I D# J o h n S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1s t
CK# W. De s Mo i n e s , I a 5 0 2 6 5
1 0 / 0 1 / 0 4 I D# John S . F l a n n e r y 1 2 . 5 01 0 2 4 2 1s t -
CK# W . Des Mo i n e s , I a 5 0 2 6 5
0 7 / 2 3 / 0 4 I D# P a t r i c i a A . Go s s el i n k 2 . 5 0
1 5 3 4 6 S 8 4 t h Av e ECK# Gr i m 1 1 , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Pa t r i c i a A . Go s s e l i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# Pa t r i c i a A . Go s s e l i n k 2 . 5 01 5 3 4 6 S 8 4 t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 0 3 / 0 4 I D# Pa t r i c i a A. Go s s el i n k 2 . 5 0
1 5 3 4 6 S 84 t h Av e ECK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 17 / 04 I D# P a t r i c i a A . Go s s el i n k 2 . 5 01 5 3 4 6 S 84 t h Av e E
CK# Gr i m 1 1 , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L A B LE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r om r e po r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o r
f o r any c o mme r c i a l p u r p os e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c ommi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d eg r e e o f c on s a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h er e i s n of 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 mn .
TOTAL ( i f l a s t page o f t h i s s c h ed u l e)
Page 1 1 o f 4 4
( f o r Sc he du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
a CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
1 0 / 0 1 / 04 I D# Pa t r i c i a A . Go s s el i n k 2 . 5 015346 S 84 t h Av e E
CK# Gr n n e l l , l a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# El l en T . Gr a f f 4 . 0 0700 Ga r f i el d S t
CK# Ta n a , I a 5 2 3 3 9 a
0 8/ 0 6 / 0 4 I D# El l en T . Gr a f f 4 . 0 0
7 0 0 Ga r f i el d S tCK# Ta ma , l a 5 2 3 3 9
0 8/ 2 0 / 0 4 I D# El l en T . Gr a f f 4 . 0 0
7 0 0 Ga r f i el d S tCK# Tama , I a 5 2 3 3 9
0 9/ 0 3 / 0 4 I D# El l en T . Gr a f f 4 . 0 0
7 0 0 Ga r f i el d StCK# Tama , I a 5 2 3 3 9
0 9/ 1 7/ 0 4 m# El l en T . Gr a f f 4 . 0 0
7 0 0 Ga r f i el d StCK# Tama , I a 5 2 3 3 9
1 0/ 0 1/ 0 4 I D# El l en T . Gr a f f 4 . 0 07 0 0 Ga r f i el d St
CK# Ta ma , l a 5 2 3 3 9
0 7/ 2 3 / 0 4 I D# And r ew J . Gr osenbac h 5 . 0 01 1 1 6 Reed St Ap t 101
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# And r ew J . Gr osenbac h 5 . 0 011 1 6 Re e d St Apt 101
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# And r ew J . Gr osenbac h 5 . 0 011 1 6 Re e d St Ap t 101
CK# Gr i n n e l l , l a 5 a 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATEDCOLUMN .
A L I S T OF I DNUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68 8 . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o pi e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S e e Page 2 o f f o r ms p a c ke t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 1 2 o f 44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c ab l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 9 / 0 3 / 0 4 I D# An d r ew J . Gr os enba c h 5 . 00
1 1 1 6 ReedS t
t 1 0 1
CK# Gr i n n e l l , I a N1 12
0 9/ 1 7/ 0 4 I D# An d r e w J . Gr os enba c h 5 . 00
1 1 1 6 Reed
S t
Ap t 1 0 1
CK# Gr i n n e l l , l a 5 K1 1 2 x
1 0 / 0 1 / 04 I D# An d r ew J . Gr os enba c h 5 . 00
1 1 1 6 Reed
S tAp t 101
CK# Gr i n n e l l , I a 5112
0 7/ 2 3 / 0 4 I D# J e n n i f e r Gu n de r s o n 2 . 50
4 0 9 Cl a y S tCK# Ma l c om, I a 5 01 5 7
0 8/ 0 6 / 0 4 I D# Je nn i f e r Gunde r s o n 2 . 50
4 0 9 Cl a y S t "CK# Ma l c o m, I a 50157
0 8/ 2 0 / 0 4 I D#Je nn i f e r Gu nd er s on 2 . 50
40 9 Cl a y StCK# Ma l c o m, I a 5 0 1 5 7
0 9/ 0 3 / 0 4 I D# J e n n i f e r Gunde r s o n 2 . 50
40 9 Cl a y St
CK# Ma l c o m, I a 5 0 1 5 7
0 9/ 1 7/ 0 4 I D# Je nn i f e r Gu n d e r s o n - 2 . 50
40 9 Cl a y S tCK# Ma l c o m, I a 50157
1 0/ 0 1/ 0 4 I D# J e n n i f e r Gunde r s o n 2 . 5 0409 Cl a y S t
CK# Ma l c o m, I a 5 0 1 57
0 7 / 2 3 / 04 I D# T r a c i A. Gu t h r i e 8 . 00
1 2 1 Ad ai r S tCK# Ke l l o gg , I a 5 0 1 3 5
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F o r I n s t r u c t i o n s , Se e B a c k o f F o r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN.A L I S T OF I D
NUMBERS I SAVA I LABLE
FROM THEI OWA
ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o r
f o r a n y c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mu 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o
f 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 pp 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 mn .Page 1 3 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
a CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c ab l e ) RA I SER
NUMBER I NCOME
0 8 / 0 6 / 0 4 I D# Tr a c i A. Gu t h r i e 8 . 0 0
1 2 1 Ad ai r S t
CK# Kel l o g g , I a 5 0 1 3 5
0 8/ 2 0 / 0 4 I D# Tr a c i A . Gu t h r i e 8 . 00
1 2 1 Ad ai r St
CK# Ke l l o gg , I a 5 0 1 3 5 s
0 9 / 0 3 / 0 4 I D# T r a c i A . Gut h r i e 8 . 00
1 2 1 Ad a i r S tCK# Ke l l o g g , I a 5 0 1 3 5
0 9 / 1 7/ 0 4 I D# Tr a c i A . Gu t h r i e 8 . 0 0
1 2 1 Ad a i r S tCK# Ke l l o gg , I a 5 0 1 3 5
1 0 / 01 / 04 I D# Tr a c i A . Gu t h r i e 8 . 0 0
1 2 1 Ad a i r S t -
CK# Ke l l o gg , I a 5 0 1 3 5
0 7/ 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t1 . 0 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t emi z ed Rec ei p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ON
NUMBERAND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI L A B LE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68 B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p or t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p mus 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
P a g e 1 4 o f 44
( f o r Sc h e du l e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
a CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR . RELATI ONSHI P AMOUNT ; I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SER
NUMBER I NCOME
1 0/ 0 1/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7 / 2 3 / 0 4 I D# An n M. Ran s s e n 6 . 00
PO Bo x 2 4 6
CK# Ke l l o g g , I a 5 0 1 3 5 a
0 8 / 0 6 / 04 I D# An n M. R a n s s e n 6 . 0 0
PO B o a t 2 4 6CK# Ke l l o g g , I a 50135
0 8/ 2 0 / 0 4 m# An a M . Ra n s s e n 6 . 0 0PO B c a c 2 4 6
CK# Ke l l o g g , I a 5 0 1 3 5
0 9/ 0 3 / 0 4 I D# An n M. Ran s s e n 6 . 0 0
PO Bo x 2 4 6CK# Ke l l o g g , l a 5 0 1 3 5
0 9 / 17 / 04 I D# An n M. Man s s e n 6 . 0 0
PO Bc x 2 4 6CK# Ke l l o g g , I a 5 0 1 3 5
1 0/ 0 1/ 0 4 I D# An n M. H a n s s e n 6 . 0 0PO Bo x 2 4 6
CK# Ke l l o g g , I a 5 0 1 3 5
0 7/ 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 06 / 0 4 I D# Ua i t e mi z e d Re c e i p t 2 . 50
CK#
0 8 / 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 50
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER ANDTHE PAC CHECK
NUMBER I N THHEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i nf o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 2 3 . 5 0
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $ -
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must b e shown t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b y
ma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 1 5 o f 4 4
( f o r Schedu l e A)
SCHEDULEA MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
a CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 9 / 0 3 / 0 4 m# Un i t en i z ed Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 0 6 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 8 / 2 0 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 9/ 0 3 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7/ 0 4 m# Un i t emi z e d Re c e i p t - 2 . 5 0
CK#
1 0 / 0 1 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 m# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u se o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c o nt r i b ut i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . ,
TOTAL ( i f l a st page o f t h i s s c h e d ul e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d e gr e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c ke t l . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s nof 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 mn .
Page 1 6 o f 4 4
( f o r S c h e du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 1 F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PACCHECK ( i f a pp l i c ab l e ) RAI SERNUMBER I NCOME
0 8 / 0 6 / 0 4 m# U n i t e mi z e d R e c e i p t 1 . 0 0
C K #
0 8 / 2 0 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 9 / 0 3 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 9 / 1 7 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
1 0 / 0 1 / 0 4 m# U n i t e mi z e d R e c e i p t 1 . 0 0
C K #
0 7 / 2 3 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 8 / 0 6 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 8 / 2 0 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 9 / 0 3 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
0 9 / 1 7 / 0 4 m# U n i t e a i z e d R e c e i p t 1 . 0 0
C K #
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE: I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o nt r i but i o ns o r
f o r a n y c o mme r c i a l p ur p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . ,
SUB- TOTAL $ 2 3 . 5 0 1TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) 1 $
' 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 mmi 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 ma k i n g a c o n t r i b u t i o n t o t h e
c o mmi t t e e . R e l a t i o n s h i p must 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 an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
P a g e 1 7 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
a CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT % f I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RA I SER
NUMBER I NCOME
1 0 / 0 1 / 0 4 I D# I I n i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 7 / 2 3 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
CK#Gr i n ne l l ,
I a 5 0 1 1 2a
0 8 / 0 6 / 0 4 I D# Peggy A. J a nt z e n 2 . 5 0
5 2 2 9 t h Avenue
CK# Gr i m 11 , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
CK# Gr i n n e l l , l a . 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# P e g g y r A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
C 3 C # Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Peggy A . J a nt z e n 2 . 5 0
5 2 2 9 t h AvenueCK# Gr i n a e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Peggy A . J a n t z e n 2 . 5 0
5 2 2 9 t h Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Di a ne J . Keenan , 2 . 5 01 2 2 8 Wes t St
C 3 C # Gr i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Di a n e J . Ke e ^ a n 2 . 5 0
1 2 2 8 Wes t St
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D# Di a n e J . Keenan 2 . 5 0
1 2 2 8 Wes t S tCK# Gr i m 11 , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e po r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . ,
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e shown t o t h e t h i r d d e g r e e o f c o ns a n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
Page 1 8 o f 44
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME
0 9 / 0 3 / 0 4 I D# Di a n e J . Keenan 2 . 5 01 2 2 8 Wes t S t
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Di a n e J . Keenan 2 . 5 01 2 2 8 Wes t S t
CK# Gr i n ne l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Di a n e J . Keenan 2 . 5 01 2 2 8 Wes t S t
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 02 5 5 4 20 t h Av e
CK# Gr i n - e l l , I s 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 02 5 5 4 20 t h Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 0
2 5 5 4 20 t h Av eCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 m# Pame l a L . Ke s s l e r 5 . 0 02 5 5 4 20 t h Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 17 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 02 5 5 4 20 t h Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Pame l a L . Ke s s l e r 5 . 0 02 5 5 4 20 t h Av e
CK# Gr i n n e l l , l a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e s a i z e d Re c e i p t 1 . 0 0
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s a m e a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o ns o rf o r an y c o mme r c i a l p u r p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu 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 ns a n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( Se e Pa g e 2 o f f o r ms p a c k e t ) I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
Page 1 9 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a p pl i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RA I SERNUMBER I NCOME
08 / 06 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
08 / 2 0/ 04 I D# Un i t e a i z ed Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
1 0/ 0 1/ 0 4 I D# Un i t e t t i z ed Re c e i p t 1 . 0 0
CK#
07 / 2 3 / 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 16 Ma i n St
CK# B r o o k l y n , I a 5 2 2 1 1
08 / 06 / 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 16 Ma i n St
CK# B r o o k l y n , I a 5 2 2 1 1
08 / 2 0/ 04 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 16 Ma i n St
CK# B r o o k l y n , I a 5 2 2 1 1
0 9/ 0 3 / 0 4 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 16 Ma i n St
CK# B r o o k l y n , I a 5 2 2 1 1
0 9/ 1 7/ 0 4 I D# Ki mb e r l y K . Kr i e g e l 2 . 5 06 1 6 Ma i n St
CK# B r o o k l y n , I a 5 2 2 1 1
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i b ut i o ns o r
f o r an y c o mme r c i a l p ur p os e b y any p e r s o n o t h er t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
' D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e )
Page 2 0 o f 4 4
( f o r Schedu l e A )
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
1 0 / 0 1 / 0 4 I D # K i mb e r l y K . K r i e g e l 2 . 5 06 1 6 Ma i n S t
C K # B r o o k l y n , I a 5 2 2 1 1
0 7 / 2 3 / 0 4 I D # U n i t e mi z e d R e c e i p t 1 . 0 0
C K # z
0 8 / 0 6 / 0 4 I D # U n i t e mi z e d R e c e i p t 1 . 0 0
C K #
0 8 / 2 0 / 0 4 I D # U n i t e mi z e d R e c e i p t 1 . 0 0
C K #
0 9 / 0 3 / 0 4 I D # U n i t e n i z e d R e c e i p t 1 . 0 0
C K #
0 9 / 1 7 / 0 4 I D # U n i t e n i z e d R e c e i p t 1 . 0 0
C K #
1 0 / 0 1 / 0 4 m# U n i t e mi z e d R e c e i p t 1 . 0 0
C K #
0 7 / 2 3 / 0 4 I D # S h a r o n L . K r t mm 2 . 5 01 5 4 1 5 N 7 5 t h 'Av e E
C K # G r i n n e l l , I a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D # S h a r o n L . K r t mm 2 . 5 01 5 4 1 5 N 7 5 t h Av e E
C K # G r i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D # S h a r o n L . K r u m m 2 . 5 01 5 4 1 5 N 7 5 t h Av e E
C K # G r i n n e l l , I a 5 0 1 1 2
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t be sa me a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T ICAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ON
NUMBER ANDTHE PACCHECK
NUMBER I NTHHE
DESI GNATEDCOLUMN .
A L I ST OF I DNUMBERS
I S AVA I LABLEFROMTHE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r a ny c o mme r c i a l p ur p o se by a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . .
TOTAL ( i f l a s t page o f t h i s s c h ed u l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h er e i s n of 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 mn .
Page 2 1 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
0 9/ 0 3 / 0 4 I D# Sha r o n L . Kx l a r m 2 . 5 01 5 4 1 5 N 7 5t h Av e E
CK# Gr i mm 11, I a 5 0 1 1 2
0 9/ 1 7/ 0 4 I D# Sha r on L . Kr u m 2 . 5 01 5 4 1 5 N 7 5t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2 x
10 / 01 / 04 I D# Sha r on L . Kr t mm 2 . 5 01 5 4 1 5 N 7 5t h Av e E
CK# Gr i n n e l l , I a 5 0 1 1 2
07 / 2 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
08 / 06 / 04 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0 / 0 4
m#Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 9/ 1 7/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0/ 0 1/ 0 4 I D# Ua i t en i z ed Re c e i p t 1 . 00
CK#
07 / 2 3 / 0 4 I D# Deb r a E . L e wi s 5 . 001 2 0 2 El m St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Co de , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o n s o r
f o r an y c o mme r c i a l p u r p os e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) 1 $
` D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o n s an g u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
SUB- TOTAL I $ 3 7 . 5 0
Page 2 2 o f 4 4
( f o r Schedu l e A)
SCHEDULEA MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SER
NUMBER I NCOME
0 8 / 0 6 / 0 4 I D# Debr a E . L e wi s 5 . 0 0
1 2 0 2 El m St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D# Debr a E . L ewi s 5 . 0 0
1 2 0 2 El m S t r e e tCK# Gr i n n e l l , I s 5 0 1 1 2
s
0 9 / 0 3 / 0 4 I D# Debr a E . L e wi s 5 . 0 0
1202 El m St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 1 7 / 0 4 I D# Debr a E . L e wi s 5 . 0 0
1 2 0 2 El m St r e et
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Debr a E . L ewi s 5 . 0 0
1 2 0 2 El m St r e et _CK# Gr i n ne l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Ua i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7 / 2 3 / 0 4 I D# Susan J . Mc Ca i n 2 . 5 04370 Hi ghwa y 6 3 , Bo x 8
CK# Ma l c o m, I a 5 0 1 5 7
0 8 / 0 6 / 0 4 I D# Susan J . Mc Ca i n 2 . 5 04 3 7 0 Hi ghwa y 6 3 , Bo x 8
CK# Ma l c o m, I a 5 0 1 5 7
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , See B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a ni z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE PROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o r
f o r an y c o mme r c i a l p u r p o se b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .
TOTAL ( i f l a s t page o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e es 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s nof 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 mn .
Page 2 3 o f 4 4
( f o r Sc he d u l e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p pl i c a b l e) RAI SER
NUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Susan J . Mc Ca i n 2 . 5 04 3 7 0 Hi g h w a y 6 3 , Bo x 8
CK# Ma l c om, I a 5 0 1 5 7
0 9 / 0 3 / 0 4 I D# Susan J . Mc Ca i n 2 . 5 0
4 3 7 0 Hi ghway 6 3 , Bo o t 8CK# Ma l c om, l a . 5 0 1 5 7
s
0 9/ 1 7/ 0 4 -I D# Susan J . Mc Cai n 2 . 5 0
4 3 7 0 Hi ghway 6 3 , Bo x 8CK# Ma l c om, I a 5 01 5 7
1 0/ 0 1/ 0 4 I D# Susan J . Mc Ca i n 2 . 5 0
4370 Hi ghway 6 3 , Bo x 8CK# Ma l c om, I a 5 0 1 5 7
0 7/ 2 3 / 0 4 m# Un i t e mi z e d Re c e i p t 1 . 00
CK#
08 / 06 / 04 I D# Un i t en i z ed Re c e i p t 1 . 00
CK#
08 / 20 / 04 I D# Un i t eai z ed Re c e i p t 1 . 00
CK#
09 / 03 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
09 / 17 / 04 I D# Un i t eai z ed Re c e i p t 1 . 00
CK#
1 0/ 0 1/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 ds )
COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD
CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a ny c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
` D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 2 4 o f 44
( f o r Sc h e du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 7/ 2 3 / 0 4 I D# # Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 I D# Un i t emi z ed Re ce i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t emi z ed Re ce i p t 2 . 5 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 I D# Rhonda R . Mv y es 5 . 0 03 0 2 2nd Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 m# Rhonda R . Moy es 5 . 0 03 0 2 2n d Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE: I F
A CONTRI BUTI ONI S
RECEI VEDFROM
ASTATE PAC
( POL I T I CAL ACTI ON COMMI TTEE) , L I S TTHE PAC
I DENT I F I CATI ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L A B LE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p or t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . . -
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 25 o f 4 4
( f o r Schedu l e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c ab l e ) RAI SER
NUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Rhonda R . May es 5 . 0 03 0 2 2 n d Av e
C 3 C # Gr i n ne l l , l a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Rhonda R . May es 5 . 0 0
3 0 2 2 n d Av eCK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 17 / 04 I D# Rhonda R . May es 5 . 0 03 0 2 2 nd Av e
C 3 C # Gr i n n e l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# Rhonda R . May es 5 . 0 03 0 2 2 nd Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 50
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 50
CK#
0 8/ 2 0 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 50
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 50
CK#
0 9/ 1 7/ 0 4 m# Un i t e mi z ed Re c e i p t 2 . 50
CK#
1 0/ 0 1/ 0 4 I D# Un i t e mi z ed Re c e i p t 2 . 50
CK#
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f F o r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t be sa me a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I L A B LE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r an y c o mmer c i a l p ur p o s e by a n y p er s o n o t h er t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e es .
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e es 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v es b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
TOTAL ( i f l a s t page o f t h i s s c h e du l e )
Page 2 6 o f - - 4 4
( f o r Sc h e d ul e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
0 7/ 2 3 / 0 4 I D# Re b e c c a L . No r t h cu t t 2 . 5 07 0 5 E F l o o d St Bo x 8 1 9
CK# Mo n t e z uma , I a 5 0 1 7 1
0 8/ 0 6 / 0 4 I D# Rebecca L . No r t h cu t t 2 . 5 0
7 0 5 EF l o o d
StBo x
8 1 9CK# Mo n t e z uma , I a 5 0 1 7 1 z
0 8/ 2 0 / 0 4 I D# Rebecca L . No r t h c ut t 2 . 5 07 0 5 E F l o o d St Bo x 81 9
CK# Mo n t e z t mi a , l a 5 0 1 7 1
0 9/ 0 3 / 0 4 I D# Rebecca L . No r t h c ut t 2 . 5 07 0 5 E Wood St Bo x 81 9
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 9/ 1 7/ 0 4 I D# Rebecca L . No r t h c ut t 2 . 5 0
70 5 E F l o o d St Bo x 81 9CK# Mo n t e zt mr l a , I a 5 0 1 7 1
1 0 / 01 / 04 I D# Rebecca L . No r t h c ut t 2 . 5 07 0 5 E Wood St Bo x 8 1 9
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 7 / 2 3 / 0 4 I D# Ua i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t e mi z ed Re ce i pt 1 . 0 0
CK#
0 8 / 2 0 / 0 4 I D# Un i t e ai z ed Re c e i p t 1 . 0 0
CK#
0 9 / 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Code , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . -
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
Page 27 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
FI CHECK THI S BOX
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p pl i c a b l e ) RA I SER
NUMBER I NCOME
0 9/ 1 7/ 0 4 I D# LMi t ea i z ed Re c e i p t 1 . 00
CK#
1 0/ 0 1/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7/ 2 3 / 0 4 I D# Un i t e mi z e x l Re c e i p t 2 . 5 0
( 3 #
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 2 0 / 0 4 m# Uh i t ea i z ed Re c e i p t 2 . 5 0
CK#
0 9/ 0 3 / 0 4 I D# Ua i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7/ 0 4 I D# Un i t ea i z ed Re c e i p t 2 . 5 0
CK#
1 0 / 0 1 / 0 4 I D# Un i t e a a i z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 I D# Mi chae l D . P a wl o ws k i 5 . 009 0 2 Hanover Dr i v e
CK# Sou t h L a k e , Tx 76092
0 8/ 0 6 / 0 4 m# ' Mi chae l D . P a wl o ws k i 5 . 009 0 2 Hknove r Dr i v e
CK# Sou t h L a k e , Tx 7 6 0 9 2
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME / Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n/
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CALACTI ON COMMI TTEE) ,
L I S T THEPAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68B . 3 2A( 6 ) , I o wa Cod e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o rf o r any c o mme r c i a l p ur p o s e b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
* D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d eg r e e o f c o n s a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c ke t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
SUB- TOTAL 1 $ 5 0 . 0 0
TOTAL ( i f l a s t p a g e o f t h i s s c h e d ul e ) I 5
Page 2 8 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I FAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( I F FORRECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME
0 8 / 2 0 / 0 4 I D # M i c h a e l D . P a wl o ws k i 5 . 0 09 0 2 H a n o v e r D r i v e
C K # S o u t h L a k e , T x 7 6 0 9 2
0 9 / 0 3 / 0 4 I D # M i c h a e l D . P a wl o ws k i 5 . 0 0
9 0 2 H a n o v e r Dr i v eC K # S o u t h L a k e , T S c 7 6 0 9 2a
0 9 / 1 7 / 0 4 I D # M i c h a e l D . P a wl o ws k i 5 . 0 09 0 2 H a n o v e r Dr i v e
C K # S o u t h L a k e , T S c 7 6 0 9 2
1 0 / 0 1 / 0 4 I D # M i c h a e l D . P a wl o ws k i 5 . 0 09 0 2 H a n o v e r D r i v e
C K # S o u t h L a k e , T x 7 6 0 9 2
0 7 / 2 3 / 0 4 I D # L i n d a M . P e a s e 5 . 0 01 1 0 8 St e e r S t
C K # G r i n n e l l , l a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D # L i n d a M . P e a s e 5 . 0 01 1 0 8 St e e r S t
C K # G r i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D # L i n d a M. P e a s e 5 . 0 01 1 0 8 S u m m e r S t
CK # G r i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D # L i n d a M. P e a s e 5 . 0 01 1 0 8 Summer S t
CK # G r i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D # L i n d a M. P e a s e 5 . 0 01 1 0 8 S u m m e r S t
C K # G r i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D # L i n d a M. P e a s e 5 . 0 01 1 0 8 S u m m e r S t
C K # G r i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME / Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n/
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC( POL I T I CAL ACTI ON COMMI TTEE) , L I ST
THE PACI DENT I F I CAT I ONNUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 688 . 3 2A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c ont r i b ut i o ns o rf o r any c o mme r c i a l p ur p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 3 5 . 0 0
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e ) 1 $ _
' D i s c l o s u r e l a w r e q u i r e s c a nd i d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s nof 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 mn .
P a g e 2 9 o f 4 4
( f o r Sche du l e A)
SCHEDULEA MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I F
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FORRECEI VED ( i f a pp l i c ab l e ) TO CANDI DATE` RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RA I SERNUMBER I NCOME
0 7/ 2 3 / 0 4 I D# J am e s R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Avenue P l a c e
CK# Gr i nne l l , I a 5 0 1 1 2
0 8/ 0 6/ 0 4 I D# J am e s R . Ph e l p s 2 . 5 0
1 6 0 2 1 0t h Avenue P l a c eCK# Gr i nne l l , I a 5 0 1 1 2a
0 8/ 2 0/ 0 4 I D# J am e s R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Avenue P l a c e
CK# Gr i nne l l , I a 5 0 1 1 2
0 9/ 0 3 / 0 4 I D# J am e s R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Av e nu e P l a c e
CK# Gr i nne l l , I a 5 01 1 2
0 9/ 1 7/ 0 4 m# J ames R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Av e nu e P l a c e
CK# Gr i nne l l , I a 5 0 1 1 2
1 0 / 01 / 04 I D# James R . Ph e l p s 2 . 5 01 6 0 2 1 0t h Av e nu e P l a c e
CK# Gr i n ne l l , I a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# J a n K . P o p e 5 . 0 06 0 3 Va n Ho r n e Ci r
CK# Gr i nne l l , l a 5 0 1 1 2
0 8/ 0 6/ 0 4 I D# J a n K . P o p e 5 . 0 06 0 3 Va n Ho r n e Ci r
CK# Gr i nne l l , I a 5 0 1 1 2
08 / 2 0/ 04 I D# J a n K . P o p e 5 . 0 06 03 Va n Ho r n e Ci r
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9/ 0 3 / 0 4 m# J a n K . P o p e 5 . 0 06 03 Va n Ho r s e Ci r
CK# Gr i n ne l l , l a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o rf o r an y c o mme r c i a l p u r p o s e by a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e ( s a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 0 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
_ _
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v ' I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RA I SERNUMBER I NCOME
0 9 / 17 / 04 I D# J an K . P o p e 5 . 0 06 0 3 Van Ho r n e Ci r
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0/ 0 1/ 0 4 I D# J an K . Pope 5 . 0 06 0 3 v an Ho r ne Ci r
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# - Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 2 0 / 0 4 I D# Ua i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7/ 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
1 0/ 0 1/ 0 4 I D# Un i t eai z ed Re c e i p t 1 . 0 0
CK#
0 7 / 2 3 / 0 4 I D# Un i t e l ; t i z e d Re c e i p t 1 . 0 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI L A B LE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 688 . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o nt r i b ut i o ns o rf o r a ny c o mme r c i a l p ur p o s e b y any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e g r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of a mi 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 mn .
P a g e - 3 1 - o f - 4 4
( f o r Sc h e d ul e A)
SCHEDUL E
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RA I SER
NUMBER I NCOME
0 8/ 2 0 / 0 4 m# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 m# Un i t en i z ed Re c e i p t 1 . 0 0
CK#s
0 9/ 1 7/ 0 4 m# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
1 0/ 0 1/ 0 4 m# Uh i t emi z e d Re c e i p t 1 . 0 0
CK#
0 7/ 2 3 / 0 4 m# Ua i t emi z e d Re c e i p t 1 . 0 0
CK#
0 8/ 0 6 / 0 4 m# Un i t emi z e d Rece i p t 1 . 0 0
C 3 C #
0 8/ 2 0 / 0 4 m# Uh i t e t i l i z ed Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 m# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7/ 0 4 m# Un i t emi z e d Re c e i p t 1 . 0 0
C S C #
1 0/ 0 1/ 0 4 m# Un i t emi z e d Rece i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a ni z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I ST THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 688 . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u se o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c ont r i bu t i o ns o r
f o r an y c o mme r c i a l p u r p o se b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . . _ -
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d eg r e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of a mi 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 mn .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
Page 3 2 o f 4 4
( f o r Schedu l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a p p l i c a b l e l TO CANDI DATE` RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a pp l i c a bl e ) RA I SER
NUMBER I NCOME
0 7/ 2 3 / 0 4 I D# Ba r b ar a J . Sa bu l t z 2 . 5 0
5 1 0 Pea r l StCK# Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Ba r b ar a J . Sc h u l t z 2 . 5 0
5 1 0 Pea r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D# Ba r b a r a J . Sc h u l t z 2 . 5 05 1 0 P e a r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 0 3 / 0 4 I D# Ba r b a r a J . Sc h u l t z 2 . 5 05 1 0 P ea r l S t
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7/ 0 4 I D# Ba r b a r a J . Sc b u l t z 2 . 5 05 1 0 Pea r l S t -
CK# Gr i n a e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Ba r b a r a J . Sc h u l t z 2 . 5 05 1 0 P e a r l S tCK# Gr i n n e l l , I a 5 0 1 1 2
0 7 / 2 3 / 0 4 I D# Un i t e mu . z e d Re c e i p t 1 . 0 0
CK#
0 8 / 0 6 / 0 4 I D# Un i t emi z e d Re c e i p t _ 1 . 0 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Uh i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r m
CONTR I BUT I ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s a m e a s o n St a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE ) , L I ST THE PAC I DENTI F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLETROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r an y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h e du l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mu 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 ns an g ui n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c ke t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 3 o f 4 4
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
" -DATE - - PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SER
NUMBER I NCOME
0 9 / 1 7 / 04 I D# Ua i t e mi z e d Re c e i p t 1 . 0 0
CK#
1 0/ 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 7/ 2 3 / 0 4 I D# - Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 XD# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t e ai z e d Re c e i p t 2 . 5 0
CK# -
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9 / 1 7/ 0 4 I D# Ua i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0/ 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 2 5
CK#
0 8 / 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 2 5
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n!
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s a nd s t a t e me n t s f o r s o l i c i t i n g c o nt r i b ut i o ns o rf o r an y c o mme r c i a l p ur p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL I S 2 3 . 0 0
TOTAL ( i f l a s t page o f t h i s s c h e du l e ) I $
' D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d eg r e e o f c o ns a ng ui n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
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SCHEDULE
A MONET ARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX IAMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FORRECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE" ' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a b l e ) RAI SERNUMBER I NCOME
0 8 / 2 0 / 0 4 m# Un i t emi z e d Re c e i p t 1 . 2 5
CK#
0 9 / 0 3 / 0 4 I D# Un i t emi z e d Rece i p t 1 . 2 5
CK#a
0 9 / 1 7 / 0 4 I D#- Un i t emi z ed Rec ei pt 1 . 2 5
CK#
1 0 / 0 1 / 0 4 I D# Un i t emi z e d Rece i p t 1 . 2 5
CK#
0 7 / 2 3 / 0 4 I D# Mi c h e l e L . Si s s o n 3 . 0 01 4 2 1 4 t h Av e
CK# Gr i n n e l l , l a 5 0 1 1 2
0 8 / 0 6 / 0 4 I D# Mi c h e l e L . Si s s o n 3 . 0 01 4 2 1 4 t h Av eCK# Gr i n n e l l , I a 5 0 1 1 2
0 8 / 2 0 / 0 4 I D# Mi c h e l e L . Si s sam 3 . 0 01 4 2 1 4 t h Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 I D# Mi c h e l e L . Si s s m 3 . 0 01421 4 t h Av e
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Mi c h el e L . Si s s om 3 . 0 01 4 2 1 4 t h Av e
CK# Gr i nn e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Mi c h el e L . Si s s m 3 . 0 01 4 2 1 4 t h Av e
CK# Gr n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e Ba c k o f F o r m
CONTR I BUT I ONS - - MONEY TAKEN I N
( 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 ds )
COMMI TTEENAME / Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VER I ZON I OWA STATE GOOD GOVERNMENT CLUB
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d eg r e e o f c on s a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
STATE CANDI DATES NOTE : I F A CONTRI BUT I ON I S RECEI VED FROM A STATE PAC ( P OL I T I CAL ACT I ON COMMI T TEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE . F R OM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2A( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r any c o mme r c i a l p ur p o s e b y an y p e r s o n o t h er t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
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SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
a CHECK T HI S BOX I
AMENDI NG FORM
DATEy PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT J I F FOR
RECEI VED ( i f a pp l i c a b l e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p p l i c a b l e ) RAI SER
NUMBER I NCOME
0 7/ 2 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#s
0 8/ 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 9/ 1 7/ 0 4 m# Un i t e mi z e d Re c e i p t 2 . 5 0
CK# -
1 0/ 0 1/ 0 4 m# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
0 7/ 2 3 / 0 4 I D# Ka t h y V . St a ne k 2 . 5 0PO Bo x 92 6
C S C # Gr i n n e l l , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Ka t h y V . St a ne k 2 . 5 0PO Box 92 6
C Z C # Gr i n n e l l , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# Ka t h y V . St a ne k 2 . 5 0PO Bc x 92 6
CK# Gr i n n e l l , I a 5 0 1 1 2
0 9/ 0 3 / 0 4 I D# Ka t h y V . St a ne k 2 . 5 0PO Bc x 92 6
CK# Gr i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mus t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 688 . 3 2A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r any c o mme r c i a l p u r p o s e by an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t page o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s nof 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 mn .
Page 3 6 o f 4 4
( f o r S c h e du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I
AMENDI NG FORM
' DA TE` PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 9/ 1 7/ 0 4 I D# Ka t h y V . St anek 2 . 5 0
PO B o o t 92 6CK# Gr i n n e l l , I a 5 0 1 1 2
1 0/ 0 1/ 0 4 I D# Ka t h y V . St anek 2 . 5 0PO Box 9 2 6
CK# Gr i a ne l l , I a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 8 / 0 6 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
C S C # -
0 9 / 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
09 / 1 7 / 04 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
1 0/ 0 1/ 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 7/ 2 3 / 0 4 I D# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
0 8/ 0 6 / 0 4 m# Un i t emi z e d Re c e i p t 2 . 5 0
CK#
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F o r I n s t r u c t i o n s , Se e Ba c k o f Fo r m
CONTRI BUTI ONS - -MONEY TAKEN I N
( 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 )
COMMI TTEENAME ( Mu s t b e s a m e a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ON
NUMBER ANDTHE PAC CHECK
NUMBER I N THHE DESI GNATED COLUMN. A L I ST
OFI D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 688 . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a ny c o mme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p ag e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a n di d at e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 7 o f --44
( f o r Sc h e d u l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I
AMENDI NG FORM
DATE ~ ' PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT [ I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a p pl i c a bl e ) RA I SER
NUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
09 / 0 3 / 0 4 I D# Un i t e mi z e d Re ce i p t 2 . 5 0
CK#
0 9/ 1 7/ 0 4 I D# - Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
1 0/ 0 1/ 0 4 I D# Un i t e mi z e d Re c e i p t 2 . 5 0
CK#
07 / 2 3 / 04 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
CK# Mont ez uma , I a 5 0 1 7 1
0 8 / 0 6 / 04 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
CK# Mo n t e z t mi a , l a 5 0 1 7 1
0 8 / 2 0 / 04 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
CK# Mc n t e mmi a , I a 5 0 1 7 1
0 9/ 0 3 / 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3 -
CK# Mo n t e z t mi a , I a 5 0 1 7 1
0 9/ 1 7/ 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
CK# Mo n t e z t mi a , I a 5 0 17 1
1 0/ 0 1/ 0 4 I D# Ma r c i a Ta r v i n 2 . 5 05 0 2 7 Hwy 6 3
CK# Mont ez u ma , I a 5 0 1 7 1
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DES I GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r an y c o mme r c i a l p u r p o se by any p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
' D i s c l o s u r e l a w r e q u i r e s c a n di d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own 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 ) a nd a f f i n i t y ( r e l a t i v e s byma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 38 o f 4 4
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
0 CHECK THI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAMEANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT - / I F FOR
RECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c ab l e ) RA I SERNUMBER I NCOME
07 / 2 3 / 04 I D# Ka r e n Va n So e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e E
CK# Su l l y , l a 5 0 2 5 1
08 / 06 / 04 I D# Ka r e n Van So e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e E
CK# Su l l y , I a 5 0 2 5 1a
08 / 2 0/ 04 I D# - Ka r e n Va n So e l e n 2 . 5 01 2 6 9 5 S 9 2nd Av e E
CK# Su l l y , I a 5 0 2 5 1
0 9/ 0 3 / 0 4 I D# Ka r e n Van So e l e n 2 . 5 01 2 6 9 5 S 9 2nd Av e E
CK# Su l l y , I a 5 0 2 5 1
0 9/ 1 7/ 0 4 I n# Ka r e n Va n So e l e n 2 . 5 01 2 6 9 5 S 9 2nd Av e E
CK# Su l l y , I a 5 0 2 5 1
1 0/ 01 / 04
m# Ka r e n Van So e l e n 2 . 5 01 2 6 9 5 S 9 2 n d Av e ECK# Su l l y , I a 5 0 2 5 1
07 / 2 3 / 04 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 0 6/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8/ 2 0/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 0 3/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n ds )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 688 . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r an y c o mme r c i a l p ur p os e by a ny p e r s on o t h er t h an s t a t ut o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t pa ge of t h i s s c h ed ul e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e shown t o t h e t h i r d d e g r e e o f c on s a ng u i n i t y ( b l o o d r e l a t i v e ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 3 9 o f 4 4
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
- - DATE - - PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT v ' I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ Y R) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 9 / 17 / 04 I D# Un i t e mi z e d Rece i p t 1 . 0 0
CK#
1 0/ 0 1/ 0 4 I D# Un i t e mi z e d Rece i p t 1 . 0 0
CK#s
0 7/ 2 3 / 0 4 I D# _ Mar l i s R . Van Z an t e 2 . 5 0
1 4 0 1 7 Ewy F - 62 ECK# L y nn v i l l e , I a 5 0 1 5 3
0 8/ 0 6 / 0 4 I D# Mar l i s R . Van Z an t e 2 . 5 0
1 4 0 1 7 Ewy F - 62 ECK# L y n n v i l l e , I a 5 0 1 5 3
0 8/ 2 0 / 0 4 I D# Mar l i s R . Van Z an t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
0 9/ 0 3 / 0 4 I D# Mar l i s R . Van Z an t e 2 . 5 0
1 4 0 1 7 Ewy F - 6 2 ECK# L y nn v i l l e , I a 5 0 1 5 3
0 9/ 1 7 / 0 4 I D# Mar l i s R . Van Z an t e 2 . 5 01 4 0 1 7 Hwy F - 6 2 E
CK# L y n n v i l l e , I a 5 0 1 5 3
1 0/ 0 1/ 0 4 I D# Mar l i s R . Van Z an t e 2 . 5 01 4 0 1 7 Ewy F- 6 2 E
CK# L y n n v i l l e , l a 5 0 1 5 3
0 7/ 2 3 / 0 4 I D# Ka r l a L . Va n d er l e es t 2 . 0 01 5 2 7 0 N 7 5t h Av e E
CK# Gr i n - 11 , I a 5 0 1 1 2
0 8/ 0 6 / 0 4 I D# Ka r l a L . Va n de r l e es t 2 . 0 01 5 2 7 0 N 7 5t h Av e E
CK# Gr i n n e l l , l a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PACCHECK NUMBER I N THHE DESI GNATED COLUMN.
A L I S T OF I D NUMBERS I S AVAI LABLE ' FROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p or t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b ut i o ns o r
f o r a ny c o mme r c i a l p u r p o se b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
SUB- TOTAL
TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )
' D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h ow n t o t h e t h i r d d e g r e e o f c o ns a n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) .
I f s u r n a me o f c o n t r i b u t o r i s t h e s am e a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 4 0 o f -- 4 4
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
1 - 0 1 CHECK THI S BOXAMENDI NG FORM
DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT / I F FORRECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE" RECEI VED FUND-
( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME
0 8 / 2 0 / 0 4 I D# Ka r l a L . Va n de r l e es t 2 . 0 0
1 5 2 7 0 N 75 t h Av e ECK# Gr i n n e l l , I a 5 0 1 1 2
0 9 / 0 3 / 0 4 M# Ka r l a L . Va n de r l e es t 2 . 0 01 5 2 7 0 N 7 5t h Av e $
CK# Gr i n n e l l , I s 5 0 1 1 2
0 9 / 1 7 / 0 4 I D# Ka r l a L . Va n de r l e es t 2 . 0 0
1 5 2 7 0 N 7 5t h Av e ECK# Gr i n n e l l , I a 5 0 1 1 2
1 0 / 0 1 / 0 4 I D# Ka r l a L . Va n de r l e es t 2 . 0 0
1 5 2 7 0 N 7 5t h Av e ECK# Gr i n n e l l , l a 5 0 1 1 2
0 7 / 2 7 / 0 4 I D# Ve r i z o n Good Go v e r n l I n e n t Cl u b - Tx 1 , 2 5 0 . 0 08 1 6 Co n g r e s s Av e . , Su i t e 1 5 0 0 _
CK# Au s t i n , Tx 7 8 7 0 1
0 7 / 2 3 / 0 4 I D# Debo r ah D . Wa l ke r 4 . 9 82 3 8 Ho r s e s hoe DrCK# Mo n t e z u u t l a , l a 50171
0 8 / 0 6 / 04 I D# Debo r ah D . Wa l ke r 4 . 9 82 3 8 Ho r s e s hoe Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 8 / 2 0 / 0 4 I n # De b o r a h D . Wa l ke r 4 . 9 82 3 8 Ho r s e s hoe Dr
CK# Mo n t e z u ma , l a 5 0 1 7 1
0 9 / 0 3 / 0 4 I D# Debo r ah D . Wa l ke r 4 . 9 82 3 8 Ho r s e s hoe Dr
CK# Mo n t e z u ma , I a 5 0 1 7 1
0 9 / 1 7 / 0 4 m# Debo r ah D . Wa l ke r 4 . 9 82 3 8 Ho r s e s hoe Dr
CK# Mo n t e z t mi a , I a 5 0 1 7 1
8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
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8/7/2019 Verizon Iowa State Good Government Club__6038__Scanned
http://slidepdf.com/reader/full/verizon-iowa-state-good-government-club6038scanned 92/97
F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 ds )
COMMI TTEENAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CATI ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLETROM THE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.
CAUTI ON: Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e us e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s and s t a t e me n t s f o r s o l i c i t i n g c o nt r i bu t i o ns o r
f o r an y c o mme r c i a l p ur p o s e by a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
" D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ny r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p must b e s h own t o t h e t h i r d d e gr e e o f c o ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
P a g e 4 2 o f 44
( f o r Sc h e du l e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7) RECEI PTS
CHECK THI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT 1 I F FOR
RECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE' RECEI VED FUND-
( MM/ DD/ YR) ANDPAC CHECK ( i f a pp l i c a bl e ) RAI SER
NUMBER I NCOME
0 9/ 0 3 / 0 4 I D# J o a n a L . We l l s 5 . 00256 Newbur g Road
CK# Gr i mm 11 , I a 5 0 1 1 2
09 / 1 7 / 0 4 I D# JoamL . We l l s 5 . 00
2 5 6 Newbur g RoadCK# Gr i n n e l l , I a 5 0 1 1 2
x
1 0/ 0 1 / 0 4 I D# " Joann L . We l l s 5 . 002 5 6 Newbur g Road
CK# Gr i n n e l l , I a 5 0 1 1 2
07 / 2 3 / 0 4 m# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 8 / 06 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 8 / 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
( 3 C #
0 9/ 0 3 / 0 4 I D# Un i t emi z e d Re c e i p t 1 . 00
CK#
0 9/ 1 7/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
1 0/ 0 1 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 00
CK#
0 7/ 2 3 / 0 4 I D# Li n da J . Wi n c h e l l 2 . 503 1 5 2nd Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( i n c l u d i n g c a nd i d a t e ' s p e r s o n a l f u n d s )
COMMI TTEE NAME ( Mu s t b e s am e a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( POL I T I CAL ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROMTHE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD.
CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Cod e , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a nd s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r a n y c o mme r c i a l p u r p o s e b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . - - -
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
* D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e shown t o t h e t h i r d d e g r e e o f c o n sa n gu i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) ( S e e Page 2 o f f o r ms p a c k e t ) I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
Page 4 3 o f 44
( f o r Sc h e d ul e A)
SCHEDULE
A MONETARY
( Re v . 0 6 / 9 7 ) RECEI PTS
CHECK T HI S BOX I
AMENDI NG FORM
DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT ( I F FORRECEI VED ( i f a pp l i c a bl e ) TO CANDI DATE* RECEI VED FUND-
( MM/ DD/ YR) AND PACCHECK ( i f a pp l i c a bl e ) RA I SERNUMBER I NCOME
0 8/ 0 6 / 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 03 1 5 2 n d Avenue
CK# Gr i n ne l l , I a 5 0 1 1 2
0 8/ 2 0 / 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 03 1 5 2 n d Avenue
CK# Gr i n ne l l , I a 5 0 1 1 2 ,
0 9/ 0 3 / 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 03 1 5 2 n d Avenue
CK# Gr i n ne l l , I a 5 0 1 1 2
0 9/ 1 7/ 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 03 1 5 2 n d Avenue
CK# Gr i n n e l l , I a 5 0 1 1 2
1 0/ 0 1/ 0 4 I D# L i n da J . Wi n c h e l l 2 . 5 03 1 5 2 n d Avenue -
CK# Gr i n n e l l , I a 5 0 1 1 2
0 7/ 2 3 / 0 4 I D# Un i t e mi z ed Re c e i p t 1 . 0 0
CK#
0 8/ 0 6 / 0 4 I D# Un i t e mi z ed Re c e i p t 1 . 0 0
CK#
0 8/ 2 0 / 0 4 I D# Un i t e mi z e d Re c e i p t - 1 . 0 0
CK#
0 9/ 0 3 / 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
0 9/ 1 7/ 0 4 I D# Un i t e mi z e d Re c e i p t 1 . 0 0
CK#
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F o r I n s t r u c t i o n s , Se e B a c k o f Fo r m
CONTRI BUTI ONS - - MONEY TAKEN I N
( 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 )
COMMI TT EE NAME ( Mu s t b e s am e a s o n S t a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
STATE CANDI DATES NOTE: I F
A CONTRI BUTI ON I S RECEI VEDFROM
ASTATE PAC
( POL I T I CAL ACTI ONCOMMI TTEE) , L I ST T HE P AC I DENT I F I CAT I ON
NUMBER AND THE PAC CHECK NUMBER I N THHE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I LABLE FROM THE I OWA ETHI CS AND CAMPAI GN
DI SCLOSURE BOARD .
CAUTI ON: Se c t i o n 6 8 B . 3 2 A( 6 ) , I o wa Cod e , p r oh i b i t s t h e u s e o f i n f o r ma t i o n c op i e d f r o m r e p o r t s a n d s t a t e me n t s f o r s o l i c i t i n g c on t r i b u t i o ns o r
f o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s . . , .
TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )
` D i s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi 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 ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus 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 ns a ng u i n i t y ( b l o o d r e l a t i v e ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) ( S e e P a g e 2 o f f o r ms p a c k e t ) .
I f s u r n a me o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of 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 mn .
P a g e 4 4 o f 4 4
( f o r Sc h e du l e A)
SCHEDULE
A MONET ARY
( R e v . 0 6 / 9 7 ) RECEI PTS
CHECK THI S BOX I
AMENDI NG FORM
DATERECEI VED
( MM/ DD/ YR)
PAC I D NUMBER( i f a p p l i c a b l e )
AND PAC CHECKNUMBER
NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE'
( i f a p p l i c a b l e )
AMOUNTRECEI VED
( I F FORFUND-
RAI SERI NCOME
1 0 / 0 1 / 0 4 I D#
CK#
Un i t e a i z e d Re c e i p t 1 . 0 0
z
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FORI NSTRUCT I ONS, SEE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT
STATEPAC COMMI TTEES : NOTE : FOR CONTRI BUT I ONS MADE TO STATEWI DE OR LEGI S LA TI V ECANDI DATES, L I S T THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I ST OF I D NUMBERS I S AVAI LAB LE FROMTHE I OWAETHI CS & CAMPAI GN DI SCLOSURE BOARD .
COMMI TT EE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
TOTAL f i f l a s t p a g e o f t h i s s c h ed u l e ) 1 $
SUB- TOTAL I $ 2 , 2 0 0 . 0 0
T HI S BOX APP L I E S TO CANDI DATES' COMMI TTEES ONLY :
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )
Ex p en 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 , manag i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x pe nd i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c an d i d a t e ' s c o mmi t t e e . ( R e f e r t oSc h e d u l e G i n s t r u c t i o n s a n d I o wa Co de 5 6 . 6 ( 3 ) ( 1 ) . )
Pag e 1 o f 3
( f o r Sc h e d u l e B )
SCHEDULE
B MONETARY
( Re v . 0 9 / 9 7 ) EXPENDI TURE
2 CHECK T HI S BOX I F
AMENDI NG FORM
DATE
_EXPENDED( MM/ DD/ YR)
CANDI DATE
I D NUMBER( i f a p p l i c a b l e )
AND PACCHECK
NUMBER
NAME AND ADDRESS TOWHOMEXPENDI TURE
/ D i s b u r s e me n t / WAS MADE
PURPOSE- ( DESCRI BE TRANSACTI ON)
AMOUNT
EXPENDED
0 9 / 1 4 / 0 4 Bo y l e P t t a l i c Se r v i c e Q' mi ds i m 5 0 0 . 0 04 2 0 S . 1 1 t h St r e e t Gma i 2 0 0 4 / mami n , NE 6 8 5 0 8 Ra 7 . i t i c a l C l o 3 t r i b u t i c u
0 0 1 2 5
0 9 / 1 7 / 0 4 Th 0 1 1 OomnL t b e e s t a bs ~~4eq~, I l a t u r /np 2 0 0 . 0 0DmVQnx a u Gmec a l . 2 00 4 / i a
a l t 2 4 4 4 0 0 w , , ; t ; , t a l a l o 3 t r i b ut i m
0 0 1 1 2 8 Gd r r , p , r a 5 0 1 1 2
0 8 / 2 6/ 0 4 s t a t e a o u mn , a - - i s ,a t ur e / x e p 5 0 . 0 0ma n i c L h v i . t t Ge n e r a l 2004/ 46 1 1 wAd f f i x x i
0 0 1 2 3 T n i i f i A o l a , J I L 5 0 1 2 5
0 9 / 1 4 / 0 4 De n r r 3 e n f o r St a b s C t mm i t t e e s l a t e Sew 5 0 . 0 03 ] 1 3 K i n e%r Ave ma Geoe z a l 2 00 4 / i aDe s M: d ~ l s , l e . 5 0 3 0 9 P u l i t L C a
0 0 1 2 6
0 9 / 1 7 / 0 4 f t a i f Cr S e r i a t e s t a t e 2 00 . 0 06 0 3 8 laFr a i m coa l 2004/ aM
Rt . 1 i a l i t i ml ( l o o t r b u t i r n0 0 1 3 4 F. . MK b s c n , l a 5 2 6 2 7
0 9 / 1 7 0 4 s t a t e Vn NM/ j e r j l j e ]; 1h1EWr EP 5 00 . 0 0
P O B o o t 2 2 0 C o ~ ~ ' a l 2 00 4 / i aa s 9 h e 7 . 1 p 4C )C , I a 5 0 6 7 0 P i o l i t l c a l C l o m t ! d b u t i0 0 1 3 7
0 9 / 1 4 / 0 4 3 1 * Ge r a l d Vap - p J bUc S e v i c e P t t a l i c Se r v i c e Co mn d s s i m 5 00 . 0 01 2 0 0 l a t h St r e e t Ge c e c a l 2 0 0 4 / n e
a l l Ca s t s , NE 6 8 5 0 8 A ' 1 1 7 t L c al C b r i t i l i b u t i0 0 1 2 4
0 9 / 1 7 / 0 4 Qpp f l o g Pe pr e amt a t i v e a o un i t t e e $ t 3 t e Eb m e l / l sg; a l a t * , . Wnp 2 0 0 . 0 05 8 6 a l a l c k Gi r p G, e ~ n ~ e ~ r ~ a l ~ 2 ~ 0 ( 4 / i a 0 3 1
CI A 2 1 2 Hi g h P a " " ' . . a L Cbat 1 b u tm0 0 1 3 3 D a o l o r a h , I a 5 2 1 0 1
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FOR I NSTRUCTI ONS, SEE BACK OF FORM
EXPENDI TURES - - MONEY SPENT FROM COMMI TTEE ACCOUNT
STATE PAC COMMI TT EES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR L EGI SL ATI VE
CANDI DATES, L I ST THE CANDI DATE I DENT I F I CATI ON NUMBER I N THE DESI GNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S A VA I L A BL E FROMTHE I OWA
ETHI CS & CAMPAI GN DI SCLOSURE BOARD .
COMMI TTEENAME ( Mu s t b e s ame a s o n St a t e me n t o f Or g a n i z a t i o n )
VERI ZON I OWA STATE GOOD GOVERNMENT CLUB
TOTAL ( i f l a s t page o f t h i s s c h e du l e ) 1 $
SUB- TOTAL / $ 1 , 5 0 0 . 00
T HI S BOXAPPLI ES TOCANDI DATES' COMMI TTEESONLY:
Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e must a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o Sc 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 , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e amo un t , p u r p o s e , a nd da t e o f e a c h t y p e o f e x p e n d i t u r e made b y t h e p e r s o n / e n t i t y on b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t o
Sc h e d u l e G i n s t r u c t i o n s a nd I o wa Co de 5 6 . 6 ( 3 ) ( 1 ) . )
Page 2 o f 3
( f o r Sc h e d u l e B)
SCHEDULE
B MONETARY
( Re v . 0 9 / 9 7) EXPENDI TURE
01 CHECK T HI S BOX I F
AMENDI NG FORM
DATE
EXPENDED
( MI G1/ DD%YR)
CANDI DATE
I D NUMBER
( i f a pp l i c ab l e )
ANDPAC
CHECK
NUMBER
NAMEANDADDRESS TOWHOM
EXPENDI TURE
/ D i s b u r s e me n t ) WASMADE
PURPOSE
. , ( DE SCRI BE TRANSACTI ON)
AMOUNT
EXPENDED
0 9 / 1 7 / 0 4 3 1 * a t i 7 1 19 0 11 1 5 i w G r c w t e l s l y s e w 2 0 0 . 0 0Ga e l u a i 2 0 0 4 /
2 2 0 B e C Ee t t t o P o l i t i c a l O c n t r i b u t i m0 0 1 3 2 Cb r i c i l BI &Es, M! L 5 1 5 0 3
0 8 / 2 6 / 0 4 P o s e r f i a t S t a t e A e F c e s e c i t a t i w s t a t e 1133Wn, - T ' ; h =e /ny 50 . 0 0
Ga i S t e e r G 9 3 e a 3 2 0 0 4 / i a
C K # 2 3. 3 7 t h S t r e e t W C t l a t r i b u t i m0 0 1 2 1 A l t o a a , T h 5 0 0 0 9
1 0 / 0 4 / 0 4 Z a w n 1 C p a mt y S t a t e P h t i t i t a t EwLt y 5 00 . 0 0
9 0 9 8 1 3 4 5 l i l b i b o a r P e r i a l a y Ga e a t 2 0Wi aC0 ' D e s M b d n e s , T a 5 0 3 1 0 P c l i t i c a l O o n t r i b t i m
0 0 1 3 8
0 9 / 1 7 0 4 1 9 1 1 9 1 : 1 3M f i c r s t a t e s~ 2 0 0 . 0 0S t e w a r t 1 y e r s a z G e n e r a l 2 0 0 4 / i a 0 0 5
C E O 3 0 2 0 D o t e s - Wi l ; , . na H o e d w, 7 ; t i c s l C t n t r Am& ;m
0 0 1 3 0 n a g s , I a 5 0 0 7 1
1 0 / 1 1 / 0 4 m# J n o C i 7 s Q = I r L t t e e S t a t e Rs+-MhT, * Q / gy p 2 0 0 . 0 08 0 8 5 8 t h s t r e e t G e n e r a l 2 0 0 4 / i i
0 0 R e s t D e s M o t i v e s , 1 a 5 2 3 3 9 P t l i t i c a l Ot l o t r i b u t i m0 0 1 3 9
0 9 / 1 7 / 0 4 K i b b d e b o r S e n a t e S t a t e S e n a t e 2 0 0 . 0 0P0BI 3C190 Ge a l a a l 2 0 0 4 / s d D 4
C i d # Hmmt dmaV, I a 5 0 5 3 6 P a t i c a l O t i n t . i b u t i m0 0 1 2 9
0 8 / 2 6 / 0 4 3 1 * i o n S e n a t e S t a t e s a ~ a t e 5 0 . 0 0I i a b y _ f c cGaul 2 0 0 4 / i a
C K k T O B I C K 5 6 3 O~ i b u t i m0 0 1 2 2 N a r i m , 7 a 5 2 3 0 2
0 8 / 3. 9 / 0 4 Omm i t t e e t o Meat M9 t t . W( by S t a t e S e f l a t e 1 0 0 . 0 0Gaul 2 0 0 4 / k E l l
C [ # 4 7 2 0madp a l e . Mi t i a a l c r n r a , t r i m0 0 1 2 0 D e s Mo i n e s , l a 5 0 3 2 0