AUG-26-2004 05°37 PM 9COLLER&COMPANY .LLP 13196536745 P .

02

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PA DR-2 DISCLOSURE
(Rev . 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Orge
For Ofnae Mae
On
Washington County Citizens For Good Jobs Committee Comm . 0 C12 /A 7 1
IMPORTANT : Indicate by # type of committee you are reporting for Logged in
( 1 )Stetewldekegisletlve/Judge Standing for Retention Candidate (2 Scanned
( 4 )County Central Committee ( B )County Candidate ( 6 )CIty Candid a of
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )S oar or er oIdeal Computer
Subdlvlslon PAC ( 11 ) Local Ballot Issue Audited _ -
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (If applicable)
Late reports are subject to
possible clvll and criminal
Office Sought District (if Senate or House) penaltles .

SI NATURE OF P O FILING REPORT TEL

~9
HONE
s DATE SIGNED

8/26104
I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .
(report data) Indicate by # 10

Local Committees, enter Date of Election

EICHECK IF AMENDMENT TO REPORT DATED
8/31/04
(] Check If this Is final (termination) report and attach Notice of Dissolution Form OR-3 . County & Local Committees, enter County In
which Election Is held
(You must continue to file reports until a DR-3 is filed .) Washington

STATEMENT OF CASH ON HAND

CASH ON HAND et the beginning of the reporting period . (Total of all funds held by the
committee . This amount MUST be the same as the cash on hand at the end
16,420 .72
of the last reporting period or must be zero if this Is first report filed .) . ., . ., . . .. .  . . . . . .  .. . . . . . . . . . . .$
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) , . . ., . . . . . 30,000 .00
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . ., . . . . . . . . . . . ., . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . .
Schedule H applies to Candidates' Committees Only)
SUB-TOTAL .. . . . S 46, 42 0,72
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule 8 : Expenditures total (Attach Schedule 8) ("also see debts and loans below) . . . . 19,246 .76
Schedule F : Loan Repayments total (Attach Schedule F) . . . ., . ., . . . . . . . . . . . . . . ., . . . . . .. . . . . . . . . . . . .  . . .  . .
CASH ON HAND et the end of this reporting period (If final report balance must
27,173 .96
be zero) (Attach OR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$

"UNPAID BILLS (From Schedule D - Attach Schedule D) ., . . . . . . . . . . . . . . . . . . . . . . ., . . . . . ., . . . . . . . . . . . . . . ., . . . . . ., ., . . . . . . . S 212_2 .50_

'IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) ., . . . . .. . ., . ., . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . .$
"OUTSTANDING LOANS (From Schedule F -Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . ., .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)
AUG-26-2004 05 :339 PM IKOLLER&COMPANY,LLP 13196536745 P .03

For Instructions, Sao Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev, 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be some as on Statement of Organlzetlon) AMENDING FORM

Washington County Citizens For Good Jobs Committee

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) . LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 88B.32A(8), Iowa Code, prohibits the use of Information copied from reports and statements for sollcltlng contributions or
for any commercial purpose by any person other then statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT v IF FOR
RECEIVED (If applicable) TO CANDIDATE* RECEIVED FUND-
(MMIDDIYR) AND PAC CHECK (If applicable) RAISER
NUMBER INCOME
ID#
Catfish Bend Casino, LC
08117104 PO Box 471 ttla $30,000.00
CK#
Fort Madison, la 52627
ID#

CK#

ID#

CK#

IDO

CK#

ID#

CK#
-
ID#

CK#

ID#

CK#

CK#

I D!#

CK#
_
IDS

CK#

SUB-TOTAL

TOTAL (if last page of this schedule) I S

S 30,000,00
° Oleaosure low requires candidate committees to disclose the relationship of any relative making a conwbumn to the
Committee. Relationship must be shown to the third degree of eonsangulnity (blood relatives) and affinity (relative$ by 1 1
marriage) If surname of contributor Is the same as candidate, but there is no Page
familial relationship, enter'not applicable' In the relationship column (for Schedule A)
AUG-26-2004 05 :39 PM KOLLER&COMPANY .LLP 13196536745 P-04

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

B
EXPENDITURES w MONEY SPENT FROM COMMITTEE ACCOUNT
I
MONETARY
(Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD,

COMMITTEE NAME (Must be some as on Statement of Orgenlzetlon)

Washington County Citizens For Oood Jobs Committee
CANDIDATE NAME AND ADORES$ TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID#
Johnston & Nathanson Consulting
07/15/04 CK#995 1902 Broadway 3,000.00
Iowa City, IA 52244
ID#
almart Supplies
07/191043, 30 Hwy 1 S . 149,59
CK#998
ashington, IA 52353
ID#
tint Shop Supplies
07/20104 CK# 100I 10 . E. Main 30.75
ashington, JA 52353

ID#
arrell's Office Supply Copies
07/21104 110 W, Main
CK#1002 49.04
Washington, IA 52353
ID#
William Freeland Supplies
07/23104 CK# 1003 551 7 Ferro's Lane 36 .58
Burlington, IA 52601
ID#
Chamber of Commerce Supplies
07/27/04 12 N . Iowa Ave
CK#1004 18 .00
Washington, IA 52353
ID#
Image Graphics Copies
07/28/04 218 W. Washington
CK# 1005 32.10
Washington, to 52353
ID#
Chamber of Commerce Supplies
07/28/04 12 N. Iowa Ave
CK# 1006 15 .00
ashington, IA 52353

SUB-TOTAL

TOTAL (11 /oat page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY .,

Purchases of cenaln campaign property casting $500 or more must also be Inventoried on Schedule H. (Refer to Schedule H Instructions .)

Expenditures to personslantitles providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each" of expenditure made by the person/entlty on behalf of the candidate's committee . (Refer to
[Schedule 0 Instrucoons and love Code MA .402(3)(I),)

Page of __8_____

(for Schedule B)
AUG-26-2004 05 :38 PM KOLLER&COMPANY,LLP 1 .3196536745 P .05

FOR INSTRUCTIONS, SEE BACK OF FORM

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

STATE PAC COMMITTEES : NOTE: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS d CAMPAIGN DISCLOSURE BOARD .

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

..
0 100D11 CWAA t f S 0 G0000
CANDIDATE" NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID#
Washington Community Y Rent
07/29/04 121 E. Main 50 .00
CK# 1007
Washington, IA 52353

ID#
owa Telecom Utilities
0 Box 10481
08/02/04 101,76
CK#1008
es Moines, 1A 50306

ID# Tint Shop Supplies

08/02/04 10 E. Main St 31 .80
C01009 ashington, IA 52353

ID#
colt 6c Katie Lujan Rent
08/02104 13 1/2 W . Washington 525.00
CK#1010
ashington, IA 52353

ID# Bill Freeland Campaign Coordinator

08102/04 5517 Ferre's Lane 2500 .00
CK# 1011
Burlington, 1A 52601
ID#
Susan Westermark Office & Canvassing
08/02/04 305 Woodland Ct 400.00
001012
Washington, IA 52353

ID#
Kat Willaon Canvassing
08/02/04 PO Box 234 110.00
CK# 10 l 3
Keota, 1A 52248
- -
ID#
eff Talbot Canvassing
08/02/04 009 9th St
CK# ) 014 150.00
alona, IA 52247

SUB-TOTAL I $ 3,868 .56

TOTAL (if last page of this schedule) [ $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property coating $500 or more must also be inventoned on Schedule H . (Refer to Schedule H Instructions )

Expenditures to persons/entitles providing consulting . advertising, fund-raising . polling, managing . organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the persorventity on behalf of the candidate's committee . (Refer to
Schedule G Instruction& and Iowa Code 6BA,402(3)(I) .)

(for Schedule B)
AUG-26-2004 05039 PM KOLLER&COMPANY .LLP 13196536745 P .06

FOR INSTRUCTIONS, SEE BACK OF FORM

I
SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOT/: FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE Q CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

COMMITTEE NAME (Must be some as on Statement of Organizetlon)

Washington County Citizens For Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE 10 NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID#
Randy Martin Canvassing
08/02/04 818 N . 7th Ave 175,00
CK# 1015 Washington, TA 52353

ID#
Thomas Rowand Canvassing
08/02/04 33 S . Washington Ave 170 .00
CK#1016 Washington, IA 52353

ID#
ngela Wasson Canvassing
08/02/04 0 Box 225 130 .00
CK#1017 ellman, IA 52356

ID#
immy Fulcher Canvassing
08/02/04 35 S . Ave C 80 .00
CK#1018 Washington, 1A 52353

ID#
Melinda Hagana Canvassing
08/02/04 PO Box 81 55 .00
CK# Ip1g
Koota, IA 52248

ID#
owa Telecom Utilities
08/02/04 O Box 10481 489 .73
CK#1020
Des Moines, IA 50306

ID#
Postmaster Stamps
08/02/04 115 N . Marion Ave
CK# 1021 Washington, lA 52353
37 .00

-
ID#
mage Graphics Copies
08/02/04 18 W. Washington
CK# 1022 2622
ashington, IA 52353

SUB-TOTAL 1 $ 1,162 .95

TOTAL (if last page of this schedule) [-$

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property eosttng $500 or more must also be inventoried on Schedule H . (Rotor to Schedule H Instructions .)

Expenditures to persons/entltles providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail Itemized on
Schedule G by the amount, purpose, and dale of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Rotor to
Schedule G Instructions en d Iowa Code 68A.402 3 I .

(for Schedule B)
AUG-26-2004 05° .39 PM KOLLER&COMPANY,LLP 13196536745 P-07

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07103) EXPENDITURES

STATE PAC COMMITTI:Et3 : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS 19 AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Washington County Citizens For Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MMIDDIYR) AND PAC
CHECK
NUMBER
ID#
Iowa Electronic Devices . Inc Phones
08/02/04 125 W. Washington St 808.29
CK# 1023 Washington, IA 52353

ID#
eff Talbot Canvassing
08/04/04 1009 9th St 30 .00
CK#1024 alona, IA 52247

ID# Supplies
ill Freeland
08/04/04 517 Ferre's Lane 73 .01
CK#1025 urlington, IA 52601

IN
ay Smith Supplies
08/04/04 017 Norman Dr 65 .45
CK#1 p26
Sioux City, IA 51104
IDS !
Image Graphics Copies
08/05/04 218 W . Washington 148 .73
CK# 1027 Washington, IA 52353

ID#
Iowa Electronic Devices, Inc Phones
08/05/04 125 W. Washington 31 .79
CK#(028
Washington, IA 52353
ID#
Ainsworth Opera House Rent
08/06/04 84 Railroad St
CK# 100 ,00
1029 Ainsworth, IA 52201

ID#
a Smith Supplies
08/10/04 017 Norman Dr 21,20
CK# 1031
ioux City, IA 51104

SUB-TOTAL I S 1 .278 .47

TOTAL (if last page of this schedule) ( $

THIS BOX APPLIES TO CANDIDATE'' COMMITTEEB ONLY :

Purchases of certain campaign property costing $500 or more must also be Inventoried on Schedule H . (Refer to Schedule H Instructions .)

Expenditures to personstentitles providing consulting, advertlslng, fund-raising, polling, managing, organizing services must also be detail Hemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the psrsoNsntlty on behalf of the candidate's oommlttee. (Refer to
Schedule G Instructions and Iowa Code 68A,402(3)(I) .)

(for Schedule B)
AUG-26-2004 05 :40 PM KOLLER&COMPANY .LLP 13196536745 P .09

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT

B
(Rev, 07103) I MONETARY
EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS S CAMPAIGN DISCLOSURE BOARD.

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

Washington County Citizens For Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID# Supplies
Susan Westermark
08/10/04 1305 Woodland Ct 195.37
CK# 1032 Washington, IA 52353

ID# Copies
mage Graphics
08/10/04 18 W. Washington 38 .52
CK#1033
Washington, IA 52353
I D# owa Electronic Devices, Inc Phones
08i10/04 25 W. Washington 63 .58
CK#1034 Washington, IA 52353

IN
ay Smith Supplies
08/10/04 017 Norman Dr 64,10
CK#1033
ioux City, IA 51104

IN
Image Graphics Copies
08112104 218 W . Washington 32 .64
CK# 1036 Washington, IA 52353
IN
mage Graphics Yard Signs
08112/04 18 W. Washington 976.38
CK#1039 Washington, IA 52353
ID# Rent
Wellman Fire Department
08/12104 5 3rd St 25 .00
CK# 1040 Vellman, IA 52356

IN
ighland School District Rent
08/12/04 20 Schnoebelen 75 .00
CK# 1041 iiversidc, IA 52327
I I I I I

SUB-TOTAL $ 1470,59

TOTAL (If last page of this schedule) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property costing $800 or more must also be Inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entitles providing consulting, edvertlelrg . fund-raising, polling, managing, organizing services must also be detail Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the pereonlentity on behalf of the candldate's committee . (Refer to
Schedule G Instructions and Iowa Code 68A.402(3)(1) .)

Page __ of __a____

(for Schedule 8)
AUG-26-2004 05°40 PM KOLLERQCOMPANY,LLP 13196536745 P .09

FOR INSTRUCTIONS, SEE BACK OF FORM F77,771777 77 SCHEDULE

MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07103) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS A CAMPAIGN DISCLOSURE BOARD.

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

Washington County Citizens for Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID#
Jeff Talbot Canvassing
08/13/04 1009 9th St 295,00
CK# 1042 Kalona, IA 52247 $
ID#
ndy Martin Canvassing
08/13/04 18 N, 7th Ave 85 .00
CK#1043 ashington, IA 52353

ID#
at Willson Canvassing
08/13/04 0 Box 254 125,00
CK#1044
eota, IA 52248

I D#
ngela Wasson Canvassing
08/13/04 0 Box 225 245.00
C01045
ellman, IA 52356
ID#
Thomas Rowand Canvassing
08/13/04 935 S, Washington Ave 340.00
CK# 1046 Washington, to 52353
ID#
Timmy Fulcher Canvassing
08/13/04 35 S, Ave C 250.00
CK#1047 Washington . 1A 52353
ID#
Melinda Hagans Canvassing
08/13/04 PO Box 81 170.00
CK# 1048 eom,TA 52248

ID#
Susan Westermark Offico & Canvassing
08/13104 1305 Woodland Ct 995.00
CK# 1049 Washington, IA 52353

SUB-TOTAL 1 $ 2,505 .00

TOTAL (if lost page of this schedule) 1 $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property oostlng $500 or more must also be Inventoried on Schedule H. (Refer to Schedule H Instructions .)

Expenditures to persons/entitles providing consulting, edvertlaing. fund-raising, polling, managing, organizing services must also be detail Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee (Refer to
Schedule G Instructions and Iowa Code BeA .d02(3)(I) .)

Page - ~0 of _ e ____

(for Schedule B)
AUG-26-2004 05 :41 PM KOLLER&COMPANY .LLP 13196536745 P .10

FOR INSTRUCTIONS, SEE BACK OF FORM P.idhl7''r "ff ' 17=

rt' SCHEDULE
B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev, 07/03) EXPENDITURES

STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD .

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

Washington County Citizens For Good Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MM/DOIYR) AND PAC
CHECK
NUMBER
ID#
Tony Baughman Canvassing
08/13104 PO Box 81 180,00
CK# 1050
Keota, IA 52248

ID#
erri Miller Canvassing
08113/04 15 W, 3rd St 130 .00
CK#1051
Washington, IA 52353

ID# ay Smith Campaign Coordinator

08/13/04 017 Norman Drive 1250 .00
CK#1052 ioux City, IA 51104

ID#
alone Chamber of Commerce Rent
08/17/04 14 B . Ave 40 .00
CK#1053
alone, TA 52247

ID#
City of Brighton Rent
08/17/04 101 E . Washington 35 .00
CK# 1054 Brighton, IA 52540

ID#
rawfordaville American Legion Donation
08/17/04 Vine St 40 .00
CK#1055
rawfordsville, IA 52621

ID#
Washington Rental, Inc Rent
08/17/04 210 S . 15th Ave 31 .80
CK# 1056 Washington, IA 52353

ID#
ohnston & Nathanson Consulting
08/17/04 902 Broadway
CK# 1057 3000,00
/owe City, IA 52244

1$
SUB-TOTAL 4,706 .80
TOTAL (if last papa Of this schedule) 1 $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing 5500 or more must also be inventoried on Schedule H, (Refer to Schedule H Instructions .)

Expenditures to personstentltlea providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail Itemized on
Schedule O by the amount, purpose, and date of each type of expenditure made by the persoNenthy on behalf of the candidate's Committee . (Refer to
Sch edule 0 Inst ruction& end Iowa Code 88A
.402 3 i .) -

(for Schedule B)
AUG-26-2004 05 :41 PM KOLLER&COMPANY .LLP 13196536745 P .11

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev, 07/03) f EXPENDITURES

D
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD

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

Washington County Citizens For Oood Jobs Committee

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (0lsbursamont) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID#
mage Graphics Supplies
08/18/04 18 W, Washington 76 .32
CK# 1058 Washington, IA 52353

1D#
ill Freeland Supplies
08/23104 517 Ferre's Lane 85,62
CK#1059
urlington, IA 52601

ID#
mage Graphics Copies
08/23/04 18 W . Washington 47 .70
CK#1060 ashington, TA 52353

ID#
mage Graphics Yard Signs
08/23/04 18 W. Washington
C010611 483 .63
Washington, IA 52353
ID#
Bill Freeland Supplies
08/23/04 CK# 5517 Ferre's Lane
1062 138 .14
Burlington, IA 52601

ID#
ay Smith Phones
08/23/04 017 Norman Drive
C01063 51 .92
ioux City, IA 51104

ID#
est Chester Heritage Society Rent
08/24104 510 Main
CK# 1065 40 .00
West Chester, lA 52359

ID#

CK#

SUB-TOTAL S 923 .33

TOTAL (if last page of this schedule) S 19,246,76

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property costing $600 or more must also be Inventoried on Schedule H (Refer to Schedule H Instructions,)

Expenditures to persons/entldes providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail Itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the personiontlty on behalf of the candidate's committee . (Refer to
Schedule G Instructions and I owa Code 08A,402(3)(I) .)

Page 8____ of 8-_-_-

(for Schedule 8)
AUG-26-2004 0 5 :41 PM KOLLER&COMPANY,LLP 13196536745 P-12

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

D INCURRED
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev, D81g8) INDEBTEDNESS
Washington County Citizens For Good Jobs Committee
CHECK THIS BOX
IF AMENDING
NOTE : Debts previously reported that remain unpaid must be Included on this FORM
Schedule, as wall as any now obligations incurred In this period .

An 'Incurred debt' Is a debt for

DEBTSIOBLIGATIONS REMAINING THIS REPORTING PERIOD goods or services ordered or
(DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) received, but not paid for by the
end of the reporting period .,
regardless of whether an Invoice
has been received
DATE DESCRIPTION OF GOODS OR BALANCE OWED AT
INCURRED NAME AND ADDRESS OF PERSON SERVICES PROVIDED OR CLOSE OF
(MMIDD/YR) TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING
PERIOD*

Melinda Hagans Canvassing

08/26/04 PO Box 81 215 .00
Keota. TA 52248

Tony Baughman Canvassing

08/26/04 PO Box 81 215.00
Keom,IA 52248

Kat Willson Canvassing

08/26/04 PO Box 234 195.00
Keota, IA 52248

Term Miller Canvassing

08/26/04 415 W. 3rd St 215.00
Washington, lA 52353

Jeff Talbot Canvassing

08/26/04 1009 9th St 290.00
Kalona, [A 52247

Angela Wasson Canvassing

08!26/04 PO Box 225 160.00
Wellman, IA 52356

Thomas Rowand Canvassing

08l261Q4 935 S. Washington Ave 350,00
Washington . IA 52353

SUB-TOTAL $
1,640.00

TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD S

'If actual figure Is unknown, show "estimated" beside the figure . Page I of 21
(for Schedule D)

CANDIDATE COMMITTEES NOTE :

'Incurred Indebtedness also Includes each person/entIty with whore the candidate's committee hiss entered Into a contract during the reporting period for future
or contlnulng performance . Enter the name of the consultant who provides or procures services for Items such as advertising, fund-raising, polling, managing, or
organizing services, - Repo rt on Schedule G the nature of performanc e and the estimated performanc e-reasonably expected of the consultant.
AUG-26-2004 05 :42 PM KOLLER&COMPANY,LLP 1-3196536745 P-1 .3

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

INCURRED
COMMITTEE NAME (Must be some as on Sfafement of Organtzation) (Rev. 08198) INDEBTEDNESS
Washington County Citizens For Good Jobs Committee
CHECK THIS BOX
IF AMENDING
NOTE : Debts previously reported that remain unpaid must be Included on this FORM
Schedule, as well as any new obligations Incurred in this period,

An "Incurred debt' Is a debt for

DEBTSIOBLIGATIONS REMAINING THIS REPORTING PERIOD goods or services ordered or
(DO NOT INCLUDE LOANS -- SHOW LOANS ON SCHEDULE F) received, but not paid for by the
end of the reporting period .,
regardless of whether an Invoice
has been received .
DATE DESCRIPTION OF GOODS OR BALANCE OWED AT
INCURRED NAME AND ADDRESS OF PERSON SERVICES PROVIDED OR CLOSE OF
(MWDDIYR) TO WHOM DEBT OR OBLIGATION IS OWED PURCHASED REPORTING
PERIOD'
S
Randy Martin Canvassing
08126/04 818 N. 7th Ave 165.00
Washington, IA 52353

Jimmy Fulchcr Canvassing

08/26/04 40.00
735 S . Ave C
Washington, TA 52353

Erin Freeland Canvassing

08/26/04 5517 Ferro's Lane 277.50
Burlington, IA 52601

SUB-TOTAL $
482.50

TOTAL DEBTS OWED BY COMMITTEE AT THE END OF THIS REPORTING PERIOD S

2,122.50

'If actual figure Is unknown, show 'estimated' beside the figure . Page 2 of 2
D)
(for Schedule

CANDIDATE COMMITTEES NOTE :

-Incurred Indebtedness also Includes each personlent"y with whom the candidate's commlttes has entered Into a contract during the reporting period for future
or continuing performance. Enter the name of the consultant who provides or procures aetvlas for items such as advertising, fund-ralelng, polling, managing . or
or anizlng services . Report on Schedule G the nature of performance end the estimated performance reasonably expecte d of the consultant.