DISCLOSURE SUMMARY PAGE Reset Form DR-2 ~D SCLOSURE

(Rev. 07/2003
COMMTTEEE NAME (Mast be sWM as on SW&merOOfOrganlzathan)
For Office Us9 oriv
Comm . # -
Logged In
IMPORTANT: Indicate type of cornmlflne you era nportIIQ far. Scanned
(t )StatawId&Leglslatiw Candidam (2 )Statinrlde PAC (3 )Mm~Party (4 )Couray/LowJ Candidate Computer
Ca nfl Conxnlrae
( 3 )County PAC ( a )ee11a Issuo/Fmnd%iao ComrnPti- (7 )COunl0tY
Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name Political Party
ID /9 'TJ 1-41 lc~' -~rn
Office Sought District (If Senate or House)

7Iz-9Y,'j-79~3 /e2-/9-z0o`/
TELEPHONE DATE SIGNED
SIGNATURE OF TREASURER (or person flung this report)

Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTION QN BACK AND COMPLETE THE FOLLOWING $ENTFNCE :
I AM FILING A ~~G%~ .sFn i ZoD REPORT FOR ANNA 1 ELECTION 1(2)NON-ELECTION YEAR.
(report date) Indicate one
CHECK IF AMENDMENT TO REPORT DATED Local Committees . enter Date of Electon
XAOfS/775~f~ ~ .Z>"o ZOpY
Committees . enter County in
(termination) mport and attach Notice of Dissolt!tlon Form DR-3. County & Loral
r 1 Check if this is final which Election is hold
(You must continue to file reports until a Notice of Dissolution Is tiled.)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period. (This is the tout of all monies held
by the committee . This amount MUST be the same as the rash on hand at the end
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) .......... 8I s- Yq Yz
Schedule F: Loans Received total (Attach Schedule F) .......................................................
Schedule H: Total Sales of Campaign Property (Attach Schedule H) ................... ........... .... , moo
(Schedule H appiles to CandidatesC 2mMtMggm OrIW
SUB-TOTAL . .. .. $ l3 _J/l/ . 6'O
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below) .... G
Schedule F: Loan Repayments total (Attach Schedule F) ................ ........ .......................... .. ~ ooa . oc~
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) .... ... ... ....... . ... . ................... . . . .. ... .. ........ .... .... ..... ......... .. . .... ..............$

"UNPAID BILLS (From Schedule D - Attach Schedule D).......................... .......................................$ --

- IN KIND CONTRIBUTIONS (Front Schedule E -Attach Schedule E) .... ............. ...................... ........5 ozo

si GO
i-i

"OUTSTANDING LOANS (From Schedule F - Attach Stltedule F)........................ ...........................$ 7S-0

CANDIDATE COMMITTEES NLY :
CONSULTANT BREAKDOWN (Schedule O Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)

7
610 %%;Cij' d ScCj# ~ : : r r_~ bCiCic~`g t !r , t S:'~ 1 tr+6~,+6I L rN I i0vdlf JClCi 11dVSS]~ : W0.a A
 A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Ram 07/03) RECEIPTS
(Indudlng candidate's persorml iW+ds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on 5tatomtpntofOrgenizadon) AMENDING FORM

I Widmsn For Auditor

STATE CANDMATW NOTE IF A 111VT10N 13 RECEIVED FROM A STATE PAC (POLR1CAL ACn0N COMMITTEE). LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CRMK NUMBER IN THE DESIGNATED COLUMN. A LIST OF ID NUMBERS 13 AVAILABLIZ FROM THE IOWA UTHICH AND CAMPAIGN
01&CLOSURE BOARD.

CAUTION: Sedhn BSB.32A(6), Iowa Cof protdbob ttm use of idomnavon copied from reports and statements for soliciting conWbuttons or
for any corrttnerdal purpose by arw person oUverthan stehtlory political oolnm4teea.

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (WuppiCabin) TO CANDIDATE- RECEIVED FUND-
(MNUDDIYR) AND PAC CHECK (W appiieable) RAISER
NULIBER INCOME
ID#

)vl~yr0 C4.5 14 o.Ritemizrr -l

ID#

CK#

ID#

CK#

ID#

CK#

IDs*

CK#

iD#

CK#

ID#

CK#

I)?# .

CK#

ID#

CK#

ID#

CIC#

Ell
SU13-TOTAL

TOTAL Of lost page of this sohsdulo)

Olaclormm law mcwkw Cmrddew omrmtmea m ascloae fM refatibnahtp of eny reladbe melting a aordribution W, the
committek Relations"- must be shown to the third degree -f -n--;-;- (Wood relelSvoe) end effinRy (rdeQvee Dy
marriage) . If sumerns of contrlbubr Is the same as candldats. but there is no Page of
farnIII&I reladonshlp. enter'not applimble In Use rstedonshIp ootumn . (for Schedule A)

F~ICi;`~a 0'd ~GCi# C+~ :C'Ci 1%OOr~,i9l~ci ~~iG+~~~+~tL JPvIIlCO~1~JUJ I~~~'~;S3~ :f~~'a~
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN KIND
COMMITTEE NAME (Must be same as on Staiemerrt oFOrganization) (Rav_ 06/97)1 CONTRIBUTIONS

rTJ Is7 r7-~ 6-td

;
4C 1,Z4"0-_7V)2-
CHECK THIS BOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
(MM/DDYR OF CONTRIBUTOR ` (d applicable) CONTRIBUTION VALUE CONTRIBUTION
3

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W,--R 5-

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a
P2~r~,fr ~- ~z 0
~ ol~/o Q-I~e PqSTII oT ZqWrg

0
a
a
SUB-TOTAL

TOTAL (If last

page of this
schedule)

*Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page - of _I
I (for
committee_ Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives Schedule E)
by marriage). (See Page 2 of forms packet .) if surname of contributor is the same as candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .

F~I C)-'LI Ci' d GCi# 6? : C'0 ."91

C)07, /7 1 r;SI J?+% 1`7+GI L CIPJ I hb'ditJ00
 1665 220th Street
Sergeant Bluff, Iowa 51054
Phone: 712-25211131 Widman for Auditor
Fax: 712-252-4153

To: Iowa Ethics -Sue Brown From. David Widman

FMC 515-281-3701 Datev December 16, 2004

Phony [Click here and type phone number] Pages: 18

Re: Revised October 19th report CC: [Click here and type name]

® Urgent ® For Review 1:1 Please Comment 13 Please Reply ® Please Recycle

" Commental Revised

1. Schedule E

2. Form DR-2

3. Schedule A pogo 11 of 11

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