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DR-2 DISCLOSURE
DISCLOSURE SU1, AARY PAGE (Rev . 01/98) REPORT
`SIGN URE OF TR ' URER (or person filing this report) TELEPHONE - DATE SIGNED
Routine Penalties Due For Late Filed Reports Range from $20 t $866 ,
JAN 1 1 2002
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FOLLOWING SENTENCE : f _
l1
Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. County & Local Committees, enter County in
which Election is held
(You must continue to file reports until a Notice of Dissolution is filed.)
,1 SUB-TOTAL......$ ; 15- S0
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) .......... .... .. .. .. ................. .................. .. .. 14 (4 Ot) G
Schedule F: Loan Repayments total (Attach Schedule F) ........................................... ...... ..
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . .. ..... .. ....... .. .. ............... ..... ....... ....... .. ..... . .. ................. ................ ........$ I T) S l 0 I
UNPAID BILLS (From Schedule D - Attach Schedule D) .. ....... ....... .. ........ ....... ..... ..... ............ .... .... .. ..$
IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) ..... ... ....... ..... ..... ............ .... .. .. .. ..$
OUTSTANDING LOANS (From Schedule F - Attach Schedule F) .. .. .... .. .... ..... ..... ..... .. ..... ..... .... .. ......$ Q
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO
CAUTION : Section 68B.32A(6), Iowa Code, prohibits the use ofinformation copied from reports and statements for
soliciting contributions or for any commercial purpose by any person other than statutory political committees.
*Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution tothe
committee. Relationship my be show to the third dWroe ofconsanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 offorms packet.) IfSurname ofcontri'lxrtor is the same as candidate, but there is no familial
relationship, enter `Shot applicable" in the relationship eohnun.
Page -__ or ~ ..
(for Scneduis A)
FOR INSTRUCTIONS, SEE .BACK OF FORM
SCHEDULE
CONTRIBUTIONS - MONEY TAIMN IN MONETARY
(Including candidate's personal funds) A RFCE:PrS
(Rev. 06/97)
COMMITTEE NAME (Mua be the two as an Stdemt of Orpadzation)
CHECK THIS BOX IF
AMENDING FORM
Lensing for House District #45
STATE CANDIDATES NOTE : IF A CONTRIBUION IS RBCENED FROM A STATE PAC (POLITTCAL ACTION COMMITTEE) LIST THE
PAC IDENTIFICATION NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBER IS
AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.
CAUTION: Section 68B .32Af Iowa Code, prohibits the use of information copied from reports and statements for
soliciting contributions or for any commercial purpose by any person other than statutory political committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID # Michael J. Lensing
411 E. Fairchild
8/24/01 CK# 5754 Iowa City, IA 52245 Ex-husband $ 50.00 X
ID # Carrie Z. Norton
920 Ginter
8/24/01 CK# 6301 Iowa C' IA 52240 $ 50 .00 X
ID # Thomas A. Jepson
1003 9th
8/24/01 CK# 8081 Kalona IA 52247 $ 50 .00 X
ID # John A. Gross
4 Brickwood Knoll
8/24/01 CK# 2562 Iowa City, IA 52240 $ 50.00 X
Edwin J. Zastrow
ID #
9 S. Mt. Vernon Drive
8/24/01 CK# 4284 Iowa City, IA 52245 $ 50.00 X
ID # Robert E. Dvorsky
412 6th Street
8/24/01 CK# 2200 Coralville IA 52241 $ 25.00 X
ID # A. Ross Wilbum
1917 Taylor Drive
8/24/01 CK# 3495 Iowa City, IA 52240 $ 25.00 X
Thomas H. Baldridge
ID#
915 Oakcrest St No. 16
8/24/01 CK# 4893 Iowa City, IA 52246 $ 25.00 X
ID # Victoria L. Thiede
958 Westside Drive
8/24/01 CK# 3567 Iowa City, IA 52246 $ 25.00 X
ID # Veme Kelley
376 KoserAvenue
8/24/01 CK# 4151 Iowa City, IA 52246 $ 25.00 X
ID # Mary Masher
40 Gryn Court
8/24/01 CK# 9988 Iowa City, IA 52246 $ 25.00 X
SUB TOTALI $ 400.00 I -
TOTAL (if last page of this schedule)
*Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the
committee. Relationship my be show to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 offorms packet .) If Surname ofcontributor is the same as candidate, but there is no familial
relationship, enter "not applicable" in the relationship eolmun. Page -3-of A_
(for Schedule A)
FOR INSTRUCTIONS, SEE.BACK OF FORM
STATE CANDIDATES NOTE: IF ACONTRIBUTON IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) LIST THE
PAC IDENTIFICATION NUMBER AND THE PAC CHECKNUMBER IN THEDESIGNATED COLUMN. A LIST OF ID NUMBER
IS
AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.
CAUTION: Section 68&32A(6~ Iowa Code, prohibits the use of information copied from reports and statements for
soliciting contributions or for any commercial purpose by any person other than statutory political committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MNIDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID # Joseph L. Bolkcom
728 2nd Avenue
8/24/01 CK# 2599 Iowa C IA 52245 $ 25.00 X
ID # Harry L. Seelman
2451 IWV Rd. SW
8/24/01 CK# 9832 Oxford IA 52322 $ 10.00 X
ID # Dorothy M. Paul
608 Larch Lane
8/24/01 CK# 8532 Iowa City, IA 52245 $ 15.00 X
ID # Deborah Gill
808 - 8th Avenue
8124/01 CK# 11399 Coralville IA 52241 $ 20.00 X
ID # David P. Redlawsk
26 Gallup Place
8/24/01 CK# 9732 Iowa City, IA 52246 $ 20.00 X
ID # Joan Huntley
1501 Westview
8/24/01 CK# 6821 Coralville IA 52241 $ 20.00 X
ID # Sally Stutsman
3714 - 500th St SW
8/24/01 CK# 15745 Riverside IA 52327 $ 25 .00 X
ID # P.A. Cancilla
2257 Sugar Bottom Road NE
8/24/01 CK# 6691 Solon IA 52333 $ 25 .00 X
ID # Rod Sullivan
2326 E. Court Street
8/24/01 CK# cash Iowa City, IA 52245 $ 40.00 X
ID # Mike Partridge
1220 Village Road, Apt 9
8/24/01 CK# cash Iowa City, IA 52240 $ 20.00 X
ID # Jo McCarty
536 S Summit Street
8/24/01 CK# cash Iowa City, IA 52240 $ 20.00 X
'Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
oammittee. Relationship my be show to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 offorms packet.) IfSurname ofcontributor is the same as candidate, but there is no familial )
relationship, enter "not applicable" in the relationship colmun.
Page 3- 41_.._ of
(for SCheduf" A)
FOR INSTRUCTIONS, SEE-BACK OF FORM
SCHEDULE
CONTRIBUTIONS - MONEY TAIM IN MONETARY
(Including candidate's personal funds) A RECEIPTS
(t-. os"
COMMITTEE NAME (Must be the same as on Statement a Orgatcadon)
CHECK THIS BOX IF
AMENDING FORM
Lensing for House District #45
STATE CANDIDATES NOTE : IF A CONTRIBUTON IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) LIST THE
PAC IDENTIFICATION NUMBER AND THE PAC CHECKNUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBER IS
AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD.
CAUTION: Section 68B.32A(6), Iowa Code, prolubits the use ofinformation copied from reports and statements for
soliciting contributions or for any commercial purpose by any person other than statutory political committees.
DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FOR
(if ~~) TO CANDIDATE' RECEIVED FUND-
RECEIVED
(if applicable) RAISER
(MMIDDIYR) AND PAC CHECK
INCOME
NUMBER
Charlie Earlham
ID # 1152 E. Court
8/24/01 CK# cash Iowa City, IA 52240 $ 20.00 X
ID #
8124/01 CK# cash Various - less than $25.00 each $ 145.00 X
David R. Ulrick
ID # 514 Terrace Road
9/14/01 CK# 1016 Iowa City, IA 52245 $ 40.00
Charles A. Skaugstad
ID # 524 W. Park Road
9/14/01 CK# 8043 Iowa City, IA 52246 $ 100.00
Iowa Committee of Automotive Retailers
ID # 6059 1111 Office Park Road
10/24/01 CK# 2160 West Des Moines IA 50265 $ 100.00
Ted Townsend
ID # 2425 Hubbell
1217/01 CK# 7098 Des Moines IA 50317 $ 100.00
D#
8/01,10/01 I
11/01,12/01 CK# Interest $ 2.70
ID#
CK#
ID #
CK#
ID#
CK#
SUBTOTAL $ 507.70
TOTAL (if last page of this schedule) ?7e'00
'Disclosure law requires candidate committees to disclose the relationship ofany relative making a contribution to the
committee. Relationship my be show to the third degree of consanguinity (blood relatives) and affinity (relatives by
marriage) (See Page 2 of forms padcet.) IfSurname of conthitor is the same as candidate, but there is no familial
relationship, enter "not applicable' in the relationship colmun.
Page 14 of z4_ . .
(for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF r 'M SCHEDULE
e.`
I D#
CK# $ 06
C)Sy et v-~~
ID# ,
c7
yo
II ~C 1
CK#G
S,~0 L~wa Cr 1 Zz o
I ~C°t f
ID#
s
, 9
r
CK# 1) U5 ; S
1 p ~~
I D#
IFYr `~50~
5~ 3
I D#
~z 7I~ CK#0
ID#
CK# _ _
IZ7/6 ASS _
a_ 1
ID#
CK#
ID#
CK#
SUB-TOTAL $ 4 11 . y`
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H. (Refer to Schedule H instructions .)
Expenditures to persons/entities 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 person/entity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 56 .6(3)(1) .)
(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE
E IN KIND
COMMITTEE NAM (Mustbe same as on Sta t of Org"rabon)~ Rev. A6/9 7 CONTRIBUTIONS
~e rn -
El CHECK THIS BOX IF
AMENDING FORM
311 0 )
SUB-TOTAL
page of this
schedule)
'Disclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the Page ' I
of
committee . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives (for 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 .