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Disclosure Summary Page DR-2: Statement of Cash On Hand

This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

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Zach Edwards
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0% found this document useful (0 votes)
56 views7 pages

Disclosure Summary Page DR-2: Statement of Cash On Hand

This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

Uploaded by

Zach Edwards
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
You are on page 1/ 7

FOR INSTRUCTIONS, SEE BACK OF FORM FORM

' DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE


COMMITTEE NAME (Must be same as on Statement of 0rganiiati (Rev. 07/2004) REPORT

or Office Use Only


CITIZENS TO KEEP THE COMMISSION
Comm . #
IMPORTANT: Indicate by # type of committee you are reporting for: © Logged In
o t te'P
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate (2 )Stato PAC (3) ~ 2005 Scanned
( 4 )County Central Committee( 5 )County Candidate (6 )City Candidate (17 )School Board or Other
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )Schot'I or Other Political omputer
Subdivision PAC ( 11 ) Local Ballot Issue udited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties.

3t9' 3,94 3G Z Z /a -/ ;- asi


SIGNATURE OF PERSON FILING PORT TELEPHONE DATE SIGNED

Dissolution (January 19th)


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

Local Committees, enter Date of Election


CCHECK IF AMENDMENT TO REPORT DATED
6/14/05

C 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 DR-3 is filed.)
IINN

STATEMENT OF CASH ON HAND


CASH ON HAND at 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
953.15
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) ... .. .. ... 10,390
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 .... .$ 11,343 .15
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) (**also see debts and loans below) . . .. 11,343 .15

Schedule F: Loan Repayments total (Attach Schedule F) .. .. . .. .. ... .. ... .. ... .. .. . .. .. ... . . .. .. . . ... .. .. . .. -0-
CASH ON HAND at the end of this reporting period (if final report balance must -0-
be zero) (Attach DR-3) .. .. ... .. .. ... .. .. .. .. . . ... .. .. . .. .. ... .. ..... .. . .. .. ... .. ... .. ... .. ... .. .. . .. .. .. . . . .. .. . .. .. .. .. . .. .. ... $

**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) . .. . .. ... .. ... .. .. . .. .. ... .. .. . .. .. .. .. . .. .. .. . .. .. $ $1,600 (Forgiven)

CONSULTANT BREAKDOWN (Schedule G Attached?) YES V NO


CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) $
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev. 07/03) RECEIPTS
(Including candidate's personal funds)
Q CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
CITIZENS TO KEEP THE COMMISSION

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 ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 68B .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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE" RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Don Pfeifer
6/7/05 3221 Parkview Ct SE $250
CK#
Cedar Rapids, IA 52403
ID#
J Lloyd International
6/7/05 PO Box 8415 1,000
CK#
Cedar Rapids, IA 52408
I D#

F-1
Michael Odell
6/8/05 1833 Boomington Rd 200
CK#
Marion, IA 52301
l D#

El
Sellers Broadcasting Inc
6/8/05 500
CK# 1957 Blairsferry Rd NE
Cedar Rapids, IA 52402
ID#
Regent Investment Corp
6/8/05 222 3rd St SE 750
CK#
Cedar Rapids, IA 52401
ID#

El
Donald Thomas
6/9/05 4224 Dalewood Ave SE 500
CK#
Cedar Rapids, IA 52403
ID#
Wade Wagner
6/9/05 137 Tomahawk Tr SE - 500
CK# E::]
Cedar Rapids, IA 52403
ID#

F-1
Lyle Hanson
6/9/05 2561 'L' Ave NW 550
CK#
Cedar Rapids, IA 52405
ID#
David Zahn
6/9/05 500
CK# 7417 Idledale Rd NE
Cedar Raids IA 52402
ID#
Leech Lake Knife Inc
6/10/05 CK# 436 Fleetwood Rd SW 750
Cedar Rapids, IA 52404
SUB-TOTAL

TOTAL (if last page of this schedule)

` Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity tolood relatives) and affinity (relatives by 1 3
marriage) . If surname of contributor is the same as candidate, but there is no Page of _
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE

A
CONTRIBUTIONS -- MONEY TAKEN IN
(Including candidate's personal funds)
(Rev . 07/03) I MONETARY
RECEIPTS

CHECK THIS BOX IF


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

CITIZENS TO KEEP THE COMMISSION

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 ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D# 6/10/05
Otto Eichacker
6/10/05 168 West Post Rd NW $25
CK#
Cedar Rapids, IA 52405
ID#
Rex's Custom Concrete Inc
6/10/05 375 Collins Rd NE # 108 1,000
CK#
Cedar Rapids, IA 52402
I D#
Providence Transportation Corp
6/10/05 CK# PO Box 5399 500
Cedar Raids, IA 52406
I D#
Midwest 3rd Party Logistics
6/10/05 CK# PO Box 5399 500
Cedar Raids, IA 52406
I D#
Paul Pate
6/13/05 6801 Bowman Ln NE 1,000
CK#
Cedar Rapids, IA 52402
ID#
Lora Summerwill
6/13/05 1618 C Ave NW 100
CK#
Cedar Rapids, IA 52405
ID#
Dale Brodt
6/14/05 204 Alma Dr NW 50
CK#
Cedar Rapids, IA 52405
ID#
Peter Teahen
6/14/05 3 100 F Ave NW 300
CK#
Cedar Rapids, IA 52405
I D#
Ck to Signs Etc
6/15/05 Lost in mail .. . .re-entered into cking acct 475
CK#

ID#
Robert Levi
6/16/05 CK# 141 21st St NW 100
Cedar Rapids, IA 52405
SUB-TOTAL

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 2 3
marriage) . If surname of contributor is the same as candidate, but there is no Page of _
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN


A MONETARY
(Rev. 07/03) RECEIPTS
(Including candidate's personal funds)

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


0 CHECK THIS BOX IF
AMENDING FORM
CITIZENS TO KEEP THE COMMISSION

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 ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE* RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Wayne Engle ,
8/3/05 796 11th Street $250
CK#
Marion, IA 52302
I D#
Don Novak
8/4/05 10400 Club Rd 200
CK#
Cedar Rapids, IA 52401
ID#
Jim Novak
8/4/05 CK# 2040 44th Street SE 100
Cedar Raids, IA 52403
ID#
Ralph Palmer
8/5/05 CK# 4069 Hickory Hill Ln 145
Cedar Raids, IA 52403
1D#
Jim Sattler
8/9/05 3801 River Ridge Dr NE 145
CK#
Cedar Rapids, IA 52402
I D#

C K#

I D#

C K#

ID#

C K#

ID#

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

* Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 3 3
marriage) . If surname of contributor is the same as candidate, but there is no Page of
familial relationship, enter "not applicable" in the relationship column . (for Schedule --
A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form
SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B


(Rev . 07/03)
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 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)


CITIZENS TO KEEP THE COMMISSION

CANDIDATE NAME AND ADDRESS TO WI'OM PURPOSE AMOUNT


DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID#
CR Gazette Ads
6/9/05 CK# 500 3rd Ave SE 1,947.90
Cedar Rapids, IA 52403 $

ID#
umulus Media (KDAT) Ads
6/10/05 CK# 25 2nd Street SE 750
edar Rapids, IA 52403
ID#
MT Radio AM Ads
6/10/05 CK# 00 Old Marion Rd NE 410
edar Rapids, IA 52402

ID#
GAN TV Ads
6/10/05 CK# 00 Old Marion Rd NE 337.50
Cedar Rapids, IA 52402
ID#
Signs Etc Yard Signs
6/15/05 CK# 1111 I Ave NE Bumper Stickers 3,796.54
Cedar Rapids, IA 52402

ID#
MRY AM Radio Ads
6/15/05 957 Blairs Ferry Rd NE 1,900
CK# Cedar Rapids, IA 52402
ID#
Marge Wong Contract Phone Calling
6/15/05 CK# 5335 Avenida DeDespaico 750
Yorba Linda, CA 92887

ID#
ailing Srvices Inc Mailings
7/5/05 CK# 00 50th Ave Dr SW 247.86
edar Rapids, IA 52404

SUB-TOTAL $ 10,139 .80


TOTAL (if last page of this schedule) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :


Purchases of certain campaign property costing $500 or more must also' 3 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 68A.402(3)(i) .)

Page 1 of 2

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Form SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B


(Rev. 07/03)
MONETARY
EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE : '~SIGNATED 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)

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#
Marge Wong Contract Phone Calling
7/5/05 CK# 5335 Avenida DeDespaico 250
Yorba Linda, CA 92827 $

ID#
Sajme as above Same as above
8/4/05 CK# 500

ID#
eed Communications Ad writing
8/9/05 CK# 15 Wasatch Ct NE 453 .35
Cedar Rapids, IA 52402

I D#

CK#

1D#

CK#

ID#

CK#

I D#

CK#

ID#

CK#

SUB-TOTAL $ 1,203 .35


TOTAL (if last page of this schedule) $ 11,343 .15

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

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 68A.402(3)(i) .)
2
Page _ of 2

(for Schedule B)
FOR INSTRUCTIONS, SEE BACK OF FORM
SCHEDULE

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


(Rev . 07/03) RECEIVED
CITIZENS TO KEEP THE COMMISSION t£ REPAID

NOTE : This schedule reports money loaned to the committee which is deposited in the committee account . QCHECK THIS BOX IF
AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $ 1,600

PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD PART II - MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD
(Original source of loan, such as a bank, must be shown if a third party is (Loans forgiven must be reported on Schedule E -- In-kind Contributions.)
involved. Include loans from candidate's personal funds.)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (Include Endorser's Name, If Applicable) TO CANDIDATE OF LOAN (MM/DD/YR) (Include Endorser's Name, If Applicable) TO CANDIDATE' REPAID
MMIDDNR If A licable* If A licable

$- $ -0-
TOTAL (PART/) TOTAL CASH REPAYMENTS (PART ll)
$ 1,60 0
From Schedule E -- TOTAL LOANS FORGIVEN
$ -0-
TOTAL OUTSTANDING LOANS END OF REPORT PERIOD

0-'Disclosure law requires candidate committees to disclose the relationship of any relative
making a contribution to the committee . Relationship must be shown to the third degree of
consanguinity (blood relatives) and affinity (relatives by marriage) . If surname of contributor is
the same as candidate, but there is no familial relationship, enter "not applicable" in the
relationship column when it applies . Page I of 1
(for Schedule F)

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