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FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE


COMMITTEE NAME (Must be same as on Statement of Organization) 4 to Z, t (Rev . 07/2004) REPORT

For Office Use Only


American Federation of State, County, Municipal Employees Local 1868 Polk County
Comm . # ly
IMPORTANT: Indicate by # type of committee you are reporting for: Logged l
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party
( 4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other Scanned
Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue
Audited
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.

51,5- 2-b4P-3W1 10-1q-()


SIGNATURE OF PERSON FILING REPORT TELEPHONE DATE SIGNED

I AM FILING A 1) ELECTION /(2)NON-ELECTION YEAR .


Indicate by #E1

[-]CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

El Check if this is final (termination) report and attach County & Local Committees, enter County in
(You must continue to file reports until a which Election is held

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
of the last reporting period or must be zero if this is first report filed .) .. . ... ........ .. ...... ..... .... ...$ -Z f~
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) (*also see in-kind below) . ......... TV 54-
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 ..... $ / 3 y3. '79


SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) (**also see debts and loans below) ....
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) ........ ..... ..... ... ...... ........ ........... ... ......... ..... ........ ... ... ...... ... . . ... ..... ... ...... .$

**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) . ... .. ... ..... ... ...... ... ... .. ... ..... ..... ....... $

a
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) YES
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)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
American Federation of State, County, Municipal Employees Local 1868 Polk Co

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 I N 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
7~lfo~0~, ID#
Gary Alm $ 19 .00
409 W Broadway
CK#
BIZ7 /04 ' Colfax, 1A 50054
ID#

E:1
-1Il0I64,i Barbara Post-Althaus ~. OO
1a4l o4j CK# 1510 Thompson
101 814+ Des Moines, 1A 50312
ID#

E]
James Appleby 7 60
CK# 1321 E 27th Court
Des Moines IA 50317
I D#
Gary Ash
2335 E 34th Street iJ-' 00
CK#
Des Moines, IA 50317
ID#

El
Angela Barnes oO
CK# 2719 42nd Street ,
Des Moines, IA 50310
ID#

E:1
Fred Beattie
507 Brown Street b0
CK#
Runnells, IA 50237

E:1
ID#
William Bernard
1531 Searle 00
CK#
Des Moines, 1A 50317
I D#

E:1
Robert Conley Jr
CK# 300 Walnut #79 - 1203
Des Moines, IA 50309
ID#
Pam Conner
CK# 2715 E 40th
Des Moines IA 50317
ID#
Angela Connolly
4707 Beaver Ol)
CK#
Des Moines, IA 50310
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
marriage) . If surname of contributor is the same a s 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 MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
American Federation of State, County, Municipal Employees Local 1868 Polk Co

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 I N THE DESIGNATED COLU MN. 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 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

7flolto4- j ID#
b , 00
j
Connie Ewing $
SjJ3ltw CK# 25452 -275th Street
8IVIN Leon, IA 50144
ID#

E]
Daniel Flaherty
CK# 3924 Richmond Avenue
Des Moines, IA 50317
ID#
30 , 00 E]
David Hawkins
CK# 615 SE Titus
Des Moines IA 50315
ID#
David Hibbard ~,
0~
CK# 1042 Badger Creek Rd cJ~p
Van Meter, IA 50261
ID#

E:1
Marci Hines
CK# 2112 E 24th St /-'7 1
Des Moines, IA 50317
ID#

El
Paul Houston
CK# 5644 Northview Place
West Des Moines, IA 50266
ID#

'30 t E:1
JoelJohnson
10398 NW 44th DID
CK#
Polk City, IA 50226
ID#

CK#
Mark Jones
207 Hart Ave 15 . 00
Des Moines, IA 50315
ID#
Vaughn E Lewis
CK# 4501 Marcourt Lane
West Des Moines IA 50266
ID#

301 DU
Marlin Luing
CK# Box 316
Bondurant, IA 50035
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
marriage) . If surname of contributor is the same a s candidate, but there is no
familial relationship, enter "not applicable" in the relationship column .
Page 2 of
(for Schedule A)
For Instructions, See Back of Form SCHEDULE
I
sct Form
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
American Federation of State, County, Municipal Employees Local 1868 Polk Co

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 I N 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 J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

7 `Ibi{D~~ I Larry Noble $ ( ,O


8r~3~0 y CK# 3311 E Aurora
Des Moines, IA 50317

~12~10 '° Charles Ripley ~


9'1010+
) CK# PO Box 27122
West Des Moines, IA 50265
l0 ~~

ID#
9`~4b~
I / 3249 Scharf 10,, DO
CK# Indianapolis Ave
Des Moines IA 50317 El
6 . 00 El
ID#
Larry Thomsen
CK# 404 Grant St, N
Bondurant,IA 50317

L
I D#
Charles F . Verheul
~l.~'
CK# 107 4th Street, NW r
Mitchellville, IA 50169
ID#
James Ward
CK# 4045 46th
Des Moines, IA 50310
E:1
ID#

CK# El
ID#

CK#

ID#

CK# Ej
I D#

CK#
E]
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
marriage) . If surname of contribu for is the same as candidate, but there is no Page ___3_ _ of
familial relationship, enter "not applicable" in the relationship column . (for Schedule A)
FOR INSTRUCTIONS, SEE BACK OF FORM Reset Fomi SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT


B 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 same as on Statement of Organization)

American Federation of State, County, Municipal Employees Local 1868 Polk County

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#
US Bank Monthly Fee
7/15/04 CK# 520 Walnut St July 2004 $ 2 .00
Des Moines, IA 50309
ID#
Dennis Anderson for Sheriff Contribution
8/25/04 CK# 5085 Cleburne Court 250.00
Pleasant Hill, IA 50327
ID# US Bank Monthly Fee
8/13/04 CK# 520 Walnut St August 2004 2.00
Des Moines, IA 50309

ID#
AFSCME PEOPLE Specific Intent Donations
10/11/04 CK# 1625 L Street, NW 128 .68
Washington, DC 20036
ID#

CK#

ID#

CK#

ID#

CK#

I1D#

CK#

SUB-TOTAL $

TOTAL (if last page of this schedule) $ 382,68

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 personslentities providing consulting, advertising, fund -raising, polling, managing, organizing services must also be detail itemized on
Schedule G b y 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).)

(for Schedule B)