,

Fgin IP !S79L"CTICNS SAE cAC, , OF ~ORA "Ii

RE SUMNIAF"'j-1 PAGE DISCLOSURE

COMMITTcE 3ADfJE iIlusr be same as on Siarement of Organization) (Rev . 01!2001) RE°CRT

CARPENTERS LOCAL UNION #106 LEGISLATIVE IMPROVEMENT COMMITTEE

Far flffic2 L'se Cnly

Cornm . fr -.-
IMPORTANT : Indicate type of committee you are reporting for: 117
I Indexed
( 1 )StatewidetLegisiative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate Audited -
(S )County PAC (o )Ballot IssusiFranchise Committee (7 )CountyiCity Central Committee
1 ( 8 )Support Slate of Candidates 'omputer
I
CANDIDATE COMMITTEES ONLY' tl~ &M I
Candidate Name U 0-

Office Sought ,_._, ~.

ho
.
", ~, Di
5n

-_~THY HURLEY 515-262-807Q 1-10-05

SIGNATURE OF TREASURER (or person filing this report) TELEPHONE DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800
SEE INSTRUCTIONS ON SACK AND COMPLETE THE FOLLOWING SENTENCE :
I AM FILING A 1-19-05 REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .

(report date) Indicate one

CICHECK IF AMENDMENT TO REPORT DATED Local Committees* enter Date of Election

F~ 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 .)

STATEMENT OF CASH ON HAND

CASK ON HAND at the beginning of the reporting period. (This is the total of all monies 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.) . . . . .. . .. . . .. . . . . .. . . . . . . . . . . . . .$ 4267 .54
ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A : Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . .. . . . .
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . .. .. . . . . . . .. . . . . . . . .. . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) .. .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . .
..
(Schedule H aRviles to Candidates' Committees Only)

SUB-TOTAL$
.. .. ..
4267 .54
SUBTRACT TOTAL MONEY SPENT THIS PERIOD

Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) .. . 400 .00
Schedule F: . . . . .CK . .PRIN3:ING . .CHARGE.. . 12-90 CK PRINTING
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . .. .. . . . . . . . . . . . . . . . .. .. .. . . . .. . . . . . . . . . .$ 3854- 64

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

CANDIDATE COMMITTEES ONLY:

CONSULTANT BREAKDOWN (Schedule G Attached?) YES NO

VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
 FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 09/97) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE 0 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)

CARPENTERS LOCAL UNION *4106 LEGISLATIVE IMPROVEMENT 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# State Representative
Dave Fry Campaign
10-15-04 House Dist X158
503 N Freemont
CK# 2181 200 .00
Stuart, Ia . 50250 $
ID#
Adair County Democrates
10-15-0 CK# 2182 c/o Cody McIntire
2430 350th St, Menlo Ia . 0164 200 .00
ID#

CK# 2183 VOID CK -0-

ID#

CK#

` ID#

CK#

ID#

CK#

ID#

CK#

IN

CK#

SUB-TOTAL $

TOTAL (if last page of this schedule) $ 400 .00

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/entifes 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) .)

Page - ____ of __

(for Schedule B)