10VIA ETTiICS AND CAMPAIGN D1SOLCSURE EGARID Form

514 EAST LOCUST, SUITE. 104 VERIF!ED STATEMENT

RE:i3STRATICN
DES MOINES, 1A 511309-1912 (Cut-of-;-:bate Ccrrmitti=esj
(Rev . .fao)

VERRED STATE EN 3 RiGIST !ION I

It For =toe use oniv
(Out-as-.:fate Committee) i Comrn.
Indexed
COMMI1E=S
-1 NOT ORGANIZED IN ICWA TO COMPLETE IN CURUCATE .
SEND ORIGINAL COPY TO 71-?E SCARD AND Audited
ONE COPY'iVfTH EACii'CONTRlEIfrCN TO Ti-iE IOWA CCMMITTs. Checked
P1-ASE REFER TO DETAILED INSTRUCTCNS ON BACK OF FORM.
Czmputer
COMMI I I E= NAME
Officai Name cf Out-of-State C=miftee (Do not atbreviate committee name. Whiten explanation must be provided far Acronym)
MTT T zTCxT T-QCAT . 1T-L4T ON 2158 PAC 48048
Mailing Address
2707 62ND STREET COURT I
City, State, Zip Code Ares Code Telephone No. i
BETTENDORF IA 52722 (5-63 ) 332-2158
TREASURER OTHER OFFICERS (Attar second page if needed)

Marne of Treasurer Name of Chairperson

KARL KOST STAN LIEDEL
Mailing Address
2707 62ND STREET COURT 2707 62ND STREET COURT
City, State, Zp Code Telmhone City, State, Zip Code Telenhone
.3),332-21
(S6
BETTENDORF , IA 52722 (563 ) 332 -215 BETTENDORF, IA 52722 8
IOWA RESIDENT AGENT
PARENT ENTrrY, AFRLIATH, SPONSOR OF COMMITTEE
(Use separate page fi needed to list more Man one en*)
Typed Name of Iowa Resident Name
KARL KOST MILLWRIGHT LOCAL UNION 2158
Mail, Address
1738 110TH STMT _ L
5 53 452-355
2707 62ND
STREET OURT
CLAREI+7CE, IA 52216
City, State, Zia Case
~i aty, S
HETTENDORF, IA
Zia Cafe
~ 22

PURPOSE OF COMMITTEE: Tn gjT*oDORT (LRop-PQSF T Rg1TF-rnNCRRN=Ni, QRCANT ZF.n

LABOR_ OR TO SUP-PORT-CANDIDATES FAVORABLE TO ORGANIZED LABOR

IOWA COMIIKITTE£ RECIIVING CONTR1HUTION

STATE OR FEDERAL. JURISDICTION WHERE COIAAAr'TC= -
S REGISTERED OR OPERATES Mane
.-- of CQnwvttp-e
Fitzsimmoms for Auditor
Name of Jurisdic im ress
ILLINOIS STATE BOARD OF ELECTIONS 3510 Rockingham Road
Mailing Address Uat9 If in }Gnd Ccrrtributon, Desc;te
1020 S SPRING STREET 23 04 I
City, State, ZIp Ccde Teieohcne Amourrt
SPRINGFIELD, II, 61087t217)782-414 100 .00

fERIFIED STATEMENT OF COMMITTEE:

KARL KOST , symar that the =urrbuien reported above is ac:uraie. ! furher swear 4W ate infonnamn about this out-
a1-tare commutes is =rmct and ac-urate :o the trest of my knowledge. l attest :hat Ire .,mrris 81ed in the gamed jwisdicttn =rnp* with requirements vvhic7 are
ubstandally similar to /cm Cede secvcrr '5a'. E, 4du&g the aisUosme of aff c:.ntricutions received and all excendgm es made. 1 further aitesi that the anruriirution
parted above was :made :"ram an aunt which does not accept ccntrJbutions Morn corporations or ether prohibited contributors under Iowa Code section 5o". tS
understand That Iowa committees ors prohibited tom accappting canMbrrdcns from out-oil committees unless a signed original of this fmm rigs been pled 1Hith
re Iowa =-'.him and~Camcarrn Oiscbsup Board, orthe cut-et-sloe committee is registered and firrrg cud discosure reports :n Iowa.

TREASURER
(Cniv Signature of Treasurer or Chairperson) R'fieI
TRACY M . DVORAK
;cover"iced and swan trr re
at me his day ~~Q . 2C:'J f - ~bn Mymber 705162
My Cammlson res

9y notary =m.mission expires M ber 14, 2006

Notarv Rudic
 S

'CS CniYIF .A1GI`S Sd1SzCLCZUR s ECARL° f arm

,',"-L EAST LCCUS:7, Si1I TE i 04 VERIFED STAzcAE-)T
IREG 3ST^iATICN
CES MCINEZ, iA 30-209-?912 ;Cur~iStag Ccmmiitess ;
(Rev. f=,

Far office use n

Out-cf-State Committee) Comm- 4
Indexed
C_MNIi i
F E:.S NCT ORGANIZE-D IN !CWA iO CCIt1F+y:c IN CL°LC>TE_
SENC ORIGINAL. COPY TO 7HE 3CAR0 ANC Audited -
ONE CCFY'JVI7t~ FAC1'C0NTRIEU IGN TO 77-iE IOWA C MMI i i ~. Cae~ced
Fh=ASE REFER TO DEiAILC INS',RLCT ;GNS ON SAC( OF FORM .
computR&
COMMITTEE NAME
Officat Name cf Out-of-S~te Cz;mmidee (no not acbteviate cammilbL-_ name. Written expianaticn must be prawded for Acronym.)
MTT,T,T-zTC7 ;T T~0 _ T . UNT_ON 2158 PAC 48048
Maiiing Address
2'207 62ND STREET CCURT
City, Sam, Z:p Cane Area Code ieienbone No.
BETTENDORF __I`1 52722 - ~5 6 332-2158

TREASURER CT HE.R OFFICERS (Attacn seeand page it needed)

Name ofTreasurer Name of G'Mirperson
KARL KOST STAN LIEDEL
Mailing Address Matt Address
2707 62ND STREET COURT 2747 62ND STRETT COURT
City, State, Zip code Telephone City, State, Zi Code Teleohane
BETTENDORF, IA 527 22 (563)332- 215E BETTENDORF, !A 52722 .5(63)332-21 8

IOWA RESIOEWAGENT
PAREW ELI=, AFRUATE, SFCNSOR OF COMMITTEE
f law) Resident Agent (Use separate page if needed to list more than one entity)
Typed Name of iawa Resident Name
KARL KOST MILLWRIGHT LOCAL UNION 2158
Mailirig
1:738 110TH STREET 2707
STREETCOURT62ND
City, State, Zip Code Telephone
IA 52216
CLARENCE,- _L5h 3; 452-355 0, BETTENDORF, IA . 5272C°de
_

PURPOSE CF COMMITTEE: Tn (_,uP,'oO.B'r 0E_ nPLr)SF T .=5; rcNcy x '_3C, nRC

.ANT TFn
LABOR OR TO SUPPORT CAYDIDATES FAVORABLE TO ORGANIZED LABOR

IOWA COMMITTEE REC-2VING CONTRIBUTION

STATE OPT FEDERAL JURISDIC71ON INFERS CJMMl7c,=
IS REGISTERED OR OPERATES Narne of Cornmith-e
Committee to Re-Elect Jim Hancock
Name of .:unsdiaicn Matting Address
ILLINOIS STATE BOARD OF ELECTIONS 2163 W 30 th Davenport, IA 52804-
Maiiin address Cate If In Kind Ccntnbutan, Descihe
1020 S SPRING STREET 8/17/04
C<ty State, Zip Cade Telephone Amourrt
SPRINGFIELD, IL 61087 1217 ,,782-4141 100 .00

,IERIFIED STATEMENT OF CCMM13TE=:

t KARL KOST . swear tat he c.^,nuinutian mated ?dove is .accurane / further swear hat tee intcrmadan about this our-oi
:are c;mmidee Is =new and ac_-:rate e the nest ct my :mcwteege. i )test nat he :eprrrs iiiea :it he reamed junyaicdca r;mniy with regwremenrs NniQ'2 are
tcubstanaafy similarb Ic:a a Code secdorr :551Z 4ictuding the disclosure as ail =nmcuttars,e-_zived and aU p=endiiures Maria /further artesi Mat the cnniribuitan
sparred above .Has rnaae -cm an ac=urn vbicn aces :-,cr acz2pr c=nvinuticns ircm carnoradnns or ether prnhibitea (=ntnbteinrs under Iowa Code sea= X6.15.
understand hat .'own ccrrmittees are prehibfed rmm acc_-sung c::ntnouacns tram ourcr-state =rnmidees unless a signed original of this rcrm has been riled mih
he lawn ;:hips and Campaign iscbsure Soard, cr tfte cut-cf-ire c:mmltles :s regrstered and Zng ri11f dsdasure --eparts .,ii law)_

ALL TREASURER17.1L
;Only signature ciTrea:arer cr Charpersan (T:4e ;Gate)

:iubsc^cea anti swcrr. beTcre me die, "_ . ., ,,

Os ~l . 2
COMMISSiCn S`.L=,_-C° 705162
riy icmr/ :.^.mmissiar, expires My CcrnTission Ex pires
-Swrwmber 14, 2006 -
 1CV11A Eii- ICS AND CAWAiGN DISCLOSURE WARD Farm
51=.` EAST LOCUS7, SUITE.104 vERIF-ED STATEME.N
REGISTRATIC1V
DES ?MOINES, 1A 513309-1912
'Cut-3i-St-ate Committees)
-41F P , 200 .E (Rev. 1CO)
VERRED STATEMENT REGISTRATION I Far office use o
f
(out-at-State Committee) I Camrn . a#

COMM1--li EEj NOT ORGANIZED IN !CWA TO COMP-E7S IN OUP"JCA, E . 1 Index

SF-'q[) ORIGINAL COPY TO -1 14E SCARD ANC Audited
ONE COFY' V1TH EACH'CCNTRr IEI1TCN iO THE IOWA COMMI I I Caked
FUE-aSE REFER TO DIEAILED !NSTRUCrONS ON SACK OF FORM .
Camputer
COMMITTEE NAME

Ofcal Name of Out-of-Slate Committee (Oo not abbreviate commtttee name . Writtms WtartIcn must be pramded for Acronym .)
MTT ,j R T (',7iT LOC'_ATT :_ TTN ON 2158 PAC #8048
Mailing Address
Z107 62ND STREET COURT
City . State. Zip Code Area Code T'elenhone No.
BETTENDORF IA 52722 _ X55 6 3 ) 332-2158

TREASURER 01-HER OFFICERS (Attach secnrui page if needed)

Name of Treasurer Name of Clsairperson
KARL KOST STAN LIEDEL
Mailing Address
2707 62ND STREET COURT 2707 62ND STREET COURT
City. State, Zip Code Telephone City. State, Zpi Code Telephone
BETTENDORF IA 52722 56 3)332-215 BETTENDORF, IA 52722 (563L32-21 . 8
IOWA RESIDENT AGENT
f Resident Agent PARENT ENTM, AFFUJATE, SPONSOR OF COMMITTEE
(Use separate page if needed to list more tttat one entity)
TAged Name oi Iowa Resident Name
KARL KOST MILLWRIGHT LOCAL UNION 2158
Mail.r~Address Maiiin8Addr>rss
1:738 110TH STREET 2707 62ND STREETURT O
C .ty` Stme, ZIP Code Telephone City, S Z a code
CLAREAICE, IA 52216 _L563 : 452-355 BETTENDORF . IA 552'722

PURPOSF- OF COMMITTEE:
mn ST773papm op appnap SSTTx'S rS}NrF'.RN-''."fir, oRrANT 7,F.D
LABOR OR TO SUPPORT CANDIDATES FAVORABLE TO ORGANIZED LABOR

IOWA COMINITTEE RECEIVING CONTRIBUTION

STATE OR FEDERAL JURISDtLT1ON WE-RE CDMM
S REGMTERED OR OPERATES Committee-to RgWEA~"~m Hancock
Name of Junsd.C.on DMpor"T53, IA 52804 - '
ILLINOIS STATE BOARD OF ELECTIONS 2162 W 30th f
Magin Address Lei if In IGnd Cartfibuiion, Oesc,- .be ;
1020 S SPRING STREET 5 /23/04 ! ,
City, State, ZIP Crsie Telephone Amount
SPRINGFIELD, IL 61087 (217178 2-414 100 .00 !

'ERIFIED STATEMENT OF COMMITTEE:

1 KARL KOST , swear that dhe =wnbu8on reported above is arwuraw . 1 fwMer swear drat Ire irdonnadon about this out-at-
We canuniltee is erred and ac--4=e to the nest c: my rnowledge. f atfesr :hat he kris fated ire the named jw=dicdcn camoly with requvement s w61 .'2 are
.ibst naWy similar to Iowa Code secacn 55. d, Acludlng the aisclosrue of all caninbufions reczived and all exDendfi:ures made. I liother aitest the he caniributfon
parted above was made from an acacunt which does not accept cnnirmutions darn rrmamuom or other prohibied colmhuiors under fowa Code mcvon 56. 115.
lndermand that Iowa committees are prohibited from accepting c=ntribudcns tram out-of-s=e =vwitees unless a signed original of this Mrm ias been n7ed wiih
e Iowa E.hi= an ign Disclosure Board, or the out-of-state commitfee is registered and filing futf discfasure reports rn Iowa.

9/ 10
W-4~ TREASURER
(Only Signature arTreasure- orCnairperscn) _ - (f ;f.e) pA S 1
Commission Number 705162
MV Commission Expires

Natarv Ftitilc
 ICVIA E i ?^WS AND CAWAlGN DISCLOSURE EGARID i'Jrm
514 EaST LOCUST, SUITE.104 veiiFHD STATc:IAENT
REGISTRATICN
DES ",MOINES, #A 50309-1912 (Cutter-z-tate Ccmmltteesj
(Rev . :100)
VERMED S -1 ATE ENT RiGIST. TIO'N I
i For office use oniv
f
(Cut-of-state Committee) COMM*
f
Indexed
CCMMri -i=S NOT ORGANIZED IN IOWA TO COMPLE7E IN OUPLIUTE.
SE~10 ORIGINAL CDPY TO 7HE BCARD AND Audited
ONE COFY ATTH EACH'CCNTZr IBU7CN TO TEiE iCWA CCMMrr7= Checked
FLEA-SE REFER TO OEiALHD INSTRUCT.CNS ON aACt OF FORM.
C.Jmputer
COMMITTEE NAME
Offc a1 Name of Out-of-State C=mittee (Do not abbreviate committee name. Written expianaucn must be provider! for Aaanym .)
MTLLW8IGXT T~QCAT, L3NT ON 2158 PAC #8048
Mailing Address
7107 62ND.--STREET COURT
City, State, Tip Code Area Ccde Telephone No.
BETTENDORF 1A 52722 5. 6 3
(5 ) 332-2158

TREASURER OTHER OFFICERS (Attach second page if needed)

Name of Treasurer Name of 0vairpesson
KARL KOST STAN LIEDEL -
Mailing Address Main Address
2707 62ND STREET COURT 2707 62ND STRE7T COURT
City, Stale, Zip Code Telephone City, State, ZpI Code Telephone
BETTENDORF IA 52722 (563)332-215 BETTENDORF, IA 52722 .5c 6.3)332-21
IOWA RESIDENT AGENT
SLn,-~ r - ~ ""_, r -, ntAgent FARE.Af EjITTTY, AFFLIATE, SPONSOR OF COMMITTEE
(tlse separate page if needed m list more than one entity)
Typed Name of iewa Resident
KARL KOST .
Ma--,, MILLWRIGHT LOCAL UNION 2158 ^
1738 110TH STMT- 27b7 62ND STREET COU
Clty, State, Zip Code Telephone
CLARENCE, jA 52216 (563 ; 452-355, city. sShah.- Z°
Zb code 1
.

PURPOSE OF COMMITTEE:
LABOR OR TO SUPPORT-CANDIDATES FAVORABLE TO ORGANIZED LABOR

IOWA COMMITTEE RECEMNG CONTRIBUTION

STATE OR FEDERAL JURISDICTION WHERE CaM118I'fME -
S REGISTERED OR OPERATES Name of Committee -~ _
Rhomberg for Supervisor
Name of Jurisdiction Maling Address
ILLINOIS STATE BOARD OF ELECTIONS , 3330 Tremont Avenue
Mailing Address ~ i If In 1Gnd C=Mtuulon, Descibe
1020 S SPRING SREET ! 9/23/04 I
City. State, Zip Code Telephone fA
SPRINGFIELD, IL 61087 (2171782-414 ,5
100 .00

(ERIFED STATEMENT OF COMMITTEE:

J KARL KOST , swear that the =mibudon repented above is ac:rrrate. 1 funkier swear dW ire irdemzation about this out-at-
,are commutes is EMC and acc-Jrate Ca the aest of my .snowieage . 1 attest :hat re reperm filed ;n the namedjwisdicdcn =npiy with requirements whic2 are
ubs=dai1y svnflar to Iowa Ccde seconn 5n".E, inc:udinq the oisctosure or ad c:ntribudons re-ived and ad expenditures made. J ;UrTher adesi that he rririouiian
~poned above was :Trade from an ar-=um whict: does not ac-apt =Wbuffons dram carporadens or otherprohibited =nwhuiom under Iowa Code serCion 56. t5.
understand that Iowa committees are prohibited firm acting conwbudcns From out-ofstate =rrmidees antes a -owned original of this form has been n7ed with
:e Iowa Fhics and Campaign Oiscasure Heard, orthe cut-ci-slze cammittes is mglsrered and Wng tf disc'csrue,,eports .,n to-a-

TREASURER
(Only Signature oiTrea.um+ or Cbairperscn)

ubsc:ibed and swcm beTnre me is off') 0~-dav

IV ini-r =mmissior. expires