12- 15, 04 WED 10 :35 FAX 515 283 3108 NYEMASTER LAID FIRM 002

FOR INSTRUCTIONS, SEE BACK OF FORM

FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAME (Must be same as on Statement of Organization) (Rev, 07/2003) REPORT
For Office Us e! 11
Citizens for Unified Government (UNIGOV)
Comm, ft
IMPORTANT : Indicate typo of committee you are reporting for ; 6 Logged In
Scanned
( 1 )StatewidofLoglslative Candidate ( 2 )Statewide PAC ( 3 )State Panty ( 4 )County/Local Candidate
( 5 CCountyy PAC ( fi )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee Computer
Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name Political Party

Office Sought District (if Senate or House)

D EC 1 5 2004

515-283-3121
SIGNATURE OF TREASUREIT(or person Mig~this report) TELEPHONE DATE SIGNED
_f7_ R_ Ne--iimnn Chair
one`
Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCTIONS ON BACK AND COMPLETE THE FO LLOWING SENTENCE :
I AM FILING A 01119/05 REPORT FOR AN/A (1) ELECTION l(2)NOWELI=CTION YEAR.
(report dots) Indicate one
[CHECK IF AMENDMENT TO REPORT DATED Local Committees, ent,"r Date of Election
NovcmhCT 2004
(~ Check if this is final (termination) report and attach Notice of Dissolution Form DR-3. County & Local Committetes, enter County in
(You must continue to file reports until a Notice of Dissolution is filed .) which Election is held
Polk
IR

STATEMENT OF CASH ON HAND

CASH 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 .) . .. .. . ... .. . . . . . .. ... .. . .. .. . . $ 7,745.18

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) ... . . . .. .. . .. ... . ... ... ... . .. .... .. . ... ... ... . .. ... . .. -U-
Schedule H : Total Sales of Campaign Property (Attach Schedule H) .... ... ... ... .... .. ,..,. ,.  -0-
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAi 48,845 .18
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) ("also see debts and loans below), .., 48,845 .1E
Schedule F: Loan Repayments total (Attach Schedule F) .. . .. . .. ... . .. . . . . ... . .. . .. .. . . .. .... .. . ... . . .
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) . .. . . . .. . .. . . . ... . ... ..  . .,..,$
CANDIDATE COMMITTEES ONLY:
CONSULTANT BREAKDOWN (Schedule G Attached?) NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
12,,15,,04 ICED 10 :35 FAX 515 283 3108 NYE31ASTER LAW FIRM 003

For Instructions, See Back of Form

CONTRIBUTIONS -- MONEY TAKEN IN

0
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Citizens for Unified Government (UNIGOV)

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITT'cca), UST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNA- ED COLJMN A LIST OF ID NUMBERS IS AVAILABLE FROM Tr1E IOWA ETHIC ", ; AND CAMFAIGN
DISCLOSURE BOARD

CAUTION : Section 686 .32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soli6ting 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 v IF FOR
RECEIVED (it applicable) TO CANDIDATE' RECEIVED FUND-
(M1A1DDPYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME

I D#
GilcrestiJewett Lumber Company
rile '5 1,000 .00
10-20-04 1100 Alices Road, PO Box 1000
CK#
Waukee, IA 50263
[D#
Netunartn Brothers, Inc.
S2,SU0 .00
10-25-04 CK4 1435 Ohio Street, PO 13ox 1.315 rVa
Des Moines, IA 50305
I D#
Judith R. Milligan-McCarty
X100 .00
10-25-04 CK# 400-37th Street n/a
Des Moines, IA 50312
ID#
Karin Ahrold
1U-25-On ,250).00
CK# 3401 John Lyndc Road n/a
Des IvIoines, IA 50312 _
ID#
Thomas K . Koehn
n/a y2,000 .00
10-25-U4 CK# 412 S . 26th Street
West Des Moines, lA 50265 __
ID#
Pat or Bun Schwartz
550-44th Street n/a S10000
10-25-04 CK#
Des Moines, TA 50312
ID#
Thomas D. Ghrist Trust
10-25-04 3550 Lincoln Place Drive ttla S IC0 .00
CK#
Des Moines, IA 50312
ID#
Kayo R . Lozicr and Richard W . homer, Jr .
S1U0 .00
10-25-04 CK# 3780 River Oaks Drive n`a
Des Moines, IA 50312
ID#
Susan P . Katelman and Howard R . Katelnhui, %fj) .
5100 .00
10-25-04 CK# 220-37th Street n/a
Des Mouses . IA 50312
ID#
Graham and Katherine J . Gillette
tula 4~IOO .UO
10-26-04 CK# 635 Harwood Drive
Des Nfoines, IA 50312

I1
SUB-TOTAL
6,350.00

TOTAL (if last page of this schedule) I

.'
Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
marriage)
committee. Relatlonshlp must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by -1-
If sumame of contributor is the same as candidate, but there is no Page -,_-__- or ---- ---
familial relationship, enter "not applicable' in the relationship column . (for Schedule, A)
12 1,'15 , '04 WED 10 :36 FA1 515 283 3108 NYEHASTER LAW FIR31 Z ti o .1

For Instructions, See Back of Form SCHEDULI :

CONTRIBUTIONS - MONEY TAKEN IN

A MONETARY
(Rev.07i0~',~~) RECEIPTS
(Including candidate's personal funds)

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

0 CHECK THIS EOX IF
AMENDING FORM

Citivens for Unified Government (ZJNIGOV)

STATE CANDIDATES NOTE : IPA CONTRIBUTION IS RECEIVED FROM A STATE PAC !POLITICAL ACTION COMMITTEE) . LIST THE P<,_ MENTIFICA710N
NU MISER AN :) THE PAC CHECK NUMBER IN THE OESIGNATEO COLUMN . A LIST OF I O NUMBERS IS AVAILABLE FROM THE IOWA ETFi0:S AND CAMPAIGN
O'SCLOSLJRE BOARD.

CAUTION : Section 69B .32A(6), Iowa Code, prohibits the use of information copied from repats 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 v' IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I D#
Saulene M . Richer and Roger Brooke
10-26-04 CK# 5 1,(100 .00
5205 Woodland Avenue Wit
Des Moines, IA 50312-1943

E]
10#
Robert A . and Judith K. Gamble
10-26-04 3805 Brentwood Drive n/a $250 .00
CK#
Des Moines, IA 511312
I D# '
Bowen Campbell, Jr ., D .D .S .
10-26-04 CK9 205 51st Street n/a $50.00
Des Moines IA 50312 _

Paula and H . Randy Duncan, Jr,

10-27-04 4240 Foster Drive n/a ;lUU .OU
CK#
Des Moines . 1A 50312 _
ID#
Michael W. Simonson
10-27-04 3300 Elmwood 51,000 .00
CK# n/a
Des Moines, TA 50 312
ID#
Pioneer Hi-Bred Internationa), Inc .
10-28-0`1 CK# Pinaucial Operations, YO Box 257 n/a X25,000 .00
Johnston, IA 50131-0257
1o#
ENIC Insurance Companies
1U-29-U4 717 Mulberry nia SS,000 .00
CK#
Des Moines, IA 50309-3872
I D#
Arthur W . Dickson
11-1-04 CK# 5() 15 Country Club Blvd . n/a '.;500 .00
Des Moines, IA 50312 _
I D#
Dickson Industries, Inc .
11-1-04 CK# 2425 Dean Avenue n/a :+500.00
Des Moines, IA 50317

Ll
ID#
Brook Rosenberg
11-3-04 3818 Muakogee Avenue n/a htq
CK#

I,
Des Moines, IA 50312 8 100
SUB-TOTAL
33,500 .00
TOTAL (if last page of this schedule) r
' Disclosure law roqulms candidate committee to dic.doso the relationship of any relative making a contribution to the
committee . Relationship must be shown to the third degree of consanguinity (blood rolallves) and aftinfy (relatives by .2- -3-
marriage) . If surname or conlnbutor is the same as candidate, but there is no Page of
familial relationship, enter "not applicable - in the relationship column . (for Schedule , A)
12,, 15 ,'04 WED 10 :36 FAX 515 283 3108 NFEDIASTER LAW FIRjl Z o05

For Instructions, See Back of Form SCHEDULI-

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07io5) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must ba same as on Statement of Orgenizat,on) MENDING FORM

Citizens for Unified Government (UMGOV)

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (FCLITICAL AC'riON COMMITTEE) LIST THE PAC IDENTIFICATION
NUM2ER ANC THE PAC CHECK NuneSER w THE DESIGNATED COLUMN A LIST CF ID NUMBERS IS AVAILABLE FROM THC IOWA ETHIC ; AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION : Section 688 .32A(6) . Iowa Code, prohibits the use of information copied from reports and statements for solicit, ng 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#
Mango Blumenthal
11-03-04 951 S. 35th n/a ' :50.00
CK#
West Des Moines . 1A 50265

El
I D#
Richard D . TDluison and Msriorie A. Johnson
3100 .00
11-03-04 CK# PO Aox I I I a/a
Sheldahl, IA 502A3
I D#
Mercy Medical Center
11-4-t14 CK# 1111 6th Avenue n/a fi 1,000.00
Des Moines IA 50314-2611
10#

C K#

I D#

CK#

10#

C K#

ID#

CKA

I D#

CK#

ID#

CK#

I D#

C K9

SUB-TOTAL
1,2511.00
~, ;.K
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 . Ralationship must be shown to the third degroo of consanguinity (blood relatives) and effinlty (ralatlves by
.
marriage) _ 4-
If surname of contributor Is the same as candidate, but there is no Pace of
familial relationship, enter "not applicable' in the relationship column, Ifw Schedule tt)
12- 15- 01 WED 10 :36 FAX 515 293 3108 NYEMASTER LAW FIRM Z006

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

. MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev . O7/D:1)
(R 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 A101-ENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Citizens for Unified Government

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE ~ AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM)DDtYR) AND PAC
CHECK
NUMBER
ID#
Pratt Audiovisual Equipment rental
10-28-04 333 S.W . 9th, Suite N 100.80
CK#2087 Des Moines, IA 50309
ID#
hit James Reimbursement for office supplies .
10-28-04 96-18th St ., #3 7 .41
CK#2089
Los Moines . 1A 50314
ID# owa Bystander Newspaper ad
10-28-04 13-25th Street 100.00
CK#2090 Los Moines, 1A 50312

ID#
onnentara Communications, LLC Consulting services
10-28-04 301 River Road, Suite 102 8,316.62
CK#k2091
Louisville, KY 40206
ID#
Conncmara Communications, LLC Consulting services
10-28-04
CK# 2092 2301 River Road, Suite 1,02 7,418.50
Louisville, KY 40206
I D#
onnernara Communications, LLC Consulting sett,ices
10-28-04 301 River Road, Suite 102 12,53190
C01093
Louisville, KY 40206
ID#
Angie Johnson Distribute leaflets
10-30-04 Des Moines, lA 60 .00
CK#2094

ID#
ikki and Josie Starks Distribute leaflets
10-3t0-04 CK# 2094 Los Moines, 1A 80 .00

SUB-TOTAL S 28,666 .23

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 be Inventoried on Schedule H, (Refer to Schedwe H instructions.)

Expenditures to persons/entities providing consulting . advertising, fund-raising, polling, managing, organizing services must also ba detail itemized on
Schedule G my the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's 4.orrml(lee . (Refer to
Schedule G instructions and Iowa Code 66A402(3)(i),l

..
Page _1 _____ of -

(for Schedule B)
12- 15,, 0 .1 IVED 10 :37 FAX 515 283 3108 \YEMASTER LAIV FIRM Z007

FOR INSTRUCTIONS, SEE SACK OF FORM SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 0710 :3) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE CI^ E:CK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE. A LIST OF 1D NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Citizens for Unified Government

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE ~ AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If 3ppllcable) (Disbursemenq WAS MADE
(MPA1DDfYR) AND PAC
CHECK
NUMBER
ID#
Stephanie Burkhall Distribute leaflets
10-30-04 Des Moines, 1A $ 110.00
CK#2096

ID#
Andrew and Adam Logan Distribute leaflets
10-30-04 Des Moines, IA
CK#~097 40 .00

ID#
olleen and Tucker Smith Distribute leaflets
10-30-04 Des Moines, IA 50 .00
CK#2098

ID#
ffice Max Supplies
10-31-04 CK1t099 cs Moines, IA 49 .85

MacDonald Letter Service Copies

10-31-04 Des Moines, 1A 165.00
CO -21100

acqueli Easley Distribute leaflets

11-1-04 Des Moines, IA 2.33 .72
CK#k2101

ID#
Vanny Phothiboupha Distribute leaflets
11-3-04 Des Moines, IA
CK# 2102 1,01 .` .00

ID#
t .1. Fortune Distribute leaflets
10-30-04 Des Moines, IA
CK# 2103 20.00

SUB-TOTa,I . S 1,673 .57

TOTAL (if last page of this schadulp) $
l I
THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign propeny 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 he detail Itemized on
Schedule G by the amount, purpo3e, and date of each typo of expenditure made by the personientity on behalf of the candidate s committee. I Refer to
Schedule G instructions and Iowa Code 68A.402(3)(I) )

(for Schedule B)
12,,15,,04 IVED 10 :37 FAX 515 283 31(18 NYEMASTER LA1f FIRM Z ooe

FOR INSTRUCTIONS, SEE BACK OF FORM ' ~T,~n , ;'III 1;P4 . SCHEDULE

EXPENDITURES -" MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 07/03) EXPENDITURES
STATE PAC COMMITTEES : NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATNE
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 AME-NDING FORM
ETHICS 8 CAMPAIGN DISCLOSURE BOARD.

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

Citizens for Unified Government

CANDIDATE I NAME AND ADDRESS TO WHOM PURPOSE ~ AMOUNT

DATE 10 NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(b1MIDDrYR) AND PAC
CHECK
NUMBER
ID#
Cafe DiScala Food for radio show
)1)1/04 Dcs Moines, IA $ 35 .00
CK#2107

ID#
asticceria Food for after election
11/02/04 es Moines . 1A 184.41)
CK#.108

ID#
.R . Neumann Reimbursement
11/09/04 es Moines, IA 5 .29
CK#2109

ID#
'ew West Consulting services
11/12/04
CK#Z 110 uisville, KY 1,726 .46

ID#
Connemara Communications Consulting sci-vices
11/15/04 Louisville, KY
CK#2111 1,233 .08

1D#
'yemastcr Law Firm Costs advanced
11/17/04 es Moines, I.4
C K#) 112 67 .92

ID#
NyemasterLaw Firm Costs advanced
12108/04 Des Moines, IA
CK#2113 34 .22

ID# ew West Consulting services

12/09/04 -)uisville, KY
CK#2114 1,185 .77

SUB-TOTp,I~ $ 4,472 .1 .4

TOTAL (ll last page of this scheduha) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property costing $500 or more must also be invento,led on Schedule H. (Refer to Schedule H Insti uctionc .)

Expenditures to personclentities 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(entily on behalf of the candidate's ~ .ommittee
. (Refer to
Schedule G instructions and Iowa Code 68k402(3)(i) .)

'3-___
Page of

(for Schedule B)
12, , 15 ,, 0-1 tVED 10 :37 FAX 515 283 310S NYE31ASTER LAt1' FIRM Z oog

.!~
FOR INSTRUCTIONS, SEE BACK OF FORM ~po i SCHEDULE:

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev, 0710 ;.) EXPENDITURES
-,.-L
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 10 NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS & CAMFAIG14 DISCLOSURE BOARD.

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

Citizens for Unified Government

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD1YR) AND PAC
CHECK
NUMBER
ID#
Connemara Communications Consulting Services
12/09/04 CK#,2115 Louisville, KY $ 9,518 .62

ID#
emaster Law Firm Costs advanced
11/02/04 Des Moines, IA
CK#2121 36 .34

I D# -
onnemara Communications Consulting services
11/02i0=t Louisville, KY
CK#2 122 438 .02

I D# '
onnemara Communications Consultinc, services
11-02-04 CK ouisville, KY
123 2,039 .76

I D#
New West Consulting services
11-02-04 Louisville, KY
CK#2124 ',000'.00

ID#
hi I James Reimbursement for video and
12-13-04 ost check previously reported absentee report
CK#-)067 (54 .50)
0128/04)

ID#
Phil James Reimbursement for video and -
12-13-04 Des Moines, JA absentee report
CK#~ 117 54 .50
(To replace lost check #2067)

ID# -

C K#

SUB-TOTP,I- $ 14,033 .24

TOTAL (if last page of this schedulo) $ 48,845 .18

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 inshuctions
.)
Expenditures to personslentities providing consulting, advertising, fund-raising, polling. managing, organizing services must else he
detail ileml2.ed 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 .;ommittee. (Refer to
Schedule G instructions and Iowa Code 66A.402(3)(i) .)

(for Schedule B)
1 2- 15 , 04 WED 10 :38 FAX 515 283 3108 NlE3LASTER LAW FIRM Z oio

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

E IN KIND
COMMITTEE NAME (Must ba same as on Statement of Organization) (Rev . 0619 CONTRIBUTIONS
Citizens for Unified Government

CHECK THIS BOX IF

AMENDING FORM
W,FMTTR .:

DATE RELATIONSHIP DESCRIPTION ESTIMATED v IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-KAISER
(MMIDD.n'R) OFCONTRIBUTOR (if applicable) CONTRIBUTION VALUE CONTRIBUTION
.R

F7
S
Iowa Realty Advertising 3,500 .00
10-30-04 35(11 Westown Parkway
West lies Mouses, lA 50266

El

17
F1 -

F1 -

sue-TOTAL

TOTAL (if last

page of this
schedule)

'Dieclosure law requires candidates to disclose the relationship of any relative making an in kind contribution to the -1-
Page ._1- 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 packek) If surname of contributor is the same as candidate but there is no
familial relationship, enter "not applicable" In the relationship column .