pettengill dawn__1507__scanned

Upload: zach-edwards

Post on 08-Apr-2018

222 views

Category:

Documents


0 download

TRANSCRIPT

  • 8/7/2019 Pettengill Dawn__1507__scanned

    1/8

    FOR I NSTRUCTI ONS, SEEBACK OF FORMDI SCLOSURESUMMARYPAGE

    COMMI TTEE NAME ( Mu s t b e s ame as o n St a t eme n t o f O r g a n i z a t i o n )PETTENGI LL FORI OWANSI MPORTANT : I n d i c a t e b y # t y p e o f c o mmi t t e e y o u a r e r e p o r t i n g f o r : 1 1( 1 ) S t a t e w i d e / L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 ) S t a t e PAC( 3 ) S t a t e P a r t y( 4 ) C o u n t y C e n t r a l Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y C a n d i d a t e ( 7 ) S c h o o l B oa r d o r O t h e rP o l i t i c a l S u b d i v i s i o n C a n d i d a t e ( 8 ) Co L I n t y PAC _ ( 9 ) C i t y PAC ( 1 0 ) S c h o o l B o a r d o r O t h e r P o l i t i c a lS u b d i v i s i o n PAC ( 1 1 ) L o c a l B a l l o t I s sCANDI DATE COMMI TTEES ONLCa n d i d a t e NameDAWN PETTENGI LLO f f i c e So u g h tSTATE REPRESENTATI VE

    I AMF I L I NG A 1 0 / 2 9( r e p o r t d a t e )

    EJ CHECK I F AMENDMENT TO REPORT DATED

    NO- VIZ 0 0 4. DED i s t3 9

    0 Che c k i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t a n d a t t a c h No t i c e o f D i s s o l u t i o n F or m DR- 3 .( Y ou mus t c o nt i n ue t o f i l e r e p o r t s u n t i l a DR- 3 i s f i l e d . )

    I n d i c a t e b y #

    STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T o t a l o f a l l f u n d s h e l d b y t h e

    c o mmi t t e e . T hi s amoun t MUST b e t h e s ame as t h e c a s h o n h an d a t t h e en do f t h e l a s t r e p o r t i n g p e r i o d o r mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N THI S PERI ODSc h e d u l e A : Ca s h C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A) ( * a l s o s ee i n - k i n d b e l o w) . . . . . . . . . .Sc h e d u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e d u l e H : T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e d u l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    ( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . $ 5 7 2 2 3 . 3 7

    SUBTRACT TOTAL MONEY SPENT THI S PERI ODSc h e d u l e B : Ex p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) ( * * a l s o s ee d eb t s an d l o an s b e l o w) . . . .Sc h e d u l e F : Loan Re p a yme n t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    CASHON HAND a t t h e en d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t b al a nc e mus tb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

    * * UNPAI D BI L L S ( F r o m Sc h ed u l e D - A t t a c h Sc h e d u l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* I N KI ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTANDI NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY:CONSULTANT BREAKDOWN ( Sc h ed u l e G At t a ch ed ? )VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e d u l e H - A t t a c h Sc h e d u l e H) $

    FORMDR- 2 DI SCLOSURE

    ( Re v . 0 7 / 2 0 0 4) REPORT

    Comm. #Log g ed I nScannedCompu t erA u d i t e d

    L at e r e po r t s a r e s u b j ec t t op o s s i b l e c i v i l a n d c r i mi n a lp en al t i es .

    REPORT FOR ( 1 ) ELECTI ON / ( 2 ) NON- ELECT I ON YEAR

    L o c a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o n

    Co u n t y & L o c a l C o mmi t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

    1 3 0 5 6 . 3 7

    4 4 1 6 7

    3 7 6 7 1 . 8 1

    1 9 5 5 1 . 5 6

    DATE SI GNED

    4 0 , 4 3 3 . 0 0

    YES 1 _ 7 1 NO

  • 8/7/2019 Pettengill Dawn__1507__scanned

    2/8

    Fo r I n s t r u c t i o n s , SeeBac k o f Fo r mCONTRI BUTI ONS - - MONEYTAKENI N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEENAME( Mu s t b e s ame a s o n St a t e me n t o f Or g an i z a t i o n)PETTENGI LL FORI OWANS

    STATECANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CAL ACT I ON COMMI TTEE) , L I S T THE PAC I DENT I F I CAT I ONNUMBER ANDTHEPACCHECK NUMBER I N THEDESI GNATED COLUMN . A L I ST OF I D NUMBERS I S AVA I LABLEFROMTHEI OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se c t i o n 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s an d s t a t e me nt s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y comme r c i a l p u r p o s e by an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e e s .

    SUB- TOTAL

    TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )* D i s c l o s u r e l aw r e q u i r e s c a n d i d a t e commi t t ees t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ecommi t t e e. R e l a t i o n s h i p must b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b y 1ma r r i a g e ) . I f s u r name o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , bu t t h e r e i s no Page o ff a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l umn . ( f o r Sc h e d u l e A)

    SCHEDULEA MONETARY

    ( Re v . 0 7 / 0 3 ) RECEI PTSQ CHECK T HI S BOX I F

    AMENDI NG FORM

    DATE PACI D NUMBER NAMEAND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PACCHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOME

    I D# STEVE&JOYCELUCAS $ 3 0 . 0 01 0 / 1 5 / 2 0 0 4 CK# 1 4 0 1 B AVEVI NTON, I A 5 2 3 4 9I D# LOLA BOSSLER1 0 / 1 5 / 2 0 0 4 CK# POBOX 2 6 3 2 0 . 0 0 1 2 1VAN HORNS, I A 5 2 3 4 6I D# SHANESCHELLHORN1 0 / 1 5 / 2 0 0 4 CK# 2 1 2 0 PARKVI EWDR BOX 7 0 4 1 0 0 . 0 0GI LBERTV I L LE I A 5 0 6 3 4I D# BETTYTRI MBLE1 0 / 1 5 / 2 0 0 4 CK# 4 0 5 CEDARST . 3 0 . 0 0 E E IGARRI SON, I A 5 2 2 2 9I D# GENE & F RI EDA DA VI S1 0 / 1 5 / 2 0 0 4 CK# 2 1 6 RI VERVI EWDR 2 5 . 0 0 EJVI NTON, I A 5 2 3 4 9I D# DAVI D THOMPSON1 0 / 1 5 / 2 0 0 4 CK# 1 0 4 EMAI N ST 2 0 . 0 0 EJGARRI SON, I A 5 2 2 2 9I D# TOM&CAROL NULTY1 0 / 1 5 / 2 0 0 4 CK# 5 0 3 3RD BOX 1 8 9 4 0 . 0 0 , /VAN HORNS, I A 5 2 3 4 6I D# J I M& KATHY DAI LY1 0 / 1 5 / 2 0 0 4 CK# 1 5 0 5 4TH AVE 2 5 . 0 0

    BELLE PLAI NS, I A 5 2 2 0 8I D# PASS THEHAT - CASH FROMFUNDRAI SER1 0 / 1 5 / 2 0 0 4 CK# 1 9 2 . 0 0 E E IJ I M& JANE CLARK

    1 0 / 2 1 / 2 0 0 4 CK# 9 8 7 1 L I NCOLN AVE 2 5 . 0 0CLI VE, I A 5 0 3 2 5

  • 8/7/2019 Pettengill Dawn__1507__scanned

    3/8

    Fo r I n s t r u c t i o n s , Se e Ba c k o f Fo r mCONTRI BUTI ONS - - MONEY TAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t emen t o f O r g a n i z a t i o n )PETTENGI LL FORI OWANS

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON C OMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N T HE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V AI L A B L E FROM THE I OWA E T HI CS AND CAMPAI GNDI SCLOSURE BOARD .CAUT I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co d e, p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s an d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y commer c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

    SUB- TOTAL

    TOTAL ( i f l a s t p a g e o f t h i s s c h ed u l e )" D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o m m i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o m m i t t e e . R e l a t i o n s h i p m u s t b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) . I f s u mame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pagef a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u m n . ( f o r S c h e d u l e A )

    2 o f

    SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCHECK T HI S BOX I FAMENDI NG FORM

    DATE PA C I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELAT I ONSHI P AMOUNT I F FORECE I VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI V ED FUND-( MM/ DD/ YR ) AND PAC CHECK ( i f a p p l i c a b l e ) RA I SERNUMBER I NCOME1 D# L I NDA KI NMAN $ 2 5 . 0 01 0 / 2 1 / 2 0 0 4 CK # 3 3 0 1 EULA DRURBANDALE, I A 5 0 3 2 2I D# BARB &DAVE HURD1 0 / 2 1 / 2 0 0 4 CK # 3 0 0 WAL NUT ST . # 1 8 3 1 0 0 . 0 0DES MOI NES, I A 5 0 3 0 9I D# CRAI GCOX1 0 / 2 1 / 2 0 0 4 CK# 1 2 0 4 MARSTONAVE 2 5 . 0 0

    AMES I A 5 0 0 1 0I D# MARK & SUSAN ACKELSON1 0 / 2 1 / 2 0 0 4 CK# 5 5 2 5 SCHWEI KERDR 2 5 . 0 0

    PLEASANT HI L L, I A 5 0 3 2 7I D# LYLE KREWSON1 0 / 2 1 / 2 0 0 4 CK # 6 4 0 3 AURORA UNI T 3 4 0 . 0 0URBANDALE, I A 5 0 3 2 2I D# HERBERT HEI NI CKE PHD1 0 / 2 1 / 2 0 0 4 CK# 1 3 0 2WBOSTON 1 0 . 0 0I ND I ANOLA , I A 5 0 1 2 5I D# DONBRAZEL TON1 0 / 2 1 / 2 0 0 4 CK# 1 5 1 0 NE TRI L EI NDR 1 5 . 0 0

    ANKENY, I A 5 0 0 2 1I D# YVONNESUTTLE1 0 / 2 1 / 2 0 0 4 CK# 3 6 5 5 S 5 0 E 1 5 0 . 0 0LEBANON, I N 4 6 0 5 2I D# PAUL SHOMSHOR1 0 / 2 1 / 2 0 0 4 CK# 3 0 1 8 AVEM 1 0 0 . 0 0

    COUNCI L BLUFFS I A 5 1 5 0 1I D# r a t PRI NPACC/ O J I M LANG1 0 / 2 0 / 2 0 0 4 CK # 7 1 1 H I GH ST . 2 5 0 . 0 01 3 8 2 DES MOI NES, I A 5 0 3 9 2

  • 8/7/2019 Pettengill Dawn__1507__scanned

    4/8

    Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - - MONEY TAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e s ame a s o n S t a t e me n t o f O r g a n i z a t i o n )PETTENGI LL FORI OWANS

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VEDFROMA STATEPAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I ST THEPAC I D ENT I F I CA TI ONNUMBER AND THEPAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSUREBOARD .

    CAUTI ON : Se c t i o n 68B . 3 2 A( 6 ) , I o wa Co de , p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p o r t s and s t a t e me nt s f o r s o l i c i t i n g c on t r i b ut i o ns o rf o r a ny c omme r c i a l p ur p o se b y a ny p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c ommi t t e e s .

    SUB-TOTAL

    TOTAL ( i f l a s t p a g e o f t h i s s c h e d u l e )Di s c l o s u r e l a w r e q u i r e s c a nd i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h e

    c o mmi t t e e . Re l a t i o ns h i p mus t be shown t o t h e t h i r d d e g r e e o f c o ns a n gu i n i t y ( b l o od r e l a t i v e s ) and a f f i n i t y ( r e l a t i v e s b y 3ma r r i a g e) . I f s umame o f c on t r i b ut o r i s t h e same as c and i d at e , b ut t h er e i s no Page o ff a m i l i a l r e l a t i o ns h i p , e n t e r " n o t a pp l i c ab l e " i n t h e r e l a t i o ns h i p c o l u mn . ( f o r Schedu l e A)

    SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCHECK T H I S BOX I FAMENDI NG FORM

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT d I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM/ D D/ Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SERNUMBER I NCOMEJEFF &DEBI HOFFMAN $ 5 0 . 0 01 0 / 2 1 / 2 0 0 4 CK# 1 4 0 1 WI CKFORD PLHURON, OH 4 4 8 3 9

    I D* DUANESAND1 0 / 2 1 / 2 0 0 4 CK# 8 9 9 8 GOLDEN VALLEY DR 2 5 . 0 0 E : 1NORWAK, I A 5 0 2 1 1I D # STEPHENVEYSEY1 0 / 2 1 / 2 0 0 4 CK# 9 1 9 MURRAY DR 2 0 . 0 0AMES 1A 5 0 0 1 0I D # 6 0 4 6 J USTI CE FORALL PAC1 0 / 2 0 / 2 0 0 4 CK# 2 1 8 6THAVE SUI TE 5 2 6 1 5 0 0 . 0 0DES MOI NES, I A 5 0 3 0 9 - 4 0 9 1I D # CAROL ZANDER1 0 / 2 1 / 2 0 0 4 CK# 2 0 6 0 5 0 TH ST DR 2 5 . 0 0MT . AUBURN, I A 5 2 3 1 3I D # BEV & ED TI LFORD1 0 / 2 0 / 2 0 0 4 CK# 4 5 5 5 CRAMER RD AUNT 5 0 . 0 0MARTI NSV I LLE , I N 4 6 1 5 1I D # I OWADEMOCRATI C PARTY1 0 / 2 1 / 2 0 0 4 CK# 5 6 6 1 FLEUR DR 3 0 , 0 0 0 . 0 0DES MOI NES, I A 5 0 3 2 1 - 2 8 4 1I D # 8 0 2 6 I BEWEDUCATI ONAL COMMI TTEE1 0 / 2 2 / 2 0 0 4 CK# 1 1 2 5 1 5 TH ST . NW 3 , 0 0 0 . 0 07 9 3 1 WASHI NGTON, DC 2 0 0 0 5I D # MARY LAUER1 0 / 2 2 / 2 0 0 4 CK# 1 2 1 5 1 7 4 TH ST NE 2 5 . 0 0CEDAR RAP I DS I A 5 2 4 0 2I D # STEVEN OVEL

    1 0 / 2 2 / 2 0 0 4 CK# 2 2 5 9 WASHI NGTON AVE SE 2 5 . 0 0CEDAR RAPI DS, I A 5 2 4 0 3

  • 8/7/2019 Pettengill Dawn__1507__scanned

    5/8

    Fo r I n s t r u c t i o n s , Se e Bac k o f Fo r t hCONTRI BUTI ONS - - MONEY TAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( M u s t b e same a s o n S t a t e m e n t o f O r g a n i z a t i o n )PETTENGI LL FOR I OWANS

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROMA STATE PAC ( POL I T I CA L ACTI ON COMMI TTEE) , L I S T THE PAC I DENT I F I CA TI ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETHI CS AND CAMPAI GNDI SCLOSURE BOARD .

    CAUTI ON : S ec t i o n 68 B . 3 2 A( 6 ) , I o wa Code, p r oh i b i t s t h e us e o f i n f o r ma t i o n c o p i e d f r o m r e p or t s a nd s t a t e me nt s f o r s o l i c i t i n g c on t r i b u t i o ns o rf o r any c omme r c i a l p ur p o se b y a ny p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e e s .

    SUBTOTAL

    TOTAL ( I f l a s t p a g e o f t h i s s c h e d u l e )D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p m u s t b e s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b y 4 5m a r r i a g e ) . I f s u r n a m e o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o f _f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A )

    A MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSC I CHECK T H I S BOX I FAMENDI NG FORM

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TO CANDI DATE' RECEI VED FUND-( MM / D D/ Y R ) AND PAC CHECK ( i f a p p l i c a b l e ) R AI S ERNUMBER I NCOMI D# DEANNDREA BAI RD $ 2 5 . 0 01 0 / 2 2 / 2 0 0 4 CK# 3 9 0 0 CEDARGROVECT NECEDARRAPI DS , I A 5 2 4 1 1I D# CHERYLEMI TVALSKY1 0 / 2 2 / 2 0 0 4 CK# 3 5 2 PARK TERRACE SE 2 5 . 0 0 ElCEDAR RAPI DS, I A 5 2 4 1 1I D# BECKI LYNCHPHD1 0 / 2 2 / 2 0 0 4 CK# 6 8 3 6 TH AVE SW 2 5 . 0 0CEDAR RAPI DS, I A 5 2 4 0 41 D # ANI TA&BRUCE PERDI EW1 0 / 2 2 / 2 0 0 4 CK# 2 8 8 3WBEEL I NE RD 5 0 . 0 0SALEM, I N 4 7 1 6 7I D # 9 6 7 0 I RONWORKERS LOCAL 8 9 POL I T I CAL1 0 / 2 3 / 2 0 0 4 CK# EDUCATI ON FUND 5 0 0 0 J ST . SW 2 0 0 . 0 03 0 5 6 CEDAR RAPI DS, I A 5 2 4 0 4I D # 9 6 8 0 CEDARRAPI DS BUI L DI NG TRADES1 0 / 2 3 / 2 0 0 4 CK# COUNCI L 5 0 0 0 J ST . SW 1 0 0 0 . 0 05 0 4 9 CEDARRAPI DS, I A 5 2 4 0 4l D # 9 6 7 2 PLUMBERS &PI PEF I TERS LOCAL 1 2 51 0 / 2 3 / 2 0 0 4 CK# POL I TI CAL EDUCATI ON FUND 1 8 3 9 1 6 T H 1 5 0 0 . 0 01 1 2 2 AVE SW CEDARRAPI DS, I A 5 2 4 0 4I D # NI CHOLAS&CAROL VOLK1 0 / 2 5 / 2 0 0 4 CK# 4 8 0 B AVENUE BOX3 0 5 2 5 . 0 0WALFORD, I A 5 2 3 5 1I D # 8 0 2 6 I BEWEDUCATI ONAL COMMI TTEE1 0 / 2 5 / 2 0 0 4 CK# 1 1 2 5 - 1 5 TH STNW 5 0 0 0 . 0 07 9 4 6 WASHI NGTON DC 2 0 0 0 5I D # 6 1 1 3 AFSCME/ I OWA COUNCI L 6 1

    1 0 / 2 6 / 2 0 0 4 CK# 4 3 2 0 NW2NDAVE 2 5 0 . 0 03 0 3 0 DES MOI NES, I A 5 0 3 1 3

  • 8/7/2019 Pettengill Dawn__1507__scanned

    6/8

    Fo r I n s t r u c t i on s , See Back o f Fo r mCONTRI BUTI ONS - - MONEYTAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMMI TTEE NAME ( Mu s t b e s ame as o n S t a t e me n t o f O r g a n i z a t i o n )PETTENGI LL FORI OWANS

    STATE CANDI DATES NOTE : I F ACONTRI BUTI ON I S RECEI VED FROMA STATE PAC( POL I T I CAL ACT I ON COMM I TTEE ) , L I S T THEPAC I DENT I F I CATI ONNUMBERAND THE PACCHECKNUMBER I N THEDESI GNATED COLUMN. A L I S T OF I D NUMBERS I S AVAI LABLEFROMTHE I OWA ETH I CS AND CAMPAI GNDI SCLOSURE BOARD .CAUTI ON: Se c t i on 68B. 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e us e o f i n f o r ma t i on c op i e d f r o m r e p or t s an d s t a t e me n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r an y c o mme r c i a l p u r p os e b y any p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

    SUB- TOTALTOTAL ( i f l a s t p a g e o f t h i s s c h e du l e )

    * D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mmi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e ma k i n g a c o n t r i b u t i o n t o t h ec o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s b y 5 5ma r r i a g e ) . I f s umame o f c o n t r i b u t o r i s t h e s ame as c a n d i d a t e , b ut t h e r e i s n o Page o f _f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c h ed u l e A)

    SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSCHECK THI S BOX I FAMENDI NG FORM

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTRI BUTOR RELATI ONSHI P AMOUNT I F FORECEI VED ( i f a p p l i c a b l e ) TOCANDI DATE* RECEI VED FUND-( MM/ DD/ YR) AND PAC CHECK ( i f a p p l i c a b l e ) RAI SENUMBER I NCOMI D# J O OLDSON $ 1 0 0 . 0 01 0 / 2 6 / 2 0 0 4 CK# 4 1 8 38TH PLACEDES MOI NES , I A 5 0 3 1 2I D#CK# EjI D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#I D#CK#

  • 8/7/2019 Pettengill Dawn__1507__scanned

    7/8

    THI S BOXAPPLI ES TOCANDI DATES' COMMI TTEES ONLY :P ur c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mus t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H. ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x pe nd i t u r e s t o p e r s o n s i e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mus t a l s o b e d e t a i l i t e mi z e d o nSc h e d u l e Gb y t h e amo u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x pe nd i t u r e made b y t h e p e r s o n / e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t oSc h e d u l e G i n s t r u c t i o n s a n d I o wa Cod e 6 8A. 4 0 2 ( 3 ) ( i ) . )

    ( f o r Sc h e d u l e B)

    FOR I NSTRUCTI ONS, SEE BACKOF FORM R e b e l F o r m SCHEDULEEXPENDI TURES B MONETARY- - MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

    STATE PAC COMMI TTEES : NOTE : FORCONTRI BUTI ONSMADE TO STATEWI DEOR L EGI S L AT I V ECANDI DATES, L I ST THECANDI DATE I DENT I F I CATI ON NUMBER I N THE DES I GNATED COLUMN ANDTHE CHECK THI S BOX I FPAC CHECKNUMBER FOR EACHEXPENDI TURE A L I ST OF I D NUMBERS I S AVA I L ABL E FROMTHE I OWA AMENDI NGFORMETHI CS & CAMPAI GN DI SCLOSURE BOARD .COMMI TTEE NAME ( Must b e s ame a s o n St a t eme n t o f O r g a n i z a t i o n )PETTENGI L L FOR I OWANS

    CANDI DATE NAME AND ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MM/ DD/ YR) AND PACCHECKNUMBER

    I D# PATTY SI MMONS REI MBURSEMENTFOR1 0 / 2 0 / 2 0 0 4 CK# 1 1 CENTER AVE S NEWSPAPERADVERTI SEMENTS $ 6 09 . 8 1RBANA, I A 5 2 3 4 5I D# 0STMASTER POSTAGE1 0 / 2 1 / 2 0 0 4 CK# T . AUBURN, I A 5 2 3 1 3 9 2 . 0 0I D# WWL T E L E VI S I ON ADVERTI SEMENTS1 0 / 2 2 / 2 0 0 4 0 0 E 4THST 3 7 3 5 . 7 5CK# WATERLOO, I A 5 0 7 0 3I D# CRG T E L E VI S I ON ADVERTI SEMENTS1 0 / 2 2 / 2 0 0 4 CK# EDARRAPI DS, I A 5 2 4 0 1 2 4 2 2 . 5 0I D# KGAN T E L E VI S I ON ADVERTI SEMENTS1 0 / 2 2 / 2 0 0 4 CK# 6 0 0 OLDMARI ON RDNE 7 6 5 . 0 0CEDARRAPI DS, I A 5 2 4 0 2I D# I SUAL I T Y T E L E VI SI ON ADVERTI SEMENTS

    1 0 / 2 2 / 2 0 0 4 CK# 9 8 0 EXECUTI VE DR SUI TE A 3 0 0 4 6 . 7 5ADI SON, WI 5 3 7 1 9I D#CK#L I D#CK# SUB- TOTAL $ 3 7 , 6 7 1 . 8 1

    TOTAL ( I f l a s t p a g e o f t h i s s c h e du l e ) $ 3 7 , 6 7 1 . 8 1

  • 8/7/2019 Pettengill Dawn__1507__scanned

    8/8

    FORI NSTRUCTI ONS, SEE BACK OF FORMCOMMI TTEE NAME ( Mu s t b e s ame as o n St a t eme n t o f O r g a n i z a t i o n )PETTENGI LL FORI OWANS

    TOTAL ( i f l a s tp a g e o f t h i ss c h ed u l e )

    SCHEDULEE I N K I ND( Re v . 0 6 1 9 7 ] CONTRI BUTI ONS

    d CHECK THI S BOX I FAMENDI NG FORM

    ' D i s c l o s u r e l aw r e q u i r e s c a nd i d at e s t o d i s c l o s e t h e r e l a t i o n s h i p o f an y r e l a t i v e ma k i n g a n i n k i n d c o n t r i b u t i o n t o t h e Page 1 o f 1c o mmi t t e e . R e l a t i o n s h i p mus t b e s h o w n t o t h e t h i r d d e gr e e o f c on s an gu i n i t y ( b l o o d r e l a t i v e s ) an d a f f i n i t y ( r e l a t i v e s ( f o r Sc h e d u l e E)b y ma r r i a ge ) . ( Se e Page 2 o f f o r ms p a c k e t . ) I f s u r n ame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n of a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l umn .

    DATE RELATI ONSHI P DESCRI PTI ON ESTI MATED ~ I F FORRECEI VED NAME ANDADDRESS TO CANDI DATE OF I N KI ND FAI RMARKET FUND- RAI SER( MMI DDYR) OF CONTRI BUTOR ' ( i f a p p l i c a b l e ) CONTRI BUTI ON VALUE CONTRI BUTI ON

    1 0 / 1 5 / 2 0 0 4 PAT MI LNE2 1 1 RI VERVI EWDR FOOD FOR 3 0 . 0 0 FFUNDRAI SERVI NTON, I A 5 2 3 4 91 0 / 1 5 / 2 0 0 4 JANI CE ELDRED FOODFOR 3 0 . 0 05 1 1 CENTERAVE S FUNDRAI SER EDURBANA, I A 5 2 3 4 5

    PATTY SI MMONS FOOD FOR 2 5 . 0 01 0 / 1 5 / 2 0 0 4 5 1 1 CENTERAVE S FUNDRAI SER F ;1URBANA, I A 5 2 3 4 5I OWA DEMOCRATI C PARTY POSTAGE 3 7 , 8 4 8 . 0 01 0 / 2 6 / 2 0 0 4 1 4 0 8 LOCUST ST . FDES MOI NES, I A 5 0 3 0 9I OWA DEMOCRATI C PARTY STAFF 2 , 5 0 0 . 0 01 0 / 2 6 / 2 0 0 4 1 4 0 8 LOCUST ST . F -1DES MOI NES, I A 5 0 3 0 9

    F-1F-1F-1F- 1F -1