12/07 ;'"2004 14 29 FAY.

712 324 413E NCC Z005f(i0G

FOR INSTRUCTIONS, SEE 6ACK OF FORM 77'-7776) ~, FORM

DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev . 07/`2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only
Friends of Northwest Iowa Community College Comm . #
IMPORTANT : Indicate by # type of committee you are reporting for Logged In
( 1 )Statewide/LegislativeiJudge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
(4 )County Central Committee ( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other
Political Subdivision Candidate ( 6 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision PAC ( 11 ) Local Ballot Issue _ d - Audited
CANDIDATE COMMITTEES ONLY:
Candidate Name 0olltlcal Parry (if applicable)
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties.

12-7-04
SIGNATURE OF PERSON FILING REPORT DATE SIGNED

I AM FILING A December 7, 2(104 REPORT FOR (1) ELECTION I(2)NON-ELECTION YEAR .

(report date) Indicato by ft

Local Committees, enter Date of Election

OCHECK IF AMENDMENT TO REPORT DATED
September 14, 2004
County & Local committees, enter County in
(Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . which Election is held
(You must continue to file reports until a DR-3 Is filed .)

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (Total of ail funds held by the
committee . This amount MUST be the same as the cash on hand at the end
of the lest reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 60 .00

ADD TOTAL MONEY TAKEN IN THIS PERIOD

Schedule A : Cash Contributions total (Attach Schedule A) ('also see in-kind below) , . . . . .  . . 60 .00
Schedule F ; Loans Received total (Attach Schedule F) . . . . . . . . ., . . . . . . . . . ., . . . . . . . . . ., . . . . . ., . . . . ., . . ., . . ., . . 0 .00
Schedule H : Total Sales of Campaign Property (Attach Schedule H), .  . . . . . . . . . . . . . ., . . . . . . . . ., . . . ., 0 .00
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . . $ 60 .00
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) ( - also see debts and loans below) . . . . 60 .00
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 .00
CASH ON HAND at the end of this reporting period (if final report balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ Q_-_0_Q

"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . S 0 .00

'IN KIND CONTRIBUTIONS (From Schedule E-Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .S 0 .00
"OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . ., . ., . . . ., . .  , . ., . . . . . . . . . . . , . . . . . . . . . . . . . . . .5 0 .00
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H) 5
FI YES E NO
1'2/f'17/2(04
i14 29 F0,' 712 324 41 :36 NCC Z 0()6/() r)9

BACK OF FORM IJU'-!"'

1 - UN INS 1 h'UG 11UN5, SEE
SCHEDULE
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY
(Rev . 07103) EXPENDITURES

D
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 & CAMPAIGN DISCLOSURE BOARD,

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

Friends of Northwest Iowa Community Collegg

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDD1YR) AND PAC
CHECK
NUMBER
ID# Northwest Iowa Community
College
10-20-04 CK#1,023 603 West Park Street
Sheldon, IA 51201 S 60 .00
Wages & fringe benefits-
ID#

CK#

ID#

CK#

ID#

CK#

ID#

C K#

I D#

CK#

I D#

G K#

I D#

C K#

SUB-TOTAL $
60 .00
TOTAL (if last page of this schedule) S 60
.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 personslentit-es providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detall Itemized on
Schedule G by the amount, purpose, and date of each type of expend-ture made by the person/entity on behalf of the candidate'a
committee (Refer to
Schedule G instructions and Iowa Code 68A.402(3)(i),)

(for Schedule B)