01/18/2005 18 :09 STATE BANK OF WAPELLO -> 15152813701

FOR INSTRUCTIONS, SIX 13ACK OF FORM

FORM
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
COMMITTEE NAMC (Mual Do same as on Statement or Organllation) (Rev . 0712000) REPORT

For fJRleo Use On Y / ~~ ~~

Wilson For Supervisor COmm. E

IMPORTANT: Indicate "of committee you an reporting for: Lopped In ,1<0/1~

(1 )Statswidelleaisladve Candidate (2 )StalaWids PAC (3 )Stale Party (4 )CauntAocal Candidate

simnned
(S )County PAC (6 )ballot IsauarFranchWCommlttae- (7 )owntrqt~ C®nlml Ccmmhtae Computer _
Audited
CANDIDATE COMMITTEES ONLY,
Candidate Name JAN 1 8 2005 political Party
David K . Wilson Republican ,.
Office Sought Disldct (if Senate or House)
Louisa Co unty ,Supe-rvistst ------

563-2 .63-7618 January 1~8, 2005

,
TELEPHONE DATE SIGNED

Late filed reports are subject to possible civil and criminal penalties.
SEE INSTRUCIIONS ON BACK AND COM~ THE~ FO LLO IS SETENCE :
I AM FILING A _-_January 16, 2005-FTNAL REPORT FOR AN/A 1 ELECTION 1(2)NON-ELECTION YEAR.
port dale) Indicate one
CCHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Dato of Election

[Iq Check If this is final (termination) report and attach Notice of Dissolution Form DR-3 . County 8. Local Cafnrnldees, enter County In
(You must ooalnue to file Imports tinil) a Notice of Dissolution is filed) which Irleclion is held
Louisa Count:

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the totai or all monles 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 flied.) ...... .......... .............. .. $ -13810,1
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Conhfbulions total (Attach Schedule A) ('also see in-Kind below) .......... _
-0-
Schedule F: Loans Received total (Attach Schedule F) ....... .......................... ........
Schedule H: Total Sales of Campaign Property (Attach Schedule H) .................. ................ -0-
ISchadu ail applies Io Candidate®'Committees Only)

SUB-TOTAL ...., i 138 .01

SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule 8: Expenditures total (Attach Schedule B) ("also sea debts and loans below) .... 138 .01
Schedule F: Loan Repayments total (Attach Schedule F) ......................... ........................... -0 -
CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . ..... . ..... ............. ............ .................. ... ..... . . .. .... ..... ......... ......., ..... . ..... $

"UNPAID SILLS (From Schedule D -Attach Schedule D) ............ .. ............. .................. ..  . .S None
'IN KIND CONTRIBUTIONS (From Schedule E -Attach Schedule E) ... .... .............. . .................... . . .. . $ None
"OUTSTANDING LOANS (From Schedule F-Attach Schedule F) .............. ............ ...... ...... ..... ........ $ None
CANL)tDATE COMIIA1ITEES ONLY,-
CONSULTANT BREAKDOWN (Schedule G Attached?) YES IM NO
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) $
 01/18/2005 18 :09 STATE BANK OF WAPELLO 4 15152813701 N0,659 P03

FOR INSTRUCTIONS, SEC BACK OF FORM SCHEDULE

B MONETARY
EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT (Rev. 07I03) EXPENDITURES

STATE PAC COMtAITTEFS . NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDEOR LEGISLATIVE

CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE D CHECK THIS BOX IF
PAC CHECK NUMBER FOR EACH EXPENDITURE . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ' AMENDING FORM
ETHICS A CAMPAIGN DISCLOSURE BOARD,

COMM1TTEE NAME (Must be same as on Sla(ement d Organlzauvn)

Wilson FoT Super'v'isor.

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATA: ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (it applicable) (D10wsernmV WAS MADE
(MMIDDlyR) AND PAC
CHECK
NUMBER
ID#
1-10-05 #1012 David 1C . Wilson Final Disbursement to $138 .01
CK# 11513 Co . Rd . G-62 Close Account
Wapello, Ia . 52653
' - ID#
CK#

ID#
CK#

[D#
CK#
ID#
CK#
IQ#
CK#

CK#

ID#
CK#
SUBTOTAL
$ 138 .01
TOTAL (iflast page of this aahoduM) $, 138 .01

THIS BOX APPLIES TO CANDIDATES' COMMfITEES ONLY .

Purfses of certain campaign propertycosgng $500 or mom must also be Inventoried on Schedule H. (Refer to Schedule H Instructions_)
Eapendlluros to personslenlilles providing consulting, advertising. fund-raising, polling, managing, organtzJng services must also be detail Itemized an
Schedule G by the amount . purpose, and dale of each type of expendllwe made by the personlentity an behalf of the candidate's commutes. (Refer to
Schedule G instrucllons and Iowa Code 6111&402(3)(I) , )

(for Schedule B)