FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

(Rev. 07/2004) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office_ Use Only
Concerned Citizens of 2005 Comm . #
IMPORTANT: Indicate by # type of committee you are reporting for: Logged In
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )State PAC ( 3 )State Party Scanned
( 4 )County Central Committee ( 5 )County Candidate ( fi )City Candidate ( 7 )School Board or Other Political Computer
Subdivision Candidate (8 )County PAC (9 )City PAC ( 10 )School Board or Othe r Political Subdivision PAC
11 ) Local Ballot Issue Audited

CANDIDATE COMMITTEES ONLY:

Late reports are subject to possible civil and criminal penalties.

~,w, A411P
SIGNATURE OF PERSON FILIN G
_ TELEPHONE
3 ig-bG; --g~c X
DATE SIGNED

I AM FILING A REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .

(report date) Indicate by # R

iCHECK IF AMENDMENT TO REPORT DATED November21,2005 Local Committees, enter Date of Election
-

County & Local Committees, enter County in

Lj 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 all funds held by the
committee . This amount MUST be the same as the cash on hand at the end 0.00
of the last reporting period or must be zero if this is first report filed .) . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
1,604 .31
Schedule A : Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . . . .. . . . . . .
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.. . .... . .... . . .. $ 1,604 .31
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
0 .00
Schedule B : Expenditures total (Attach Schedule B) (*'also see debts and loans below) . . . . . . . . . . . .
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
0 .00
be zero) (Attach DR-3) . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

"UNPAID BILLS (From Schedule D - Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ _0 .00

-IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . $ 0 .00

V
"OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0 .00

CONSULTANT BREAKDOWN (Schedule G Attached?) - YES NO

CANDIDATE COMMITTEES ONLY :
$ 0 .00
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
© CHECKTHIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Concerned Citizens of 2005

STATECANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER ANDTHE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . ALIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports 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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Jerry & Cindy Kasper, 585 S Jones Blvd $350 .00
10/26/05 North Liberty, IA 52317
CK#

ID#
Jim & Bev Seelman, 2790 Kansas Ave $100.00
10/19/05 North Liberty, IA 52317
CK#

ID#
Bernie & Lori Schieltz, 810 S Jones Blvd $100.00
10/26/05 CK# North Liberty, to
52317

ID#
Sinikka A Rautiainen, 2391 Mehaffey Bridge Rd $100 .00
10/26/05 CK# NE, North Liberty, IA 52317

ID#
Robert Sentman, 2851 James Ave NW $100 .00
10/25/05 Tifftn, IA 52340
CK#

ID#
Brad & Jennifer Franzwa, 1590 Mink Circle $200.00
11/3/05 North Liberty, fA 52317
CK#

ID#
Risto & Sinikka Rautiainen, 2391 Mehaffey $150 .00
11/12/05 Bridge Rd NE, North Liberty, IA 52317
CK#

ID#
Barbara Beaumont, 2898 Naples Ave NE $25.00
11/1/05 North Liberty, 1A 52317
CK#

ID#
Richard & Priscilla Stream, 260 Elmridge Dr $25 .00
11/8/05 CK# North Liberty, IA 52317

ID#
Ron Bandy, 25 N Dubuque St $50.00
10/28/05 North Liberty, IA 52317
CK#

SUB-TOTAL

TOTAL (iflast page of this schedule)

' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to the
committee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 1 2
marriage) . ff sumame of contributor is the same as candidate, but there is no Page of -
familial relationship, enter "not applicable" in the relationship column. (for Schedule A)
For Instructions, See Back of Form SCHEDULE
A MONETARY
CONTRIBUTIONS - MONEY TAKEN IN (Rev . 07/03) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

Concerned Citizens of 2005

STATE CANDIDATES NOTE : IF ACONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . ALIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE BOARD.

CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports 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 4 IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Jay Glass, 1811 Williams Blvd SW $50.00
10/28/05 Cedar Rapids, lA 52404
CK#

ID#
Robert Teneick, 3073 - 270th St NE $25.00
11/5/05 Iowa City, IA 52240
CK#

ID#
Anthony & Betty Moey, 725 S Jones Blvd $219 .31
11/16105 CK# North Liberty, IA 52317

ID#
Beverly Bircher $10.00
11/1/05 CK# North Liberty, IA 52317

ID#
Sintkka Rautiainen, 2391 Mehaffey Bridge Rd NE, $100 .00
11/121/05 North Liberty, lA 52317
CK#

ID#

CK#

ID#

CK#

ID#

CK#

ID# a

CK#

ID#

CK#

SUB-TOTAL

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. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by 2 2
marriage) . If sumams of contributor is the same as candidate, but there is no Page of -
familial relationship, enter "not applicable° in the relationship column . (for Schedule A)
 FOR INSTRUCTIONS, SEE BACK OF FORM RO~Ot Farm SCHEDULE

EXPENDITURES - MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev. 07103) 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 AMENDING FORM
ETHICS & CAMPAIGN DISCLOSURE BOARD.

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

Concerned Citizens of 2005

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
ID#
Postmaster Mass mail information flyers
10/26/05 North Liberty, IA 52317 $ 613.68
CK#

ID#
Technigraphics Use of postage permit
10/26/05 $15.00
CK#

ID#
Poli Graphics yard signs
10/21/05 $280.00
CK#

ID#
Poli Graphics yard signs
11/4/05 $333 .63
CK#

ID#
North Liberty Leader full and half page ads
10/26/05 $362 .00
CK#

ID#

CK#

ID#

CK#

ID#

CK#

SUBTOTAL $

TOTAL (iflast page of this schedule) $ 1604,31

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY.

Purchases of certain campaign properly costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)

Expenditures to persons/entities 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 persoNentity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)

(for Schedule B)