IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form

VERIFIED STATEMENT
510 EAST 12th, SUITE 1A REGISTRATION
f orln
DES MOINES, IA 50319 rs` .. (Out-of-State Committees)
www.iowa.gov/ethic s (Rev. 07103)

VERIFIED STATEMENT REGISTRATION For office use only,

(Out-of-State Committee) Comm . # 0
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND Audited
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM .
THIS FORM MUST BE FILED FOR EACH CONTRIBUTION IN EXCESS OF $50 Computer

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym) .
D .R .I .V .E . - Democrat, Republican, Independent Voter Education
Mailing Address
25 Louisiana Ave, NW ; Washington, DC 20001
City, State, Zip Code Code T ephone No .
~~ 1 624-6

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

Name of Jurisdiction
Federal Election Co International Brotherhood ofNTeamsters
Mailing Address
999 E . St., NW 25 Louisiana Ave, NW Mailing Address

qas ftt6~WS0463 Telephone State, Zip Code

Washington, DC 20001ity'
U

PURPOSE OF COMMITTEE

Dispensing Campaign Contributions

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Steve Mandernach CMTE TO ELECT LA MARK COMBS
Mailing Address Mailing Address
5661 Fleur Drive 2743 WEST CENTRAL PARK AVE DAVENPORT IA 52806
City, State, Zip Code Telephone Date If In-Kind Contribution, Describe
Des Moines, IA 50321 (5 15 ) 244-7292 4/14/05
Amount Check # I Committee. ID #
$ 500 .00 001477

VERIFIED STATEMENT OF COMMITTEE :

1 C . Thomas Keegel , attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of my knowledge. I also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 68A.6, including the disclosure of all contributions received and all expenditures made . 1 further attest that the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under Iowa Code
section 68A.15, un s the Iowa recipient committee is a ballot issue committee. I understand that potential civil and criminal penalties may apply unless a copy of
this has bee/~f ed with the Iowa EthFs and CampAn Disclosure Board within 15 days of the date of the contribution .

Treasu rer 4/15/05

(Person submittingT3fm'J - %J (Title) (Date)
SEA' 1 4IdWA ET ICS AND CAMPAIGN DISCLOSURE BOARD Form
VERIFIED STATEMENT
510 EAST 12th, SUITE 1A REGISTRATION
DES MOINES, IA 50319 (Out-of-State Committees)
www.iowa .gov/ethic s (Rev. 07/03)

D STATEMENT REGISTRATION For office use only

(Out-of-State Committee) Comm. #
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND Audited
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM .
THIS FORM MUST BE FILED FOR EACH CONTRIBUTION IN EXCESS OF $50 Computer

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name . Written explanation must be provided for Acronym) .
DRIVE-Democrat, Republican, Independent Voter Education
Mailing Address
25 Louisiana Avenue, NW
%(Wate, Zip Code hone No .
Washington, DC Code, 624-68 1!ep

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

jurisdiction ,Name
_Federal Election Division °f _In_tema_tinal_Broth
therrho
hoood of eamsters
Mailing Address *'ling Address
999 E Street, NW 25 Louisiana Avenue, IV
Tele ily, State, Zip Code
W"%&, boe20001 pe 694-1100-- Washington, DC 2000_---_-ip _--_----------
-___-__ -------------------------

PURPOSE OF COMMITTEE

Dispensing campaign contributions .

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee
Steve Mandemach Friends of Yerington for Sherriff
__-------- ------------ ----------
Mailing Address ailing Address
5661 Fleur Drive 1000 Blythwood Place
-- - ------------ - ------
City, State, Zip Code Telephone Date If In-Kind Contribution, Describe
Des Moines, IA 50322 515 244-7292 9/7/04
--------__(-----)------_____
Amount Check # T_Committee . ID #
$ 500.00 559

VERIFIED STATEMENT OF COMMITTEE :

I- __ C . Thomas Keegel attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of my knowledge. I also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 68A.6, including the disclosure of all contributions received and all expenditures made. I further attest that the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under Iowa Code
section 68A.15, uAss the Iowa recipient committee is ballot issue committee. I understand that potential civil and criminal penalties may apply unless a copy of
thislojm has be~g liled with the Iowa Etycs.and Carr yign Disclosure Board within 15 days of the date of the contribution .
i
Treasurer -2/91&4
(Person submittingform) (Title) (Date)
 IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form
VERIFIED STATEMENT
510 EAST 12th, SUITE 1A
REGISTRATION
DES MOINES, IA 50319 (Out-of-State Committees)
www.iowa.gov/ethic s (Rev. 07103)

~VeFIFIED STATEMENT REGISTRATION For office use onIV

(Out-of-State Committee) Comm . #
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE.
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND Audited
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM .
THIS FORM MUST BE FILED FOR EACH CONTRIBUTION IN EXCESS OF $50 Computer

COMMITTEE NAME
Official Name of Out-of-State Committee (Do not abbreviate committee name. Written explanation must be provided for Acronym) .
D .R .I .V .E . - Democrat, Republican Inde pendent Voter Education
Mailing Address
25 Louisiana Ave, NW ; Washington, DC 20001
City, State, Zip Code F ~~ Cod) No .
624-6Mephone

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

Name of Jurisdiction
Federal Election Commission International Brotherhood opfeamsters
Mailing Address
999 E . St., NW 25 Louisiana Ave, NW Mailing Address
Telephone State, Zip Code
~%s gttslf bf!e20463 Washington, DC 20001ity'
U

PURPOSE OF COMMITTEE

Dispensing Campaign Contributions

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident acmeof Committee
Steve Mandernach Committee for Ted Teel
Mailing Address Mailing Address
5661 Fleur Drive 318 3rd St. ; P .O . Box 204 ; Buffalo, IA 52728
City, State, Zip Code Telephone Date If In-Kind Contribution, Describe
Des Moines, IA 50321 10/14/05
Amount Check # ( Committee . ID #
$ 250 .00 002072

VERIFIED STATEMENT OF COMMITTEE :

I C . Thomas Keegel , attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct and accurate to the best of my knowledge. I also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 68A.6, including the disclosure of all contributions received and all expenditures made. I further attest that the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under Iowa Code
sec ti 68A.15, ss the Iowa recipient committee is a ballot issue committee. I understand that potential civil and criminal penalties may apply unless a copy of
thi fc m1~s b filed with the Iowa E1hic~,and CaAign Disclosure Board within 15 days of the date of the contribution.
Treasurer 1 0/ 17/05
form) ~~ (Title) (Date)