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FOR INSTRUCTIONS, SEE BACK OF FORM
DISCLOSURE SUMMARY PAGECOMMITTEE NAME (Must be same as on Statement of On,
Gayle Collins for City Council
IMPORTANT : Indicate by # type ofcommittee you are reporting for :( 1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2(4 )County Central Committee ( 5 )County Candidate ( 6 )City CandidPolitical Subdivision Candidate ( 8 )County PAC ( 9 )City PAC ( 10 )SSubdivision PAC ( 11 ) Local Ballot IssueCANDIDATE COMMITTEES ONLY:
Candidate Name
Office Sought
SIGNAJURE OF PERSON FILING REPORT
I AM FILING A
12
(report date)
CHECK IF AMENDMENT TO REPORT DATED Alit I I ~,
Rese FORM
DR-2(Rev . 07/2004)
For Office Use OnlyComm . #Logged InScanned'ComputerAudited
Political Party (if applicable)
District (if Senate or House)
5j"5-'w,T
13TELEPHONE
Ft l<-e lys pinor tv ~r~rr~tr
6tv~~n~ Check if this i
final (terminate n) report
nd attach Notice of Dissolution Form DR-3 .(You must continue to file reports until a DR-3 is filed .)
REPORT FOR (1) ELECTION /(2)NON-ELECTION YEAR .Indicate by # 1-1
STATEMENT OF CASH ON HANDCASH 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 endof the last reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A : Cash Contributions total (Attach Schedule A) (*also see in-kind below) . . . . . . . . . .
21,093 .00Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
(Schedule H applies to Candidates' Committees Only)
SUB-TOTAL . . . . .$
21,266 .86SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . . . .
14,407.04
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0
CASH ON HAND at the end of this reporting period (if final report balance must
6859.82be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
**UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
*IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
**OUTSTANDING LOANS (From Schedule F-Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H - Attach Schedule H)
$
Late reports are subject topossible civil and criminalpenalties .
8/,76/0/_
DATE SIGNED
DISCLOSUREREPORT
Local Committees, enter Date of Election
ty 11, ZO0'yCounty & Local Committees, enter County inwhich
lection is held~WK
173 .86
YES NO
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Schedule A: Contributions -- Money Taken In,Committee Name'iGayle Collins for City Council
Status Filed Committee Type Municipal Candidate - CityCouncil
Committee ID 13303
04/16/2004 01 :15:06
Statutory Due Date 14/8/2004Adjusted Due DateFiled Date
14/15/2004Amended DateReceived Date
Schedule AContributions
SCh-A
Fund-Raiser
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Page 1 of 16
IOWA ETHICS ANDCAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Contribution ContributionDate Committee ID Name and Address of Contributor Relationship To
Candidate(,ContributioniAmount
3/9/2004 Nahas, Edward None $500.00
219 4th StreetCheck #
3817 Des Moines, IA 50309-2253
3/9/2004 Ryan, Susan None $100.00
,3307 SW 24th StreetCheck #6050 Des Moines, IA 50321-2616
3/12/2004 Ceilley, MD, Roger I None $500.00
16000 UniversityCheck # Ste. 4502452 Des Moines, IA 50266
3/12/2004 Hurd, David None $250.001
1300 Walnut StreetI
Check #18312425 Des Moines, IA 50309
3/12/2004 ' Kirsner, Alvin H None I, $250.00
3131 Fleur DriveCheck# Apt 8073789 Des Moines, IA 50321
3/12/2004 !, Kruidenier, David None $1,000.00
715 Locust Street
j Check # 9th Floor1059 Des Moines, IA 50309
Committee Name
jGayle Collins for City Council
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Status Filed
i
Check #
II,1994
Committee TypeMunicipal Candidate - City_Council__
Committee ID 13303
11 416 SE Gray Street
(Des Moines, IA 50315-1744
04/1612004 01 :15:06 Schedule AContributions
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Page 2 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1(515) 281-4028
Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004
Amended DateReceived Date
ContributionDate
Contribution'Committee ID
Name and Address of Contributor Relationship ToCandidate
Contribution Fund-Amount (Raiser
3/12/2004 McCoy, Matthew None $125.00
4720 Woodland Ave.
Check #
4833 Des Moines, 1A 50312
3/12/2004 Politte, James D None $500 .00
1604 Grand OaksCheck #
7316 !, West Des Moines, IA 50265
3/12/2004 Quinn, MD, Jon Edward None $100 .00
2711 Glenwood DriveCheck #
1844 Des Moines, IA 50321
3/12/2004 IISporrer, Kim M None $50.00
1012 Polk BlvdCheck #
4038 Des Moines, IA 50311
3/16/2004 Babb, Deborah None $100.00 X
6005 E . Oakwood Drive
~!, Check #1,3307 Pleasant Hi ll, IA 50327
3/16/2004 Belken, Harold & Nadine None $50.00' X
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!Committee Name
IGayle Collins for City Council
Status Filed Committee Type Municipal Candidate - CityCouncil
Committee ID 13303
04/16/2004 01 :15:06 Schedule AContributions
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Page 3 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 i (515) 281-4028
Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004Amended DateReceived Date
Contribution ContributionDate Committeei-
3/16/2004
ID Name and Address of Contributor
Brown, Gregory A
Relationship ToCandidate
None
ContributioniAmount
$25.00''1
Fund-Raiser
X
12714 Ingersoll AvenueCheck # j Apt. 3053056 Des Moines, IA 50312
3/16/2004 Buhr, Glenn & Florence None j $50.00 X
4127-30th StreetCheck #
4672 Des Moines, IA 50312
13/16/2004 II, Caracciolo, Ralph & Katherine None $25.00 X
1822 SW PorterCheck #
X9671 Des Moines, IA 50315
13/16/2004 Carney, James W None $50 .00 X
400 Homestead Bldg .Check # 303 Locust Street12157 Des Moines, IA 50309
3/16/2004 Celsi, Claire None $25.001 X
743-37th Street'Check #
~~10422 Des Moines, IA 50312'
13/16/2004 Colosimo, Anthony J None $100.0011 X
14092 Willow DriveII,I1
Check#6447- Clive, IA 50325
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Contributions
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Page 4 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 I (515) 281-4028
Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004
Municipal Candidate - City Amended DateStatus Filed Committee Type
Council Received Date__
Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser
3/16/2004 Conner, Pamela None $25.00' X
i 2715 E . 40th StreetCheck #2359 Des Moines, IA 50317-3939
3/16/2004 Connolly, Angela None $25 .001I
X
4707 NW Beaver DriveCheck #2395 Des Moines, IA 50310
3/16/2004 i Curran, Susan A None $25.00 X
4015 Muskogee Avenue
I
Check #
3/16/2004
'3268 - Des_ Moines, IA 503 1 2
' Dearden, Dick None $100.00 X
113113 Kinsey AvenueCheck #
4672 Des Moines, 1A 50317-6603
3/16/2004 Flaherty, Patrick D None $25.00 X
5146 Aspen CircleCheck #6082 Pleasant Hill, IA 50327
3/16/2004 Flansburg, James S. & Carol M None $25.00' X
3709 UrbandaleCheck #
1 1820__ Des Moines, IA 50310 _
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Committee Name
Committee ID 13303Gayle Collins for City Council
Status Filed Committee Type Municipal Candidate - CityCouncil
04/16/2004 01 :15:06 Schedule A
Contributions
Statutory Due DateAdjusted Due DateFiled DateAmended DateReceived Date
4/8/2004
4/15/2004
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Page 5 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1 (515) 281-4028
Contribution ContributionDate Committee ID
Name and Address of Contributor Relationship ToCandidate
ContributionAmount
Fund-Raiser
3/16/2004 Fundraiser at Java Joes N/A $538.00', X
214-4th Street ~I I
Des Moines, IA 50309
3/16/2004 Giovannetti, E.J .i
None $25.00 X
;3004 Melanie DriveCheck #
19293 Urbandale, IA 50322-6848
'3/16/2004 Gorsuch, Gordon Troy None $25.00' X
4007-39th PlaceCheck #
money order !Des Moines, IA 50310-2832
3/16/2004 Gray, WilliamI
NoneI
$25.00 X
4617 Franklin Avenue I
Check #
20139 Des Moines, IA 50310
3/16/2004 Harding, Kimberly K N/A $25.00 X
4803-38th PlaceCheck #
10206 Des Moines, IA 50310-4304
3/16/2004 Jensen, Darrell L None $25.00' X
III1423 175th Place!~ Check #
1133 Ackworth, IA 50001
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Contributions
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Page 6 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 i (515) 281-4028
!Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004
Municipal Candidate - City Amended DateStatus Filed Committee Type Council Received Date
Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser
3/16/2004 Kaiser, John E None
_~.._$25
.00, X
5800 SE 2nd StreetCheck #5456 Des Moines, IA 50315
3/16/2004 Kirsner, Lawrence None $250 .00 X
(Check3662 Ingersoll Ave
# #4071235 Des Moines, IA 50312
3/16/2004 Marturello, Connie None $50 .00 X
3620 SW 9th StreetCheck #
3653 Des Moines, IA 50315
3/16/2004 McAninch, Dwayne & Glennis !None $250 .00~ X
PO Box 1486Check#
_ _ 8429 Des Moines, IA _ 50306
3/16/2004 McIntosh, Edwin None $250.00 X i
1677 NW 109th St .Check #
8945 Clive, IA 50325
3/16/2004 Meyer, Stephen P None $450.00 (! X
II300 Walnut StreetCheck # Unit 115
X 5563 Des Moines, IA 50309-2242
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Committee Name
iGayle Collins for City Council
'Status Filed
1
Committee Type Municipal Candidate - City. Council
Committee ID 13303
04/16/2004 01 :15 :06 Schedule AContributions
Statutory Due DateAdjusted Due DateFiled DateAmended DateReceived Date
4/8/2004
4/15/2004
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Page 7 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Contribution ContributionName and Address of Contributor Relationship To Contribution Fund-
Date Committee ID Candidate Amount Raiser
3/16/2004 Mundy, Bruce Nonei! $25 .00 ; X
200 GrandCheck # #220
1009 Des Moines, IA 50309
3/16/2004 Noon, Fred L None $25.00 X
349 Forest AvenueCheck #
12747 Des Moines, IA 50314
3/16/2004 Oldson & Oakley, Joanne & Brice None $100.00 ; X
418 - 38th PlaceCheck #
2923 Des Moines, IA 50312
3/16/2004 Pederson, Merle None $250.00' X
6034 N. Waterbury RdCheck #
_-241402 Des Moines , IA 503 12
3/16/2004 Person, Steven O None $25.00 X
11300 Walnut StreetCheck # Unit 73~~2649 Des Moines, IA 50309-2241
3/16/2004 Raker, Robert D None $30.00, X
3201 Bel Aire RoadCheck #
1378 Des Moines, IA 50310
Committee Name
Gayle Collins for City Council
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Status Filed Committee Type Municipal Candidate - CityCouncil
Committee ID 13303
3726
Des Moines, 1A 50312
04/16/2004 01 :15 :06 Schedule AContributions
Statutory Due Date 14/8/2004Adjusted Due DateFiled Date
14/15/2004Amended DateReceived Date
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Page 8 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1 514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Contribution ContributionDate Committee ID Name and Address of Contributor Relationship To
Candidate'Contribution(Amount
Fund-Raiser
3/16/2004 Renda, John None $500.00 X
1120-5th StreetCheck # #82146 West Des Moines, IA 50265
3/16/2004 Sackett, Jill E ' None $250.00 X
1817-77th StreetCheck #
4189 Windsor Heights, IA 50322
3/16/2004 Sackett, Randy J None $250.001 X
1817 - 77th StreetCheck #4188 Windsor Heights, IA 50322
3/16/2004 Scearcy, Thomas H None $200.00 X
1526 CarpenterAvenueCheck #1190 Des Moines, IA 50314
3/16/2004 Stillians, Nancy None $25.00 X
1604-24th Street PlaceCheck #16510 Des Moines, 1A 50310
3/16/2004 Wegner, Ferol & Fredrick None $25.00'1j
X
6215 Pleasant DriveCheck#
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2893
I Des Moines, IA 50309
04116/2004 01 :15 :06 Schedule AContributions
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Page 9 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1 (515) 281-4028
Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004
Municipal Candidate - City Amended DateStatus Filed Committee Type
Council Received Date
Contribution li Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID !Candidate Amount Raiser
3/16/2004I
Wegner, Fredrick None $25.00 X
6215 Pleasant DriveCheck #
6324 Des Moines, IA 50312-1255
3/16/2004I
Winters, Craig G None $500.00 Xi
512 Tuttle StreetCheck #
_ 5462 Des_Moines, IA 50309
3/16/2004 Wolnerman, Michael J None $25 .00 X
422 Glenview DriveCheck #
2861 Des Moines, _ 1A 50312
3/18/2004
-
Coppola, Michael A None $250 .00
4521 Fleur DriveCheck #1944 Des Moines, IA 50321
3/18/2004 Farley, Patrick None $50 .00
4702 University AvenueCheck #
5456 Des Moines , IA 5031 1
3/18/2004 Gerleman, Bruce W None $250.00
303 Locusti
Check# Suite 150
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;Committee Name
I,Gayle Collins for City Council
'Status Filed
Contribution i ContributionDate
Committee ID
Check#
2380
Committee Type Municipal Candidate - CityCouncil
Name and Address of Contributor ' Relationship To 'ContributionCandidate Amount
11000 Walnut Street
Des Moines, IA 50309
Committee ID 13303
04116/2004 01 :15 :06
Statutory Due DateAdjusted Due DateFiled DateAmended Date
4/8/2004
4/15/2004
Received Date
Schedule AContributions
__
_ I
Fund-Raiser
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Page 10 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
3/18/2004 ICI Huser, Geri None $250.00
213-7th Street NWCheck #8671 Altoona, IA 50009
3/18/2004 Jochum, Tom None $500.00
1137-36thCheck #1217 - Des Moines, IA 50311
3/18/2004 Skinner, Ed I None $250.00
PO Box 367Check #
2677 ;Altoona, IA 50009
3/18/2004 Skinner, Lois None $250.00
PO Box 367Check #
7988 Altoona, IA 50009
3/18/2004 Skinner, Robert Bradley None $250.00
1810 Andrews Drivei
Check #,2468 Pleasant Hill, IA 50327
3/19/2004 Dana, Monique None $50.00,,I
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04116/2004 01 :15 :06nn
__
-
-I!Committee Name~Gayle Collins for City Council
Status Filed Committee Type Municipal Candidate - CityCoun cil
Committee ID 13303
Schedule AContributions
Fund-Raiser
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Page 11 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004Amended DateReceived Date
ContributionDate
3/19/2004
ContributionCommittee ID Name and Address of Contributor
Stoffer, Dick
RelationshipCandidate
None
To '(Contribution(Amount
$25.00
5411 PonderosaCheck #
4117 West Des Moines, IA 50266
3/23/2004 Barnes, Evie J None $250.00
615 Park StreetCheck # Suite 30032371 Des Moines, IA 50309
3/23/2004 Barnes, Michael D None $250 .00
615 Park StreetCheck # Suite 300~I32370 ~ Des Moines, IA 50309
3/23/2004 fY ~~Central IA Building & Construction
I!N/A $500.00Trades Council PAC
PO Box 7310Check #3118 Des Moines, IA 50309-7310
3/23/2004 Claypool, Alicia P None $100.00
5754 Gallery CourtCheck#8706- West Des Moines, IA 50266
3/23/2004 Goodwin, William N None $1,000.00
223-49th StreetCheck #
13032 - Des Moines, IA 50312-2144 l
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Committee Name
Committee ID 13303Gayle Collins for City Council
Status Filed Committee Type Municipal Candidate - CityCouncil
04/16/2004 01 :15:06 Schedule AContributions
FundRaiser
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Page 12 of 16
IOWA ETHICS ANDCAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Statutory Due Date 4/8/2004Adjusted Due DateFiled Date 4/15/2004Amended DateReceived Date
ContributionDate
ContributionCommittee
Relationship ToID
Name and Address of ContributorCandidate
ContributionAmount
3/23/2004 Graham, Wayne None $1,000.00
5626 Glen Oaks PointCheck #
5673 West Des Moines, IA 50266-6625
3/23/2004 Margeas, Dr. Robert None $500.00
1056 Polk BlvdCheck #
11 1122 Des Moines, IA 50311
3/23/2004 Margulies, Richard B None $500.00
12100 Westown ParkwayCheck # Suite 22043041 West Des Moines, IA 50265-1539
3/23/2004 Smith, Kari Hillebo None $50.00
300 WalnutCheck # #415186 Des Moines, IA 50309
3/23/2004 Spina, Marilyn ! None $50.00
12545 E . Ovid AvenueCheck #1761 'Des Moines, IA 50317
3/23/2004 Wasker, C.F . None $100.00
4201 Westown Pky.Suite 250West Des Moines, IA 50266-6720
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Page 13 of 16
IOWA ETHICS ANDCAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004
Municipal Candidate - City Amended DateStatus Filed Committee Type Council Received Date
( Contribution Contribution Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate Amount Raiser
3/24/2004 Bierma, Lon _None I $500.p0',
2825 Grand Avenue
j Check # #4022246 Des Moines, IA 50312
3/24/2004 Bookey&Bass-Bookey, Harry &
None $500 .00Pamela
400 Locust StreetCheck # Suite 79012463 Des Moines IA 50309
3/24/2004 Farver, Charles S None $500.00
617 Franklin Place1 Check # Suite 200
;3/24/2004
1014 Pella, IA 502 1 9-1679
Riley, Jr ., Robert G None $100.00
'3121 Dean AvenueCheck #4831 Des Moines, 1A.50317
3/24/2004 Wilson, Jonathan C ' None $100.00i
2924 Druid Hill DriveCheck #201 3 Des Moines, IA 5031 5
3/26/2004 'Flagg, George E None $100.00
13101 Onondaga Point j
Check #2990 Des Moines, IA 50321
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0411612004 01 :15:06 Schedule AContributions
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04/16/2004 01 :15 :06
Page 14 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 I (515) 281-4028
Committee Name Committee ID 13303 Statutory Due Date 4/8/2004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004
Municipal Candidate - City Amended DateStatus Filed Committee Typ
Council_ Received Date
[Contribution ! Contribution
_
Name and Address of Contributor Relationship To Contribution Fund-Date Committee ID Candidate /Amount Raiser
3/26/2004 Hubbell, III, James W None $500 .00
9286 Harding Street j
Check #
10140 Indianola, IA 501 25
3/26/2004 F Nesbit, Michael J & Maria H . None $300.00
PO Box 12039Check #
7136 Des Moines, IA 50312-9401
3/26/2004 Schroeder, Larry J None $500.00
4537 51 st StreetI
Check #6486 Des Moines, IA- 50310 _-
3/30/2004 Ainsworth, Leonard L None $250 .00
108 N . Hickory BlvdCheck #0161 33 Pleasant Hill, IA 50327
3/30/2004 Hedberg, Mark T None $500.00'
840 Fifth AvenueCheck #5000010177 Des Moines, IA 50309
3/30/2004 Nelson, Steven L None $250.00
5300 Shriver AvenueCheck#
_ _ cash - Des Moines , IA 503 12-2044
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Committee Name
Committee ID 13303Gayle Collins for City Council
04/16/2004 01 :15:06
Fund-Raiser
Schedule AContributions
Statutory Due DateAdjusted Due DateFiled Date
4/8/2004
4/15/2004
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Page 15 of 16
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 I (515) 281-4028
Status Filed
Contribution ContributionDate Committee
Committee Type Municipal Candidate - CityCouncil
IDName and Address of Contributor
Amended DateReceived Date
Relationship To ~ContributionCandidate (Amount
3/31/2004 Brick, James E None $500.00
550 39th StreetCheck # Ste. 200
II8526 Des Moines, IA 50312-3529
, 3/31/2004 Civil Servants Political Education N/A $1,000.00League
12121 DelawareCheck #1055 Des Moines, IA 50317
3/31/2004 Lillis, William J None $100 .00
3000 Patricia DriveCheck #
12565 I Des Moines, IA 50317
(13/31/2004T 'Malone, John P None $250.00'
236-51st StreetCheck #1713 Des Moines, IA 50312
3/31/2004 Westergaard, Linda C None $100.00
4009 E . 23rd StreetCheck#13792 Des Moines, IA 50317
4/2/2004 Moss, Terry None $100.00
1746 Burr Oaks DriveCheck #'7317 West Des Moines, IA 50266
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Committee Name
Committee ID 13303Gayle Collins for City Council
Status Filed
ContributionDate
ContributionCommittee ID
Committee Type Municipal Candidate - CityCouncil
04/16/2004 01 :15:06 Schedule AContributions
Statutory Due DateAdjusted Due DateFiled DateAmended DateReceived Date
4/8/2004
4/15/2004
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1(515) 281-4028
4/2/2004 :~q,27.7
Check #
1234
Sheet metal Contractors of Iowa N/A
1454 30th StreetSuite 201
I West Des Moines, IA 50266-1312
$150.00
Total Regular Contributions $16,100.00Total Fundraiser Contributions $4,843 .00Grand Total All Contributions $20,943.00
For Instructions, See Back of Form
CONTRIBUTIONS -- MONEY TAKEN IN(Including candidate's personal funds)
COMMITTEE NAME (Must be same as on Statement of Organization)
Gayle Collins for City Council
Reset Form
STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATIONNUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA ETHICS AND CAMPAIGNDISCLOSURE BOARD.
CAUTION: Section 68B.32A(6), Iowa Code, prohibits the use of information copied from reports and statements for soliciting contributions orfor any commercial purpose by any person other than statutory political committees .
SUB-TOTAL
TOTAL (if lastpage of this schedule)
' Disclosure law requires candidate committees to disclose the relationship of any relative making a contribution to thecommittee. Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (relatives by
4
4marriage) .
If surname 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)
SCHEDULE
A MONETARY(Rev . 07/03) RECEIPTS
Q CHECKTHIS BOX IFAMENDING FORM
DATE PAC ID NUMBER NAME ANDADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT IF FORRECEIVED (if applicable) TO CANDIDATE` RECEIVED FUND-(MM/DD/YR) ANDPAC CHECK (if applicable) RAISER
NUMBER INCOMEID#
Fundraiser at Java Joes$150.003/16/04 CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
ID#
CK#
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Schedule B : Expenditures -- Money Spent From Committee AccountCommittee Name
Committee ID 13303Gayle Collins for City Council
Status
Filed
Committee Type Municipal Candidate - City_ f'_nmnril
Expenditure Expenditure
Expenditure Name & Address
PurposeDate Committee
3/8/2004
1 N/A
3/8/2004
,3/11/2004
3/16/2004
Check #
n/a
N/A
Check #
no #
N/A
Check #i no #
Carter Printing
N/A
(Java Joes
1739 East Grand Avenue
Des Moines, IA 50316
Carter Printing
1739 East Grand Avenue
Des Moines, IA 50316
Carter Printing
1739 East Grand AvenueCheck #
no #
Des Moines, IA 5031 6-
214 4th Street
Des Moines, IA 50309
04/16/2004 01 :15:06
Schedule BMonetary Expenditures
Statutory Due DateAdjusted Due DateFiled DateReceived Date
4/8/2004
4/15/2004
Amended Date
Printing & Reproduction
$375.24
invoice 79141letterhead, envelopes,cards
Printing & Reproduction
invoice 79125photocopies
Printing & Reproduction
invoice 79182yard signs, stickers,postcards
Fund-Raiser (Holding)
snacks, plates,napkings, cups andwater set-up for
Sch-B
ExpenditureAmount
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$29.68I'I
$1,398.14
$42.40
IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1 (515) 281-4028
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Committee Name
Committee ID 13303Gayle Collins for City Council
Status
Filed
Committee Type Municipal Candidate - City_ . Cnuncil
I
Check #no number
1165 Second Avenue
Des Moines, IA 50309
04/16/2004 01 :15 :06
Schedule BMonetary Expenditures
Statutory Due DateAdjusted Due DateFiled DateReceived Date
4/8/2004
4/15/2004
Amended Date
Postage cost for mailer
T-
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 104 1 DES MOINES, IA 50309 1(515) 281-4028
Expenditurei Date
toCommittee Expenditure Name &Address Purpose 'Expenditure
(Amount
3/16/2004 N/A Henry, Mitch Professional Fees $150.00
campaign managementfees
1900 MLK Jr . ParkwayCheck#
'cash Des Moines, IA 50314
3/17/2004 N/A Carter Printing Printing & Reproduction $222.60
invoice 79256
1739 East Grand Avenuecampaign cards
Check #no # Des Moines, IA 50316
3/18/2004 N/A 11 Mailtech, Inc Postage, Shipping,$1,027.71Delivery
Mail processing fee for"Let's Flip the Switch"
712 E. 2nd Street flyerCheck #
~no # Des Moines , IA 50309
3/18/2004 N/A I United States Postal Service Postage, Shipping,$2,346 .83 ;Delivery
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Committee Name Committee ID 13303
14015 Muskogee AvenueCheck #no number
Des Moines, IA 50312
04/1612004 01 :15 :06
Schedule BMonetary Expenditures
Statutory Due Date 4/8/2004
Reimbursement forpurchase of 23 centstamps for postcard
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 i (515) 281-4028
~I Gayle Collins for City Council Adjusted Due DateFiled Date 4/15/2004Received Date
Status Filed Committee Type Municipal Candidate - City Amended Date_-Cnunnil
TExpenditure Expenditure
Expenditure Name & Address Purpose ExpenditureDate Committee 'Amount
3/23/2004 N/A Davitt Photo Alliance Photography $150.00
campaign photos1 1520 Walnut
Check #no # Des Moines, IA 50309
3/23/2004 N/A Henry, Mitch Professional Fees $237.00
campaign management
1900 MLK Jr. Parkwayfees
Check #
no number Des Moines, IA 50314
3/23/2004 N/A I111 TL &Associates Professional Fees $3,000.00
telemarketing services1100 Euclid Ave.
Check #
no number Des Moines, IA 50313
13/24/2004 N/A Curran, Mary K Postage, Shipping,$460 .00Delivery
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Committee Name
Gayle Collins for City Council
Status
Filed
Committee Type Municipal Candidate - City__
-
Expenditure_Expenditure
Expenditure Name & Address
PurposeDate Committee
3/26/2004 N/A
3/28/2004
3/30/2004 N/A
3/31/2004
1 N/A
N/A
Dahl's Food Mart
Check #
1001
Check #
Henry, Mitch
1900 MLK Jr . ParkwayCheck #no #
Des Moines , IA 50314
!purchase of 23 centstamps for postcard
3425 Ingersoll Avenue
mailing
Des Moines, IA 50312
West Bank
PO Box 65020
Committee ID 13303
West Des Moines, IA 50265-0020
11739 East Grand AvenueCheck #
1003
Des Moines, IA 50316
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Schedule BMonetary Expenditures
Statutory Due DateAdjusted Due DateFiled DateReceived Date
Amended Date
4/8/2004
4/15/2004
Professional Fees
campaign managementfees
Advertising
Bank Charges
check printing charges
invoice 79300yard signs and wires
ExpenditureAmount
$150.00
$69.00 111
$15.50
Carter Printing
Printing & Reproduction
$1,050 .46
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 i (515) 281-4028
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Schedule BMonetary Expenditures
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 i (515) 281-4028
Committee Name Committee ID 13303 Statutory Due Date 4/8/2_004Gayle Collins for City Council Adjusted Due Date
Filed Date 4/15/2004Received Date
', Statu s Filed Committee Type Municipal Candidate - City Amended Date
Expenditure ExpenditureExpenditure Name & Address Purpose Expenditure
Date Committee Amount
( 3/31/2004 1N/A Carter Printing Printing & Reproduction $262.88'
Iinvoice 79357
1739 East Grand Avenue4x6 cards - apr 13
Check #
1004 Des Moines, IA 50316
4/1/2004 N/A ~TL & Associates Professional Fees
_
$3,000.00 I
I
( telemarketing fees100 Euclid Ave .
Check #
Des Moines, IA 50313
4/1/2004 N/A Jasnos, Jason Professional FeesI
_
$250.00
iPayment for email list
756 17th Street and blitz services
Check #
Des Moines, IA 50314
4/2/2004 N/A ( Carter Printing Printing & Reproduction j $169.60
:invoice 79417campaign cards
1739 East Grand Avenue 2/2-reorderCheck #1005 Des Moines, IA 50316
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Schedule B^^
Monetary Expenditures
,Committee Name
Committee ID 13303
IGayle Collins for City Council
Status
Filed
Committee Type Municipal Candidate - Cityrm,nnii
ExpenditureDate
ExpenditureCommittee Expenditure Name & Address
Statutory Due DateAdjusted Due DateFiled DateReceived Date
4/8/2004
4/15/2004
Amended Date
Purpose ExpenditureAmount _
Total Amount
-~-$1 4,407.04
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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD 1514 EAST LOCUST STREET, SUITE 1041 DES MOINES, IA 50309 1 (515) 281-4028