10!15!

'004 09 :08 1319,832799 RFSkl AtID CO PAGE 01

FOR INSTRUCTIONS, SEE BACK OF FORM 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
Miller for Iowa Housc Comm . #
IMPORTANT, Indicate by* type of committee you are reporting for: Logged In !~[L
( 1 )Statewide/Legislative/Judge 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 (8 )County PAC ( 9 )City PAC ( 10 )School Board or Other Political Computer
Subdivision P AC -( 11 ) Local allot I ss ue Audited
CANDIDATE COMMITTEES ONLY :
Candidate Name Political Party (if appiicable)
Ronald Miller
OCT 5 2004
Democrat
Late reports are subject to
possible civil and criminal
Office Sought District (if Senate or House) penalties .
Housc Rcprcscnativc -~ - - 21

31 q-a83°3a.~d -15-0
SIGNATURE O PERSON FILING REPORT TELEPHONE DATE SIGNED

October 19 Disclosure
I AM FILING A REPORT FOR (1) ELECTION l(2)NON-ELECTION YEAR,
(report date) Indicate by # 0

Local Committees . enter Date of Election

CICHECK IF AMENDMENT TO REPORT DATED

D Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 . County & Local Committees, enter County in
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 3,748 .18
of 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) . . . . . . . 6,765 .00
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . , ., . . ., . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H ; Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
e_dule H appliesto Candidates' Committees Ohl
SUB-TOTAL . . . . . S 10,513 .18
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule 5 : Expenditures total (Attach Schedule 13) ("also see debts and loans below) .  . 5,459 .47
Schedule F : Loan Repayments total (Attach Schedule F) . . .  .  , .  . . . . . . . . . . ., . . . . . ., . . .  .  ,
CASH ON HAND at the end of this reporting period (if final report balance must
5,053 .71
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
I'll . . . . . . . . . ... .. . . . . . . . . . . . . . . . . . ., . . ., . . . .$

""UNPAID BILLS (From Schedule D -Attach Schedule D) . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .  , .  ., ., 5

'IN KIND CONTRIBUTIONS (Frpm Schedule E -Attach Schedule E) . . . . . . . . . . . ., . ., . . ., . . . ., . . . . . . . . . . . . . . . ., . 75 .00
'"'OUTSTANDING LOANS (From Schedule F-Attach Schedule F) .  , ., , . . ., . . . . . . . . . .  , .,_ .$ 2.000 .00
CANDIDATE COMMITTEES ONLY :
CONSULTANT BREAKDOWN (Schedule G Attached?)
VALUE OF CAMPAIGN PROPERTY (From Schedule H : Attach Schedule H) $
101151'2004 09 :08 13192832799 RFS!J Af1D CO PAGE 02

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN
(Including candldaln's personal funds)
(Rev . 07/03) I RECEIPTS

CHECK THIS BOX IF

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

Miller for Iowa House

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST 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

RECEIVED (ifapplicable) TO CANDIDATE' RECEIVEC
(MMIDDYR) AND PAC CHECK (if applicable)
NUMBER
ID#
John Frost.
7-16-04 410 Roxannc Drive $100.00
CK# 4329
Fairbank, Iowa 50629
ID#
6129 Heavy Highway PAC
7-19-04 2415 Ingersoll Ave 250.00
CK#
1857 Des Moines, Iowa 50312-5233
ID#
Irma Hopkins
7-21-04 CK# Box 668 15 .00
2930 ,Tesu , Iowa . 50648
ID# 6()84
Iowa Suite UAW
7-26-04 27005 River Rd 500.00
CK# 732
Dcs Plaines. IL 60018
ID#
Bonita Davis
7-26-04 207 Allcrton Ave Sw 25 .00
CK#
7543 Tndependence,Iowa 50644
I D#
Marry Dodge
7-31-04 307 Terrace Drive 20 .00
CK# 1472
Independence, Iowa 50644
ID#
Debra T3rase
7-29-04 1217 110th St 50 .00
CK# 4368
Fairbank, Iowa 50629
ID#
Dick Cameron
8-1-04 CK# cash 1372 Otterville Blvd 40 .00
led endenec, Iowa 50644
ID#
Pass the hat
8-1-01 CK# 155.00
cash
ID#
Marry), Klotzbech
5-1-04 CK# 401 3rd Ave SW 30 .00
7655 Independ encc,I owa 50644
SUB-TOTAL
~~1g5
TOTAL (if last page of this schedule)
S
Disclosure law requlrCs candidate commlitees to disclose the relationship of any relsltive making s contribution to the
committee. Reletlonship must be shown to the third degree Or consanguinity (blood relatives) and affinity (relAllves by
marriage) 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)
10!15/2004 09 :08 13192832799 RF&4 AND CO PAGE 0 .3

For Instructions, See Back of Form SCHEDULE

CONTRIBUTIONS -- MONEY TAKEN IN

A I MONETARY
(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
Miller for Iowa Hou9e

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE) LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUN18ERS 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 solldtlng contributions or
for any commercial purpose by any person other than statutory political committees .

DATE PAC 10 NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT d IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MM/DD/YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID*
Ed Zimmer
8-I-04 $ 15 .00
CK# gT4g 501 2nd Ave NE
Independence, Iowa 50644
I DO
Richard Shillinsglaw, ht .A .
8-1-04 508 3rd Ave SE 100 .00
CK#
418 Independence, Iowa 50644
ID*
Lea Dy Ave
8-1-04 417 3rd NE 20 .00
CK#
13411 El
Independence, Iowa 50644
ID#
David Neil
8-1-04 CK# 30 .00 ,/
932413ishop
1972 LaPorte Citv, Iowa 50651
10#
Karen Connell
8-1-04 CK# 20 .00
312 2nd Ave SW
4818 El
Independcncc,Iowa 50644
ID#
Jeanette Randall
$-1-04 706 3rd avc Sw 15 .00
CK# 5012
Independence, Iowa 50644 El
1D#
Wrn . Reedy
8-1-04 CK# 3046 Evcrly Ave 50 .00 f
3939 Brandon, Iowa 52210
I D#
Marty Mahoney
8-1-04 702 4th St NE 15,00
CK# 8009 El
Independence, Iowa 50644
I D#
Diane Curry
8-1-04 CK# 610 2nd St NW 40 .00
11326 El
Ind endence Iowa 50644
ID#
Gladys Peters
5-1-04 CK# 407 3rd S1 30 .00 ,/
4962 Washburn .Iowa 50706
SUB-TOTAL

TOTAL (if last page of this schedule)

Disclosure law requires candidate committees to disclose the relationship of any relative making a contrihution to the
committee . Relationship must be shown to the third degree or consanguinity (blood relatives) end aHinlly (relatives by
marriage) If surname of contributor is the same as candidate, but there Is no Page _ of
familial relationship, enter "riot applicable" in the relationship column . (for Schedule A)
10115/21 004 09 :08 1319'21332799 RFSA AHD t.0 PAGE 04

For Instructions, Sao Back of Form SCALE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07,03) RECEIPTS

D
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must bo same as on Statement of Organization) AMENDING FORM
Miller for Iowa House

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

CAUTION: Section E8B.32A(6), Iowa Code, prohibits the use of Information copied from reports end statements for soliciting contrlbutlons or
for any commerdal purpose by any person other than statutory political committees .

DATE PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT v IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD,'YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
I
DA
Danny Hinde
$ 100 .00
5-1-04
CK# 5407 612 4th Ave NE
Independence, Iowa 50644
I D#
Pass the hat
3-8-04 25 .00
CK#
cash

ID#
AG Lakc
25 .00
8-4-04 CK# 515 7th St SW
3257 Ind endencc Iowa 50644
ID#
Frances TRebon
3-6-04 10 .00
CK9 1534 Baxter
7451
Fait- bank, Towa 50629
I D#
Beverly Taylor
8-7-04 2396 232nd St 30 .00
CK# 5951 Indcpcndcncc,Iowa 50644
ID#
Dianna Osaman
8-15-04 CK# 311 st AVC 25 .00
8963 Rowley, Iowa 52329
I DA
Dana Irvine
5-20-04 1979 105th St 25 .00
CK# 4143
Gelwein, Iowa 50662
ID#
6021 Credit Union Political Action Committee
8-20-04 3737 Westown Parkway 5(10.00
CK# 1773
West Des Moines, Iowa 50266
I D#
Rebecca Fauser
8-20-04 508 Cedar Drive 25 .00
CK#
2427 Fairbank . Iowa 50629
I D#
Darlcnc Nus
8-20-04 CK# Box 36 25 .00
3558 Fairbank, Town
. 50629
SUB-TOTAL
S -7 '? O
TOTAL (if last page of this schedule) 1
Disclosure law requires candidate commmons to disclose the relationship of any relative making e contribution to the
commit!" . Relationship must be shown to the third degree of consanguinity (blood relatives) and affinity (rlntives by
marriage) If sumarne 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)
10/15/2004 09 :08 13192832799 RFSI,J AND CO PAGE 05

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
Miller for lows I4ousc

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION!
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN, A LIST 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 ,/ IF FOR
RECEIVED (ifapplicable) TO CANDIDATE' RECEIVED FUND-
(MPnIDDlYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Kathleen Frame
5-21-04 $15.00
CK# 6021 Box 251
Fairbank, lown 50629
I D#
Barb Kastli
8-21-04 Box 304 5.00
CK#
4515
Fairbank . Iowa. 50629
I D#
Robert Bellis
8-21-04 25 .00
CK# 610 W. Main
9339
Fairbank . Towa 50629

E:1
I D#
Marv Bellis
8-21-04 25 .00
CK# 204 Grove St .
6444
Fairbank, Iowa 50629
ID#
6060 In Committee on Political Education
Q-21-04 2000 Walker Suite A 200.00
CK#
2300
Dcs Moines, Iowa 50317
I D#
Pass the hat
8-26-04 265.Of) ,/
CK# cas
h

EE
ID#
Janice Vonvald
8-26-04 Box 411 20 .00
CK#
1503
Fairbank, Iowa 50629
ID#
Tom and Judy Bochmc
8-26-04 1371 BAxtcr AVc 20 .00
CK# 5443
Fairbank, Tnu, a 50629
10#
Win Hickey
5-26-04 CK# 314 6th A.vc SW 25 .00
6403
Indc cndcnce Iowa 50644

17]
ID#
Wilma Welsh
8-26-04 Box 249 25 .00
CK# 9865
Fairbank, Iowa 50629

SUB-TOTAL

TOTAL (if last page of this schedule)

- Dlsdo~uro law requiree candidate committees to dlaclogs the relationship of any relative making e contribution to the
committee. Relationship mual be shown to the third degree of consanguinity (blond relatives) end affinity (relatives by
marrisge) . If surname of contributor is the same as candidate, but there Is no
familial relationship . enter "not applicable" in the relationship column .
Page - ~
4 of
(for Schedule A)
10/1512004 09 :08 13192832799 RFSh,I AfID CO PAt3E 05

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev, 07/03) RECEIPTS
(Including candidate's personal funds)

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

a CHECK THIS BOX IF
AMENDING FORM

Miller for Iowa House

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMMITTEE), LIST THE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN A LIST OF IONUMBERS IS AVAILABLE- FROM THE IOWA ETHICS AND CAMPAIGN
DISCLOSURE EOARD.

CAUTION: Section 6813,32A(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 J Ir FOR
RECEIVED (If applicable) TO CANDIDATE' RECEIVED FUND-
(MMiDDIYR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Robert Shields
9-26-04 $25.00
CK# 9035 301 Washington St VW
Fairbank, Iowa 50629
ID#
Dennis Frost
8-26-04 503 W Main 25 .00 ,/
CK#
3640 Fairbank, Iowa 50629
ID#

12]
Rudy Kubik
8-26-04 2277 Iowa Ave 100.00
CK#
6478
Independence . Iowa 50644
ID#
R.O . Link
8-26-04 25,00
CK# 703 5th St SE
2348
Oelwein, Iowa 50662
ID#
Shirley Duffy
11-24-04 102 S . Walnut 10 .00
CK#
12415
Fairbank . Iowa 50629
ID#
Ralph Higgine
606 2nd St NE 10 .00
5-28-04 CK#
'1406 Fairbank, Iowa 50629
ID#
Glenda Buscy
8-31-04 Fairbank, Iowa 50629 20 .00
CK#
1913

10#
Penny Collcr
9-1-04 306 Rhonda Rd 15 .00
CK#
603
Fairbank, Iowa 50629

16139

El
United Steel Workers of America
9-12-04 CK# 125 NW Broadway 100 .00
2207
Des Moines Iowa 50313
ID#
6113 AFSCME'Iowa Council 61
9-15-04 CK# 4320 NW 2nd Ave 250.00
6113 Dcs Moines, Iowa 50313

SUB-TOTAL

TOTAL (if last page of this schedule)

' Dlaciosure I»w roouires candidate comm ;ttoos 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 (raistives by
marriage) . If surname of contnbuter Is the same as candidate, but there is no Page of
familial relationship, enter "not applicable' in the relationship column,
(for Schedule A)
10/1512004 09 :08 13192832733 RFSkI AND CO PAGE 07

For Instructions, See Back of Form SCHEDULE

A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07103) RECEIPTS
(Including candidate's personal funds)
CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM
Miller for Iowa House

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

CAUTION : Section 688 .32A(6), Iowa Code, prohibits the use of Information copied from reports and statements for soliciting contrlbutlons or
for any commercial purpose by any person other than statutory political committees .

DATE- PAC ID NUMBER NAME AND ADDRESS OF CONTRIBUTOR RELATIONSHIP AMOUNT J IF FOR
RECEIVED (if applicable) TO CANDIDATE' RECEIVED FUND-
(MMIDD,'YR) AND PAC CHECK (if applicable) RAISER
NUMBER INCOME
ID#
Bev Crumbs-Gcsmc
9-15-04 700 Linden St $ 50 .00
ID # 1904
Decoralt, Iowa 52101-2012
ID# 15`0
Heartland Regional Council of Carpenters
9-15-04 201 E 3rd St 504.00
CK# 000 1,Z07
Sterling, 111 . 61081-3945
I D#
Donald Weber
9-23-04 CK9 1324 4th St 20.00
5350 Jcsu ,Iowa 50648
IDI#
8026 IBEW Educational Committee
4-27-04 CK# 1 125 150th St NT, 100 .00
07360
Washington . DC 20005
ID# Qei ..IaQr hu+rs+
G-A-oLl CK# 3ql? Iilekl - s P,Iud .
D, S_ C) D
CttJtor Fall,-, Z al Sprof3
ID# T_-7 0.rd Gret4 boCh
1411 3rd St Pp . Boy 133
10-I-Uy CK#
7bb3 15. o0
+u~lie ~~ Sbc~3~f
ID#
(p04(~ J11 .S+i ce -For A i I
Fn r m e rij "r-e- H0 .1 F T u s 4
10 CK#
ol.l$ &K Aue s+E TIa~ 0 . 00
1D#
t .Ulf1 HfcU j
(ft- Ave
Ib -3 .pc~ CK# ~ 3114 . shy
a5- Op
ZA 50(aL44
ID#
Gaurd 1Jea I
CK# ) 43aq (~t'shoF
IO'3-a~l Sb- 00
(~(0(0 La . ~1 a 5o U S
C, L .
I D# '

~U- 3-Oy CK# 6; -r! O . UU

SUB-TOTAL

TOTAL (if last page of this schedule)

' Disclosure law roquires 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 rolatives) and efflnlly (relatives by
marriage) , If surname of contributor Is the same as candidate, but there Is no
Page _-L of
familial relationship, enter "not applicable" in the relationship column . (for Schedula A)
 10/15/2004 09 :08 1319283799 PFSA AtiD CO PAGE 08

00000' -

SCHEDULE
For Instructions, See Back of Form
A MONETARY
CONTRIBUTIONS -- MONEY TAKEN IN (Rev . 07 , 03) RECEIPTS
(Including candidate's personal funds)
U
NJ CHECK THIS BOX IF
COMMITTEE NAME (Must be same as on Statement of Organization) AMENDING FORM

M111cr for Iowa House

STATE CANDIDATES NOTE : IF A CONTRIBUTION IS RECEIVED FROM A STATE PAC (POLITICAL ACTION COMN11TTEE), LISTTHE PAC IDENTIFICATION
NUMBER AND THE PAC CHECK NUMBER IN THE DESIGNATED COLUMN . A LIST OF ID NUM8FRS 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 .

o
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# =LA 7777777 i qr+j

"
S
~ O S(d101 ~~tsL<tr p' -
it) (o , D~ CK# OcWy-~~ $l U(~
es I~lofnP~, .~A 5~3a1- a8~1
ID# ~~ O (o Z-FA -PAC (YA S+ra-B rit . rr
~rp1 S4 . p41i+dal PC4,on
CK# "1'l -7

f 31 1$ $ ~! A So30
I D#
Te-Irr y Mc 6ir~. Ae

1() -`l -U ~ CK# c~~ C .alt:e sl cue, ~D~,

r- I
ID#

- ~- 0~ CK# ((rya. Sr.r~IGna A~~ ~J

.1 SD
lD# Lo (,ij P0C
E . L r) t:aasa S+ . .3ro~
CK# 7 jai
Jb1 0, 3~ Sn3r, 9 0310 0
In_c
ID# aSO SO rL-
BIctICK HOLk)r (Ar\l a1, Counc~ I - ( c~

CK# a3c~ 1(n%S 6tcrte(\ A,,c (Pr)I,+rCr),(E~u M~

1o-13-dy a 0~
Wx4Prl`oo s l D unC~~
ID#

CK#

ID*

CK#

ID# --

CK#

ID#

CK#

SUB-TOTAL

TOTAL (if last page of this schedule)

'Disclosure law requires candidate commltlees to disclose the relationship of any relative making a contribution to the
committee. Relationship must ba shown to the third degree of consanguinity (blood relativeg) and affinity (relatives by
msrrlage) If surname of contributor is the same as candidate, but thero is no Page 7 _ of
familial relationship, enter "not applicable" in the relatlonshlp column . (for Schodule A)
10/15/2004 09 : 013 13192832799 FF'31VI AtID C I0 PAGE 09

FOR INSTRUCTIONS . SEE BACK OF FORM `eset Fbzr~: ~; SCHEDULE

B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (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 El 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)

Millcr for Iowa Hottse

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (If applicable) (Disbursement) WAS MADE
(MM/DDwR) AND PAC
CHECK
NUMBER
ID#
La Fortc City Printing newspaper ad
7-15-04 2 313 Main Strcct 31,04
CK# 1Q1
LaPorte City, Town 50651

ID#
Carter Printing campaign cards
7-15-04 1739 T-, Grand Ave 310 .80
CK#1p13
Des Moines, Iowa 50316

ID*
Kerns Company pencils
7-15-04 1stAvcNE 1,318.82
CK#1014 clwcin, Iowa 50662

ID#
U.S . Post office 3 rolls stamps
7-15-04 111 .00
CK#1015

I D#
U .S . Pest Officc 4 rolls stamps
5-10-04
1 1016 148 .00

ID#
Merle Wilson paint and supplies for signs
8-10-04 1.051 175th St
CK#1 017 41 .44
esup, Iowa 50648

ID#
Kerns Company yard signs
8-18-04 CK# ' 1 `t Ave NE
101 Q 857 .47
Oe)wcin, Iowa 50662

1D#
Iowa Democratic Party donation
R-26-04
cK#1019 250 .00

SUB-TOTAL
$306, 9,,S - 7
TOTAL (if last page of this schedule)

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY:

Purchases of certain campaign property costing 5500 or more must also be inventoried on Schedule H. (Refer
to Schedule H instructions .)
Expenditures to pemonslontities providing consulting, advertising. fund-raising, polling, msnsgglng, organizing
services must Also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made oy the personlentity on
behalf of the candidate's committee. (Refer to
Schedule G Instructio ns and Iowa Code 68A,402(3)(i) .)

(for Schedule B)
1011512004 09 :08 131322932799 RFSW AHD CO PAGE 10

FOR INSTRUCTIONS, SEE BACK OF FORM I RIB" f` ~f ISI SCHEDULE

EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT B MONETARY

(Rev . 07/03) 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 Organlzatlon)

Miller for Iowa House

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#
Joan Miller reimburse - tv ad, parade material,
9-1-04 Box 34 sign material, meat for fund raiser, 166 .63
CK# 1020 Fairbank, Iowa 50629 hall rental etc . . $

ID#
Joan Miller reimburse - campaign shirts, parade
9-1-04 ox 34 supplies, banners, sign material etc... 233 .73
CK#1021
airbank, Iowa 50629
ID#
Carter Printing campaign cards and post cards
9-7-04 1739 Grand Avc 471 .70
CK#1022 Des Moines, Iowa 50316

I D#
Mcrlc Wilson paint and supplies for signs
9-15-04 1051 175th St. 14 .08
CK#1023
Jesup, Iowa 50648
ID# U .S . Post Office postcard stamps
9-20-04 230 .00
CK# 1024

I D#
U .S . Post Office postcard stamps
9-23-04
CK#1025 299 .00

ID#
Jesup Citizen Herald newspaper ad
9-23-04 930 6th St Box 545
CK# 1026 90 .00
Jesup,Iowa 50648
ID#
Dunketton News ncurspaper ad
9-23-04 11 Big Jinn Court
CK# 107
1027 72 .00
unkerton, Iowa 50626

SUB-TOTAL $
TOTAL (iflast page
/E21
of this schedule) $

THIS BOX APPLIES TO CANDIDATES' COMMITTEES ONLY :

Purchases of certain campaign property coating $500 or more must also be inventoried on Schedule H. (Refer to Schedule H
instructions .)
Expenditures to porsonslentlties providing consulting, adverbsing, fund-raising, polling, managing, organizing services must
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity also be detail itemized on
Schedule G instructions an d Iowa Code 68A .402(3)(1) .) on behalf of the candidate's committee (Refer to

(for Schedule 13)

10/15/2004 09 :08 13192832799 RFSIWI AND CO PAGE ?1

FOR INSTRUCTIONS, SEE BACK OF FORM SCHEDULE

B MONETARY
EXPENDITURES -- MONEY SPENT FROM COMMITTEE ACCOUNT (Rev, 07/03) EXPENDITURES

STATE PAC COMMITTEES: NOTE : FOR CONTRIBUTIONS MADE TO STATEWIDE OR LEGISLATIVE

CHECK THIS BOX IF
CANDIDATES, LIST THE CANDIDATE IDENTIFICATION NUMBER IN THE DESIGNATED COLUMN AND THE
PAC CHECK NUMBER FOR EACH EXPENDITURE A LIST OF ID NUMBERS IS AVAILABLE FROM THE IOWA AMENDING FORM
ETHICS 8 CAMPAIGN DISCLOSURE BOARD

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

Miller for Iowa House

CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT

DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MMIDD/YR) AND PAC
CHECK
NUMBER
ID#
Oelwein Register newspaper II
9-23-04 Box 511 $ 364 .59
CK# 1025 Uelwcin, Iowa 50662

I D# U. . Avs+ Q f ~~ ^.~
pUS +o Qe f :~~-l'! M FS ~,n r
ri CK# ~Uaq
ID# Ror% ftllo-
Goy
ID-(D-0`I CK# IC3O CIA 6It. -Ii- U t^rd 3S . (30
jy
zA Sma
ID# (,Uln~l~rap , titt 4.)S

lo'-boy CK# 103 aox 9 a `?a . 0 O

2l hgA r U I .A SO c~ a
ID#
(,(S . P nS4 r) ~ ' c .~ t. . R M S
I CK# (~3a P
Ibis Lr~ Pnr-k Prllr\4i'n3

I. CK# -,~ 313 MQtn

10 .>-1 ~~ c -7~ . COQ
La (I C.t t, T.A ~xvs i
ID#
koMG I I Rc~~~
Io 13r C)~ C K#j03~~ fox aal ~~c~ ; o ids I(~D-SGT
Al l
ID#

CK#

SUB-TOTAL $ I
TOTAL (iflast page of this schedule) $ ,'

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 personsientltles providing consulting, sdverlising, 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 personlentity on behalf of the candidate's committee. (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)

(for Schedule e)
10/1512004 09 :09 13192832799 RFSW ACID CO PAGE 12

FOR INSTRUCTIONS, SEE BACK OF FORM

I
SCHEDULE
E IN KIND
COMMITTEE NAME (Must be some as on Statement of Organization) (Rev .06(97) CONTRIBUTIONS
Miller for Iowa House
O CHECK THIS SOX IF
AMENDING FORM

DATE RELATIONSHIP DESCRIPTION ESTIMATED J IF FOR

RECEIVED NAME AND ADDRESS TO CANDIDATE OF IN KIND FAIR MARKET FUND-RAISER
MMIDDIYR) OF CONTRIBUTOR '(If applicable) CONTRIBUTION VALUE CONTRIBUTION

Kerns Company amount taken off $ 75 .00

3-11-04 7 I si. Ave NE total of yard sign
Oclwcin, Iowa 50662 l~TrtM

F7
El

71

F7

0
SUB-TOTAL

TOTAL (if last

page of this
schedule)

`Disclosure law requln:s candidates to disclose the relationship of any relative making an In kind
committee . Relationship must be shown to the third degree of consanguinity (blood
contribution to the Page ~_ of I i
relatives) and affinity (relatives (for Schedule E)
by marriage) . (See Page 2 of forms packet .) It surname of contributor
Is the same as candidate, but there Is no
famiiiel relationship, enter "not applicable" in the relationship column .
FOR INSTRUCTIONS . SEE BACK OF FORM
SCHEDULE

COMMITTEE NAME(Must be sarrme as on Stafemeal of Organization) F LOANS

(Rev 07103) RECEIVED
Miller for Iowa House
& REPAID

NOTE : This schechAe reports money loaned to the committee which is deposited in the committee account CHECK THIS BOX IF
2'000.00 AMENDING FORM
TOTAL UNPAID LOANS FROM LAST REPORTING PERIOD $

PART I - MONETARY LOANS RECEIVED THIS REPORTING PERIOD PART 11- MONETARY LOAN REPAYMENTS MADE THIS REPORTING PERIOD
(Original source of loan, such as a bank, must be shovm if a third patty' is (Loans forgiven must be reported on Schedule E - In-khd ContnDylOns.)
involved Induce loans from candidate's personal funds)
DATE NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT DATE PAID NAME AND ADDRESS OF LENDER RELATIONSHIP AMOUNT
RECEIVED (include Endorsers Name, If Applicable) TO CANDIDATE OF LOAN (f,1MIDDIYR) (Include Endorsers Name, If Applicable) TO CANDIDATE' REPAID
(tAWDDNR I(A livable' II A livable
S 3

TOTAL (PART I) TOTAL CASH REPAYMENTS (PART It)

From Schedule E-TOTAL LOANS FORGIVEN

TOTAL OUTSTANDING LOANS END OF REPORT PERIOD 2,000.00

S

'Disclosure law requires candidate committees to disclose the relationship of any relative
making a contribution to the committee . Relationship must be shown to (he third degree of
consanguinity (blond relatives) and affinity (relatives by niamage) . If sumame of contributor is
the same as candidate, but there is no (amiiial relationship, enler'not apprrcable" in the
relallowhip column when it applies . Page l of I
(for Schedule