-LA

i DWADSURE BOARD

' FOR INSTRUCTIONS, SEE BACK OF FORM JAN 4 2002

FORM

DISCLOSURE SUMMARY PAG Rte-+

m I-3 DR-2
(Rev . 01198)
DISCLOSURE
REPORT

For Office Use Only

COMMITTEE NAME (Must be same as on Statement of Organization) Comm . # ) 3 7 !)

MARCELLA FORSYT14F THQMp-,nN Rnu cm4TF gXggjzcjZNmnm~Vg Indexed

Audited
IMPORTANT: Indicate type of committee you are reporting for: [1 Computer C-c---

( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate

( 5 )County PAC ( 6 )Ballot Issue/Franchise Committee ( 7 )County/City Central Committee
( 8 )Support Slate of Candidates - -
641-417-GF72 I 3- aooa
SIGNATURE OF TREASURER (or person fling this report) TELEPHONE DATE SIGNED

Routine Penalties Due For Late Filed Reports Range from $20 to $800

SEE INSTRUCTIONS ON BACK AN D COMPLETE THE FOLLOWING SENTENCE :

I AM FILING A JANUARY 19, 2002 REPORT FOR AN/A (1) ELECTION /(2)NON-ELECTION YEAR .
(report date) Indicate one

-]CHECK IF AMENDMENT TO REPORT DATED

(- Local Committees, enter Date of Election
JUNE 4, 2002
County & Local Committees, enter County in
E] 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 Notice of Dissolution is filed .)
APPANOOSE

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (This is the total
of all monies 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 filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 0 .00
ADD TOTAL MONEY TAKEN IN THIS PERIOD
Schedule A: Cash Contributions total (Attach Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ :2115 .02 C
Schedule F : Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Schedule H: Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .
(Schedule Ha pplies to Candidates' Committees Only)
$215 .02
SUB-TOTAL . .. . . . $
SUBTRACT TOTAL MONEY SPENT THIS PERIOD t
Schedule B : Expenditures total (Attach Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $10 .33
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND at the end of this reporting period (if final report, balance must
be zero) (Attach DR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$, $204 .69

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?) YES NO

VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H)

 CONTRIBUTIONS MARCELLA SCHEDULE A
FORSYTHE THOMPSON
FOR
STATE REPRESENTATIVE
DATE PAC # CK # NAME ADDRESS RELATIONSHIP AMOUNT FUNDRAISER

10/10/01 WILLIAM & LIL PERRY 324 W TYLER, WASHINGTON FRIEND $20.00 NO
10/10/01 PAUL & LINDA THOMSEN 5173 SUN VALLEY DR, DUBUQUE FRIEND $25.00 NO
10/10/01 ROBERT & SHERRI BLOUGH 1201 LIBERTY DR, FAIRFIELD FRIEND $25.00 NO
10/18/01 MARGARET HUTCHINSON 1546 HWY 85, MONTEZUMA FRIEND $10.00 NO
10/26/01 JEAN KELLER 1201 COUNTRY MEADOWS, WAVERLY, IA FRIEND $20.00 NO
11/4/01 LYNN POWELL 518 E OAK, C'VIILE FRIEND $50.00 NO
11/27/01 JOHN & SHIRLEY KLAUS 408 W. HONEY CREEK DR .,MANCHESTER, IA FRIEND $15.00 NO
11/27/01 MISCELLANEOUS FRIENDS $30.00 NO
12/11/01 LOUISE KENNIS 316 E FRANKLIN, C'VILLE FRIEND $20.00 NO
12/31/01 DEERE CREDIT UNION 999 N 18TH, C'VILE BANK-INTEREST 0.02 NO

SUB TOTAL $215.02

TOTAL $215.02
EXPENDITURES MARCELLA SCHEDULE B
FORSYTHE THOMPSON
FOR
STATE REPRESENTATIVE

DATE PAC # CK # NAME & ADDRESS PURPOSE AMOUNT

10/22/01 DEERE CREDIT UNION, CENTERVILLE, IWA BOX OF CHECKS $10.33

SUB TOTAL $10.33

TOTAL $10.33