Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 M~§~t:J~"~~~1www.iowa.gov/etbics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

August 2013

AmounWalue*

Area Code & Telephone Number

Email Address (optional)

$1892.43

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. 1further affirm that the information concerning thed,"O~~u~m~="ect andtruetothebestofmyknowledge l JOV/~ SIgna"'.. ~ ) Date

DATE NAME ADDRESS ITEM COSTAugust 1, 2013 Kabbi Vossi Paoibson 943 Cummins Phal Des Moines, IA 50312 Book $12.00

August 5,2013 Bob & Dee Steben 5299 E University Ave Pleasant Hill, IA 50327 Magazine $300.00

August 5,2013 Upper Room 1908 Grand Ave. P.O. Box 340004 Nashville, TN 37203 Booklets $38.55

August 5, 2013 The Word Among Us 7115 Guilford Dr. Ste 100 Frederick MD 21704-5234 Booklets $225.00

August 5,2013 The Catholic Mirror None Newsletter $2.50

August 13, 2013 Catholic Worker None Newsletters $3.50

August 13, 2013 Chayenu 1526 Union St. Brooklyn NY 11213 Books $8.00

August 13,2013 Eternal Perspective Ministries 39085 Pionerr Blvd, Suite 206 Sandy, OR 97055 Books $84.95

August 13, 2013 Prisoner To Prisoner P.O. Box 750354 Dayton, Ohio 45475-0354 Booklets $4.00

August 14, 2013 Hans Peterson None Cds $30.00

August 14,2013 Fred & Charlie (Meditation Folks) None Book $22.95

August 14, 2013 Dave Edwards None Book $15.95

August 19, 2013 Chayenu 1526 Union St. Brooklyn NY 11213 Books $8.00

August 19, 2013 The Catholic Mirror Newsletters $2.50

August 21,2013 Dennis E Wright 530 NW Prairie Creaek Dr. Grimes, ta 50111 Booklets $311.48

August 21,2013 Dennis E Wright 531 NW Prairie Creaek Dr. Grimes, la 50111 Booklets $5.99

August 29, 2013 Daily Bread PO Box 297 Grand Rapids MI 49501-0297 Booklets $588.06

August 29, 2013 Catholic Digest None Booklets $4.00

August 29, 2013 The Word Among Us 7115 Guilford Dr. Frederick, MD 21704-5234 Booklets $225.00

Total $1,892.43

....•. -

Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 1~~~~tll'H~Emlwww.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

March 2014

AmounWalue*

Area Code & Telephone Number

Email Address (optional)

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

$9702.38

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

~<~* ~- i1 .J~~~~

s-/-IfDate

DATE NAME ADDRESS ITEM COSTbooks, tables, chairs,

01/2013-04/2013 Visiting Mom Project toys, shelves, $9,702.38

sKevised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 l!l~$'~t:~ft~~mlwww.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Ernail Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Various DonatorsName

Mailing Address City, State, Zip Code

December 2013

AmounWalue*

Area Code & Telephone Number

Date of Gift, Bequest, or Grant

Email Address (optional)

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

$698.95

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

Date

, DATE NAME ADDRESS ITEM COST

December 2, 2013 Catholic Digest None Booklets $4.95

December 2,2013 Prisoner To Prisoner P.O. Box 750354 Dayton, Ohio 45475-0354 Booklets $4.00

December 2,2013 The Word Among Us 7115 Guilford Dr. Ste 100 Frederick MD 21704-5234 Booklets $225.00

December 2, 2013 La Palabra Entre Nosotros 7116 Guilford Dr. Frederick,MD21704 Booklets $22.50

December 10, 2013 Daughter Of Destiny 3028 N. EI Paso St Colorado Springs, CO 80907 Newsletter $200.00

December 18, 2013 Dennis Wright 530 NW Prairie Creek Dr. Grimes IA 50111 Rosaries $100.00

December 18, 2013 Dennis Wright 530 NW Prairie Creek Dr. Grimes IA 50111 Pamphlets $20.00

December 19, 2013 Shawna Coffman PO Box 1242 Raymore MO 64083 Newsletter $100.00

December 31, 2013 La Palabra Entre Nosotros 7116 Guilford Dr. Frederick,MD21704 Booklets $22.50

Total $698.95

Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 1ij~$~tiit61Qroolwww.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville, Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

November 2013

AmounWalue*

Area Code & Telephone Number

Email Address (optional)

$463.65

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

~~s?L~7.k2Date

DATE NAME ADDRESS ITEM COST

November 7,2013 La Palabra Entre Nosotros 7116 Guilford Dr. Frederick,MD21704 Booklets $22.50

November 7, 2013 Catholic Worker None Newsletter $3.50

November 7, 2013 Indian Life None Newsletter $3.00

November 7,2013 The Word Among Us 7115 Guilford Dr. Ste 100 Frederick MD 21704-5234 Booklets $225.00

November 18, 2013 EI Aposento Alto 1908 Grand Ave P.O. 340004 Nashville, TN Booklets $38.55

November 20,2013 The Upper Room January 1909 Grand Ave P.O. 340004 Nashville, TN Booklets $107.10

November 20,2013 The Catholic Mirror None Newsletter $4.00

November 20,2013 Interpreter The Advance P.O. Box 320 Nashville, TN 37202-0320 Booklets $10.00

November 20,2013 The Serving Brother None Booklets $50.00

Total $463.65

Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 Ii!~!~i::($imlwww.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

October 2013

AmounWalue*

Area Code & Telephone Number

Email Address (optional)

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

$6715.01

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

~-I-I..fDate

DATE NAME ADDRESS ITEM COST

9/2/13 World Services 830 Kindleberger RD Kansas City Ks 66115 Books $420.00

9/4/13 La Palabra Entre Nosotros None Booklets $22.50

9/4/13 Chayenu 1526 Union St. Brooklyn NY 11213 Booklets $4.00

9/5/13 Bertram & Buffalo UMC 211 Angle St. Bertram, la Clothing $100.00

9/5/13 Consortium & On With Life 715 SW Ankeny, Ankeny la Clothing $30.00

9/5/13 Just Faith Study Group Des Moines, la Clothing $20.00

9/5/13 Ankeny UMC 602 SE Delaware Ankeny, la Clothing $80.00

9/5/13 Immanuel Lutheran 600 Orchard Mediapolis, la Clothing $90.00

9/5/13 New Covenant Parish Victor, la 52347 Clothing $50.00

9/5/13 Malcom UMC PO Box 89 Malcom, la 50157 Clothing $30.00

9/5/13 Diane Eberhart/Jeff Smith Grinnell UMC Grinnell, la Clothing $100.00

9/5/13 Bev Marshall-Goodell Tiffin Grace UMC Clothing $10.00

9/5/13 Scott Hibben Altoona UMC Altoona, la 50009 Books $10.00

9/5/13 Deborah Wise Trinity Waverly UMC Clothing $30.00

9/5/13 Leila Disburg Willard Street UMC Clothing $20.00

9/5/13 Bernie Pint St. Marks UMC la City, la Clothing $10.00

9/5/13 Nancy Bender Lamont,la Clothing $20.00

9/5/13 Emily Peasley SlaterlSheldahl Suitcases $25.00

9/5/13 Ann Ure/Andree Halden Burlington Firt UMC Clothing $250.00

9/5/13 June Bestworth First UMC Indianola. la Suitcases $25.00

9/6/13 Catholic Worker None Newsletters $3.50

9/6/13 First Umc 119 S Georgia Mason City, la 50401 Clothing $150.00

9/8/13 United Methodist Women Oakville, la 52646 Suitcases, Clothes $90.00

9/10/13 Lisa Congdon First UMC Cedar Falls, la. Clothes $85.00

9/11/13 First Umc 313 2nd St SE Independence, la. 50644 Clothing $90.00

9/11/13 Resurrection Lutheran Ankeny.Ia ClothinglSuitcases $200.00

9/18/13 Loaves & Fishes 14377 Old State Pikeville TN 37367 Booklets $200.00

9/24/13 The Star Of Bethlehem None CD $10.99

9/24/13 The Catholic Mirror None Newsletters $3.25

9/24/13 Catholic Digest None Booklet $4.00

9/27113 EI Aposento Alto (Upper Room) 1908 Grand Ave Nashville, TN 37203 Booklet $38.55

Total $2,221.79

Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 1~!S!f~litl!fOlIwww.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift, Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville, Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

September 2013

AmounWalue*

Area Code & Telephone Number

Email Address (optional)

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

$2221.79

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

Date

DATE NAME ADDRESS ITEM COST

9/2/13 World Services 830 Kindleberger RD Kansas City Ks 66115 Books $420.00

9/4/13 La Palabra Entre Nosotros None Booklets $22.50

9/4/13 Chayenu 1526 Union St. Brooklyn NY 11213 Booklets $4.00

9/5/13 Bertram & Buffalo UMC 211 Angle St. Bertram, la Clothing $100.00

9/5/13 Consortium & On With Life 715 SW Ankeny, Ankeny la Clothing $30.00

9/5/13 Just Faith Study Group Des Moines, la Clothing $20.00

9/5/13 Ankeny UMC 602 SE Delaware Ankeny, la Clothing $80.00

9/5/13 Immanuel Lutheran 600 Orchard Mediapolis, la Clothing $90.00

9/5/13 New Covenant Parish Victor, la 52347 Clothing $50.00

9/5/13 Malcom UMC PO Box 89 Malcom, la 50157 Clothing $30.00

9/5/13 Diane Eberhart/Jeff Smith Grinnell UMC Grinnell, la Clothing $100.00

9/5/13 Bev Marshall-Goodell Tiffin Grace UMC Clothing $10.00

9/5/13 Scott Hibben Altoona UMC Altoona, la 50009 Books $10.00

9/5/13 Deborah Wise Trinity Waverly UMC Clothing $30.00

9/5/13 Leila Disburg Willard Street UMC Clothing $20.00

9/5/13 Bernie Pint St. Marks UMC la City, la Clothing $10.00

9/5/13 Nancy Bender Lamont,la Clothing $20.00

9/5/13 Emily Peasley Slater/Sheldahl Suitcases $25.00

9/5/13 Ann Ure/Andree Halden Burlington Firt UMC Clothing $250.00

9/5/13 June Bestworth First UMC Indianola. la Suitcases $25.00

9/6/13 Catholic Worker None Newsletters $3.50

9/6/13 First Umc 119 S Georgia Mason City, la 50401 Clothing $150.00

9/8/13 United Methodist Women Oakville, la 52646 Suitcases, Clothes $90.00

9/10/13 Lisa Congdon First UMC Cedar Falls, la. Clothes $85.00

9/11/13 First Umc 313 2nd St SE Independence, la. 50644 Clothing $90.00

9/11/13 Resurrection Lutheran Ankeny,la Clothing/Suitcases $200.00

9/18/13 Loaves & Fishes 14377 Old State Pikeville TN 37367 Booklets $200.00

9/24/13 The Star Of Bethlehem None CD $10.99

9/24/13 The Catholic Mirror None Newsletters $3.25

9/24/13 Catholic Digest None Booklet $4.00

9/27113 EI Aposento Alto (Upper Room) 1906 Grand Ave NashVille, TN 37203 Booklet $38.55

Total $2,221.79

Revised 06/05

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD510 EAST 12TH, SUITE 1ADES MOINES, IOWA 50319

FAX: (515) 281-3701 1~··.·'¥(0!n~;.....nrD;PI_a,~.~!i;tQt'm_www.iowa.gov/ethics

Iowa Code section 8.7 requires all gifts, bequest, and grants given to any department of thestate of Iowa or received by the Governor on behalf of the state be reported to the Iowa Ethicsand Campaign Disclosure Board and the Government Oversight Committee. The Board willprovide a copy of this report to the Government Oversight Committee. This form is required to befiled within 20 days of receipt of the gift, bequest, or grant.

DEPARTMENT OR OFFICE RECEIVING THE GIFT, BEQUEST, OR GRANT:

FORM-GBGGift Request, or Grant

information

received by a department or

accepted by the Governoron behalf of the state

For office use only

Iowa Correctional Institution for WomenName of Department or Office

420 Mill Street SW Mitchellville, Iowa 50169Mailing Address City, State, Zip Code

(515) 725-5050Area Code & Telephone No.

CONTACT PERSON FOR RECIPIENT DEPARTMENT OR OFFICE:

Name

Mailing Address (if different from above) City, State, Zip Code (if different from above)

Email Address Area Code & Telephone No. (if different from above)

DONOR OF GIFT, BEQUEST, OR GRANT:

Date of Gift, Bequest, or Grant

Various DonatorsName

Mailing Address City, State, Zip Code

July 2013Area Code & Telephone Number

Email Address (optional)

Provide a description of the gift, bequest, or grant purpose thereof:

All donations for offenders benefit.

$193.25

AmounWalue*

Criteria to use this form:

Receipt of any gift, bequest, or grant that is received by any department of the state or received by the Governor on behalf of the state.

Statement of Affirmation:

I, Diann Wilder-Tomlinson, affirm that the gift, bequest, or grant reported above is accurate. I further affirm that the information concerning thedonor and assessment of the fair market value (if applicable) is correct and true to the best of my knowledge.

\~tc.A-~Date

DATE NAME ADDRESS ITEM COST

June 7, 2013 Lois Crilly 8201 Northview Dr Urbandale Paper $10.00

July 24,2013 Dennis E. Wright 530 NW Prairie Creek Grimes, IA Rosaries $10.00

July 24,2013 Dennis E. Wright 530 NW Prairie Creek Grimes, IA Booklets $29.75

July 24,2013 Dennis E. Wright 530 NW Prairie Creek Grimes, IA Booklets $15.90

July 24,2013 Dennis E. Wright 530 NW Prairie Creek Grimes, IA Booklets $10.00

July 26,2013 La Palabra Entre Nosotros None Booklets $22.50

July 29,2013 EI Aposento Alto 1908 Grand Ave P.O. 340004 Nashville, TN Booklets $38.55

July 30,2013 The Upper Room 1909 Grand Ave P.O. 340004 Nashville, TN Booklets $56.55

July 30,2013 Reading Glasses

Total $193.25