FOR INSTRUCTIONS, SEE BACK OF FORM FORM

DISCLOSURE SUMMARY PAGE DR-2 I DISCLOSURE

(Rev . 1212005) REPORT
COMMITTEE NAME (Must be same as on Statement of Organization)
For Office Use Only /
Petersen for State Representative Comm . # -------4L4L__
IMPORTANT: Indicate by # type of committee you are reporting for : 1 Logged In _
( 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 )C PAC (9 )City PAC ( 10 )School Board or Other Political Computer ----------------------
Subdivision PAC 11 Local Ballot I t~A F_

os c'~la.`4p.~i %
Audited -----------------------
CANDIDATE COMMITTEES ONLY. U/S
Uo, `
Candidate Name °iifical Party (if applicable) File with :
Janet Petersen MAY Democrat Iowa Ethics and Campaign
Disclosure Board
Office Sought F'/):ED O~ District (if Senate or House) 510 E. 121", Ste . 1A
Iowa House of Representativ 64 Des Moines, Iowa 50319
Fax : 515-281-3701
Late reports are subject to possible civil and criminal penaltie~ s.Chant to Iowa Code section 68B .
the candidate, for a candidate's committee, and the chairperson, for any other type of committee, is t
individual responsible f ' ely and accurate reports .
5- It 6

SIGNATU OF PERSON FILING REPORT TELEPHONE DATE SIGNED

1/1/06 - 5/14/06 REPORT FOR (1) ELECTION /( 2)NON-ELECTION YEAR .

I AM FILING A
t . .
(report date) - - Indicate by

0 CHECK IF AMENDMENT TO REPORT DATED Local Committees, enter Date of Election

0 Check if this is final (termination) report and attach Notice of Dissolution Form DR-3 .
(You must continue to file reports until a DR-3 is filed .)
County & Local Committees, enter County in
which Election is held

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 $ 20,581 .10
of the last reporting period or must be zero if this is first report filed .) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
ADD TOTAL MONEY TAKEN IN THIS PERIOD
1,000 .00
Schedule A : Cash Contributions total (Attach Schedule A) ("also see in-kind below). . . . . . . . .
Schedule F: Loans Received total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .1 . . . ., . . . . . . . . . .
Schedule H : Total Sales of Campaign Property (Attach Schedule H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Schedule H applies to Candidates Committees Only)
SUB-TOTAL . . . . .. . . . . ... . . . . . . . . .$ 21,581 .10
.
SUBTRACT TOTAL MONEY SPENT THIS PERIOD'" '
105 .00
Schedule B : Expenditures total (Attach Schedule B) (**also see debts and loans below) . .
Schedule F : Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . . .
CASH ON HAND at the end of this reporting period (if final report balance must 21,476 .10
be 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .,I. . . . . . . . . . . . . . . .$
CONSULTANT BREAKDOWN (Schedule G Attached?) _ - YES - NO

CANDIDATE COMMITTEES ONLY:

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

STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year.
 Janet Petersen for State Representative -Schedule A
Date PAC ID Name Address Relationship Amount

1/5/2006 ID# ???? KOCHPAC, . 655 15th St . NW, Suite 445, 1/ashington, No Relation $500 .00
CK# 4767 DC 20005

1/5/2006 ID# ???? Microsoft Corp PAC, . 16011 NE 36th Way, Redmor~d, WA 98073 No Relation $500 .00
CK# 5092

TOTAL $1,000.00

fill' t(l

Sub-Total: $1,000 .00

Wednesday, May 17, 2006 Page 1 of I
(for Schedule A)
SCHEDULE B: Expenditures -- Money Spent From Committee Account
ID: 1206
Name : Petersen for State Representative
Type : State House
Date Check # Name and Address To Whom Expe diture Amount Expended
(Disbursement) Was Made
1/16/2006 1211 Business Web Builders $52.50
PO Box 802
Anken ,IA 50021
OTHER EXPENDITURE: Web Hosting

4/7/2006 1213 Business Web Builders $52 .50

PO Box 802
Anken ,IA 50021
OTHER EXPENDITURE: Web Hosting

TOTAL: $105.00

Page Total

Wednesday, May 17, 2006 Page 1 of 1

(for schedule B)