06/13/2003 11 44 FAX 202 962 3693 ICMA

;HICS AND CAMPAIGN DISCLOSURE BOARD

510 EAST 12T , SUITE 1A ONE-TIME CONTRIBUTION IN
DES MOINES, IA 50319 EXCESS OF $750 BY -A
PERMANENT ORGANIZATION
Fax : (515)281 "3701
www .lowa.gov/ethics For office use only
Indexed
C ~ DIME CONTRIBUTION IN EXCESS OF $750 Audited
BY A PERMANENT ORGANIZATION Checked
Computer
Iowa Code i n 66A .402(9) requires a permanent organization that contributes In excess of
$750 to regt ti d file reports as a PAC. This form is intended to serve those purposes . The
form-musit 11 _~ with the Board on or befor tho tenth day of the date the check was issued,
ORGANIZA Cr MAKING CONTRIBUTIONa

CONTACT 115,11! ON FOR THE ORGANIZATION .-

1, the L- Perego
Name
N . Capitol Street, N . E. Washington, D .C . 20002
Mailing Adt ! City, State, Zip
pereao@icma .orq 202-962-3668
6~

Email Add, tional) Area Code & Telephone Number

COMMITTEE RECEIVING THE CONTRIBUTION :

Citi- :!L for a Better Cedar Rapids

Name of C., ! or Committee

Cedar Rapids, IA
City, State, Zip Code
52404
319-396-8461
Area Coda & Telephone Number

ididate, disclose source of original funds used to matte

attach additional pages If necessary) .

1. 'n impelgn contribution In excess of $750 was made to a state or local candidate, party, political committee (PAC) for either a
nI .ate or a ballot issue, or any other organization that advocates the election defeat of a candidate or ballot Issue.
of

2 ~u I a permanent organization not established for election purposes .

~3

3. I3In son gave money to the organization for the purpose of the organization then using the money to make the contribution .
4. ` tr ontributlon was made to a candidate, no funds from a corporation or other prohibited contributor under Iowa Code section
1 were used to make the contribution (this does not apply to a contribution made to e ballot issue Committee) .
5. 'n re contribution to any campaign committee except for a ballot issue committee was made in a calendar year. No more than one
nr ~ltion may be made to any one ballot issue committee during a ballot issue election . If more than one conlrlbutlon and the total
Til of the conMbuttons exceed $750, the organization must register with the Board as a polldcal committee (PAC) within 10 days of
t

io the $750 threshold .

Statement( e, I f ination :

I, Marth ' rego affirm that the contribution reported above is accurate . I further affirm that the informadon concerning the organization is
correct and to t best of my knowledge . I understand that by filing lhis form, I am subject to the laws found in Iowa Code chapter 6BA and
evil
di

administrative .I( Fund In chapter 351 . I also understand that the failure to timely file this form leads IC the imposition of penalties and the
intentional fall la the form may lead to additional civil
and criminal sanctions .

6/13/05
Date

1 'Contrlbutlor i 11 t ss goods or services that are provided for free or otherwise less than fair market value.