Peterson Judith__1538__scanned

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    FOR I NSTRUCT I ONS, SEE BACK OF FORM

    DI SCL OSURE SUMMARY PAGECOLR4,rT,T , E. . ~ E NAME ( M e same a s o t a t e m e n t o f O r g a n i z a t i o n )l r . P / I P. l S O N ~ u r ~,OJGI MPORTANT : I n d i c a t e t y p e o f c o mmi t t e e y ou a r e r e p o r t i n g f o r :( 1 ) S t a t e w i d e / L e g i s l a t i v e C a n d i d a t( 5 ) C o u n t y PAC ( q ) B a l l o t I s s u( 8 ) S y p p : ~ t S l a t e Cao i d ) *

    e w i d e PAC ( 3 ) S t a t e P a r t y ( 4 ) C o u n t y / L o c a l C a n d i d a t e; o m m i t t e e ( 7 ) C o u n t y / C i t y C e n t r a l C o mmi t t e e

    Z - 7 7 3 - ) VSI GNAT RE " I T T WSUNER- f s f p e r s o n f i l i n g t h i s r e p o r t ) TELEPHONE -P e n a l t i e s Du e F o r L a t e F i l e d R e p o r t s R a n g e f r o m $ 1 0 t o $ 4 0 0

    SEE I N S T R UC T I O N S ON BACK AND COMP L E T E T H E FOL LOWI ASENENCE :I AM FI L I NG A ftw REPORT FORA~ A ( 1 ) E L ECT I ON / ( 2 ) NON- E L ECT I ON YEAR.n( r e p o r t d a t e ) I n d i c a t e on e[ ] CHECK I F AMENDMENT TO REPORT DATED ` 4 \ 10 Ch e c k i f t h i s i s f i n a l ( t e r mi n a t i o n ) r e p o r t and a t t a c h N o t i c e( Y o u must c o n t i n u e t o f i l e r e p o r t s u n t i l a N o t i c e

    STATEMENT OF CASH ON HANDCASH ON HAND a t t h e b e g i n n i n g o f t h e r e p o r t i n g p e r i o d . ( T h i s i s t h e t o t a l

    o f a l l mon i e s h e l d b y t h e c ommi t t e e. T h i s amount MUST b e t h esame as t h e c a s h on h an d a t t h e en d o f t h e l a s t r e p o r t i n g p e r i o d ,o r must b e z e r o N t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEYTAKEN I N T HI S PERI ODSc h e du l e A : Cash C o n t r i b u t i o n s t o t a l ( A t t a c h Sc h e d u l e A ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : Loan s Re c e i v e d t o t a l ( A t t a c h S c h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e H : T o t a l Sa l e s o f Campa i g n P r o p e r t y ( A t t a c h Sc h e du l e H ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    ( Sc h ed u l e H a v a l i e s t o Ca n di d a t e Commi t t e e s On l y )SUB- TOTAL . . . . . S

    SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h e du l e B: E x p e n d i t u r e s t o t a l ( A t t a c h Sc h e d u l e B ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sc h e du l e F : Loan Repa y men t s t o t a l ( A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

    CASH ON HAND a t t h e e n d o f t h i s r e p o r t i n g p e r i o d ( i f f i n a l r e p o r t , b a l a n c e mustb e z e r o ) ( A t t a c h DR- 3 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ,

    UNPAI D B I L LS ( Fr om Sc h e du l e D - A t t a c h Sc h e d u l e D ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $I N K I ND CONTRI BUTI ONS ( F r o m Sc h e du l e E - A t t a c h S c h e d u l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $OUTST ANDI NG LOANS ( Fr om Sc h e du l e F - A t t a c h Sc h e d u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CANDI DATE COMMI TTEES ONLY :CONSUL TANT BREAKDOWN ( S c h e d u l e G A t t a c h e d ? )VALUE OF CAMPAI GN PROPERTY ( Fr om S c h e d u l e H - A t t a c h Sc h e d u l e H) $

    FORMDR- 2 I DI SCLOSURE( Re v . 1 1 / 9 7 ) REPORTF o r O f f i c e Un On l y WComm. #I n d e xA u d i t e dCo mp u t e r

    L o c a l C o mmi t t e e s , e n t e r D a t e o f E l e c t i o nC o u n t y & L o c a l C o mmi t t e e s , e n t e r C o u n t yw h i c h E l e c t i o n i s h e l d

    U9 1 & t

    YES NO

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    Fo r I n s t r u c t i o n s , Se e Ba c k o f F o r mCONTRI BUTI ONS - MONEY TAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )CO I T TEENAME ( Mu be s ame a s St a t eme n t o f Or g a ni z a t i o n)

    SCHEDULEA MONETARY( R ev . 0 7 / 0 3 ) I RECEI PTSOCHECK T HI S BOX I FAMENDI NG FORM

    STATECANDI DATES NOTE: I F ACONTRI BUT I ON I S RECE I VED FROMA STATE PAC ( P OL I T I C AL ACT I ON COMMI TTEE ) , L I S T THEPAC I DENT I F I CATI ONNUMBER ANDTHEPAC CHECKNUMBER I N THEDESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVA I L AB LE FROMTHEI OWA ETHI CSANDCAMPAI GNDI SCLOSURE BOARD.CAUTI ON : Se ct i o n 68B . 3 2 A ( 6 ) , I o wa Code , p r o h i b i t s t h e u s e o f i n f o r ma t i o n c o pi e d f r o m r e p o r t s an d s t a t e me n t s f o r s o l i c i t i n g c on t r i bu t i o ns o rf o r any c o mme r c i a l p u r p o s e by an y p e r s o n o t h e r t h an s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

    SUB- TOTAL

    TOTAL f f f l as t page o f t h i s s c h e du l e )* D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c ommi t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a ny r e l a t i v e mak i n g a c o n t r i b u t i o n t o t h ec ommi t t e e . R e l a t i o n s h i p must be s h o w n t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a nd a f f i n i t y ( r e l a t i v e s b yma r r i a g e ) . I f s u r n ame o f c o n t r i b u t o r i s t h e same as c a n d i d a t e , b u t t h e r e i s no P ~f a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l umn . ( f o r Sc h e d ul e A)

    DATERECEI VED

    PAC I D NUMBER( i f a p p l i c a b l e ) NAME ANDADDRESS OF CONTRI BUTOR RELATI ONSHI PTO CANDI DATE' AMOUNTRECEI VED d I F FOFUND-( MM/ DD/ Y R) ANDPACCHECKNUMBER ( i f a p p l i c a b l e ) RAI SERI NCOM

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    F o r I n s t r u c t i o n s , S e e B a c k o f F o r mC O N T R I B U T I O N S - M O N E Y T A K E N I N

    ( i n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )CO ~/ / 5

    t 7~( Mu s t

    V4s aGt Ye a s o P O r g a n i z a t i o n )STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECE I VED FROM A STATE PAC ( P O L I T I C A L ACTI ON C O M M I T T E E ) , L I S T T HE PAC I D E N T I F I C A T I O NNUMBER AND T HE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S A V A I L A B L E FROM THE I OWA E T H I C S AND CAMPAI GNDI SCLOSURE BOARD .CAU T I ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa C o d e , p r o h i b i t s t h e u s e o f i n f o r m a t i o n c o p i e d f r o m r e p o r t s a n d s t a t e m e n t s f o r s o l i c i t i n g c o n t r i b u t i o n s o rf o r a n y c o mme r c i a l p u r p o s e b y a n y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c o mmi t t e e s .

    D i s c l o s u r e l a w r e q u i r e s c a n d i d a t e c o mm i t t e e s t o d i s c l o s e t h e r e l a t i o n s h i p o f a n y r e l a t i v e m a k i n g a c o n t r i b u t i o n t o t h ec o mm i t t e e . R e l a t i o n s h i p m u s t b e s h o wn t o t h e t h i r d d e g r e e o f c o n s a n g u i n i t y ( b l o o d r e l a t i v e s ) a n d a f f i n i t y ( r e l a t i v e s b ym a r r i a g e ) . I f s u r n a me o f c o n t r i b u t o r i s t h e s a m e a s c a n d i d a t e , b u t t h e r e i s n o P a g e o ff a m i l i a l r e l a t i o n s h i p , e n t e r " n o t a p p l i c a b l e " i n t h e r e l a t i o n s h i p c o l u mn . ( f o r S c h e d u l e A

    SCHEDULEA MONETARY( R e v . 0 7 / 0 3 ) RECEI PTSOCHECK T HI S BOX I FAMENDI NG FORM

    DATE PAC I D NUMBER NAME AND ADDRESS OF CONTR I BUTOR RELAT I ONSH I P AMOUNT d I F FORECE I VED( MWDD/ YR) ( i f a p p l i c a b l e )AND PAC CHECK TO CANDI DATE '( d a p p l i c a b l e ) RECE I VED FUND-RA I SENUMBER I NCOMD# 10~qw ' T L , w I j i l P ( , -c / 6 $y e al D#

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    Fo r I n s t r u c t i o n s , Se e Back o f Fo r mCONTRI BUTI ONS - MONEYTAKEN I N

    ( I n c l u d i n g c a n d i d a t e ' s p e r s o n a l f u n d s )COMY( f TEE NAME ( Mu s tbe s ame a s o n S t a t 9 f i -* n t o f O r g a n i z a t i o n )

    X/ 1U50N -

    f o r an y c omme r c i a l p u r p o s e b y an y p e r s o n o t h e r t h a n s t a t u t o r y p o l i t i c a l c ommi t t e es .

    STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A S T A T E PA C ( P O L I T I C A L A C T I ON C OMM