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8/7/2019 Peterson Eddie__5120__scanned

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FOR I NSTRUCTI ONS, SEE BACKOF FORMDI SCLOSURE SUMMARY PAGECOMMI TTEE NAME ( Mu s t b e same as o n St a t emen t o f O r g a n i z a t i o n )

~P~~r SAt ) L r " _! QCCP Q~ 1 9I MPORTANT I n d i c a t e b y # t y p e o f c o m m i t t e e y o r e p o r t i n g f o r :( 1 ) S t a t e w i d e l L e g i s l a t i v e / J u d g e S t a n d i n g f o r R e t e n t i o n C a n d i d a t e ( 2 )( 4 ) C o u n t y C e n t r a l Co mmi t t e e ( 5 ) C o u n t y C a n d i d a t e ( 6 ) C i t y CaS u b d i v i s i o n C a n d i d a t e ( 8 ) C o u n t y PAC ( 9 )( 1 1 ) L o c a l B a l l o t I s s u e

L a t e r e p o r t s a r e s u b j e c t t o p o s s i b l e c i v i l an d c r i m i n a l p e n a l t i e s P u r s u a n t t o I o w a Code s e c t i o n 6 8 B . 3 2 A ( 7 ) t h e c a n d i d a t e , f o r a c a n d i d a t e ' s c o mm i t t e e ,an d . t h e c h a i r p e r s o n , f o r a n y o t h e r t y p e o f c o mm i t t e e , i s t h e i n d i v i d u a l r e s p o n s i b l e f o r f i l i n g t i m e l y a n d a c c u r a t e r e p o r t s .1 1

SI RG OF PERSON F I I REPORT

I AM F I L I NG A I - 19- 0 t p( r e p o r t d a t e )

C3CHECK I F AMENDMENT TOREPORT DATED

Reset For l n

PAC ( 3 ) S t a t e P a r t yo o l B o a r d o r O t h e r P o l i t i c a lP o l i t i c a l S u b d i v i s i o n PAC

J ~ -Check i f t h i s i s f i n a l ( t e r m i n a t i o n ) r e p o r t an d a t t a c h N o t i c e o f D i s s o l u t i o n F o r m DR- 3 .( Y ou 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 DR- 3 i s f i l e d . )

5 / 5 1 - - v ( oTEL EPHONE DATE SI GNED

REPORT FOR ( 1 ) ELECT I ON / ( 2 ) NON- EL ECT I ON YEAR .I n d i c a t e b y #

STATEMENT OF CASH ON HAND

( Sc h ed u l e H a p p l i e s t o Ca n d i d a t e s ' Commi t t e e s On l y )SUB- TOTAL . . . . . . . . . . . . . $

SUBTRACT TOTAL MONEY SPENT T HI S PERI ODSc h ed u 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 du l e B ) ( * * a l s o s ee d e b t s an d l o a n s b e l o w) . . . . . . . . . . . .Sc h e du l e F : L o a n Re p ay me n t s t o t a l ( A t t a c h Sc h e du l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

CASH ON HAND a t t h e en 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 ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $

STATE COMMI TTEES : Submi t a r e c o n c i l e d c amp a i g n a c c o u n t b a n k s t a t e me n t i n J a n u a r y o f ea c h y e a r .

FORMDR- 2 DI SCL OSURE( Re v . 1 2 / 2 0 0 5 ) REPORTF o r O f f i c e Use On l yComm . # , 1 % 5 1 - 9 0L o g g e d a t e , ,ScannedCo mp u t e rA u d i t e d

L o c a l C ommi 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 omm i t t e e s , e n t e r C o u n t y i nw h i c h E l e c t i o n i s h e l d

2y3a . o ~I 3 X5 , R~1 I o ( y

* * UNPAI D BI L L S ( F r o mSc h ed u l e D - A t t a c h Sc h e du l e D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ ~ 'I N K I ND CONTRI BUTI ONS ( F r o m Sc h ed u l e E - A t t a c h Sc h e du l e E ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $* * OUTSTAND I NG LOANS ( F r o m Sc h ed u l e F - A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $CONSULTANT BREAKDOWN ( Sc h ed u l e G A t t a c h e d? ) - YES kNOCANDI DATE COMMI TTEES ONLY :VALUE OF CAMPAI GN PROPERTY ( F r o m Sc h e du l e H - A t t a c h Sc h e du l e H) $

CASHON 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 o t a l o f a l l f u n d s h e l d b y t h ec o mmi t t e e . T h i s amoun t MUST b e t h e same a s t h e c a s h o n h a n d a t t h e en do 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 mu s t b e z e r o i f t h i s i s f i r s t r e p o r t f i l e d . ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ADD TOTAL MONEY TAKEN I N T HI S PERI ODSc h ed u 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 ed u l e A) ( * a l s o s ee i n - k i n d b e l o w) . . . . . . . . . . . . . . . . . . y 3a . 0 - 9Sc h ed u l e F : L o a n s Re c e i v e d t o t a l ( A t t a c h Sc h ed u l e F ) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 060 , 00Sc h ed u l e H : T o t a l S a l e s o f Campa i gn P r o p e r t y ( A t t a c h Sc h e du l e H) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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Fo r I n s t r u c t i o ns , Se e Ba c k o f Fo 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 )

R e s e t P oi n t

COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )e e- r c { - 6 L r o f r I ( r1 1 - /STATE CANDI DATES NOTE : I F A CONTRI BUTI ON I S RECEI VED FROM A STATE PAC ( P OL I T I C A L ACTI ON COMMI T T E E ) , L I S T THE PAC I D EN T I F I C A T I ONNUMBER AND THE PAC CHECK NUMBER I N THE DESI GNATED COLUMN . A L I S T OF I D NUMBERS I S AVAI LABLE FROM THE I OWA E T HI C S AND CAMPAI GN

DI SCLOSURE BOARDCAUTI ON : S e c t i o n 6 8 B . 3 2 A ( 6 ) , I o wa Co 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 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 o n t r i b u t i o n s o rf o r an y c omme 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- TOTALTOTAL ( I f l a s t p a g e o f t h i s s c h ed u 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 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 ma 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 mu s t b e s h ow n t o t h e t h i r d d e g r e e o fwi ndy( 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 yma r r i a g e ) . I f s umame o f c o n t r i b u t o r i s t h e s ame a s c a n d i d a t e , b u t t h e r e i s n o Pa 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 umn . ( f o r S c he d u l e A

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

DATE PAC I D NUMBER NAME ANDADDRESS OF CONTRI BUTOR RELAT I ONSH I P AMOUNT 4 I FRECEWED ( i f a p p l i c a b l e ) TO CANDI DATE* RECEI V ED FUN( MM1DD/ YR) AND P AC CHECK ( i f a p p l i c a b l e ) RAINUMBER I NCI D# ma x Pa l n n e r

00u - CY l d ~ n e S =I D# Ne l e r \CK# ( ) L . a d - uo

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4/7

T HI S BOX APPL I ES TOCANDI DATES' COMMI TTEES ONLY :P u r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n Sc h e d u l e H . ( R e f e r t o S c he d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mu s t a l s o b e d e t a i l i t e m i z e d o nS c he d u l e G b y t h e a m o u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t u r e m a d e b y t h e p e r s o n l e n f t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t oS c he d u l e G i n s t r u c t i o n s a nd I o wa Code 6 8 A . 4 0 2 ( 3 ) o . )

( f o r Sc h e d u l e B )

FOR I NSTRUCTI ONS, SEE BACK OF FORM etFJ SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROMCOMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TU RES

STATE PAC COMTTEES : NOTE : FOR CONTRI BUTI ONS MADE TO STATEWI DE OR LEG I SLAT I VE D CHECK T HI S BOX I FCANDI DATES, L I S T THE CANDI DATE I DENT I F I CAT I ON NUMBER I N THE DESI GNATED COLUMNAND THEPAC CHECK NUMBER FOR EACH EXPENDI TURE . A L I S T OF I D NUMBERS I S AVAI LABLE FROMT HE I OWA AMENDI NG FORMETHI CS & CAMPAI GN DI SCLOSURE BOARD.COMMI TTEE NAME ( Mu s t b e s ame a s o n St a t e me n t o f O r g a n i z a t i o n )

CANDI DATE NAME AND A i o - R ES S TOWHOW PURPOSE AMOUNTDATE I D NUMBER EXPENDI TURE ( DESCRI BE TRANSACTI ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MWDDI YR) AND PACCHECKNUMBERI D # o Qh ( Y Z , ~ \ e ~ - Se c r e t c ~. r y of 0J r ' c c{ I I - u - I _

$D5 ODi F} Oo c i y e ,I D # CS aaol K C. h e c ~ or d er C- h ~ - r j e .CK# AL . ` ~ a

1 3 0_r 4 Dcd P , ~~sal QS; ~ S ~I D# ~ e c YI QX S ~ - o r u ~ L . I - - c ~ 1 ~ ~ e r So?Q50 5t v i / a u ~ SL I . L, I v e o J ~' SI~ I I p ~v S CK# I Ov ~ F - 1 - _ da d e , ~H 5 S ~ 1 ~o~ , L . I SI D# Ca r ~ , p u t ~ n Co- - - ds1~3~ t = 4a i C~ r ~ l A- e .s CK#1W.3 DeS l T 1D~ ~ eS, T - a 4 So 3 1l o _S~oJ w1 t S I D # C o 0 ~c ~ c l ~ , Com t , UEb S% Qe ~~ Sf r a - t - ~ a~# L L a

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a ; 2 ALA POCK#` ' SUB- TOTAL $

TOTAL ( ! f l a s t p a g e o f t h i s s c h e d u l e ) $


5/7

T HI S BOXAPP L I E S T O CANDI DATES ' COMMI TT EES ONLY :Pu r c h a s e s o f c e r t a i n c a mp a i g n p r o p e r t y c o s t i n g $ 5 0 0 o r mo r e mu s t a l s o b e i n v e n t o r i e d o n Sc h ed u l e H . ( R e f e r t o Sc h e d u l e H i n s t r u c t i o n s . )E x p e n d i t u r e s t o p e r s o n s l e n t i t i e s p r o v i d i n g c o n s u l t i n g , a d v e r t i s i n g , f u n d - r a i s i n g , p o l l i n g , ma n a g i n g , o r g a n i z i n g s e r v i c e s mu s t a l s o b e d e t a i l i t e m i z e d o nSc h e d u l e G b y t h e a m o u n t , p u r p o s e , a n d d a t e o f e a c h t y p e o f e x p e n d i t t i u e mad e b y t h e p e r s o N e n t i t y o n b e h a l f o f t h e c a n d i d a t e ' s c o mmi t t e e . ( R e f e r t oL Sc h e d u l e G i n s t r u c t i o n s a n d I o wa Cod e t i 8 A . 4 0 2 ( 3 ) ( ) . ) --

( f o r Sc h e d u l e B )

FOR I NSTRUCT I ONS , S E E BACK OF FORM I R Fo l m SCHEDULEEXPENDI TURES B MONETARY- MONEY SPENT FROM COMMI TTEE ACCOUNT ( Re v . 0 7 / 0 3 ) EXPENDI TURES

S T A T E PAC COMAKTTEES : NOTE : FOR CONTRI BUT I ONS MADE T O STATEWI DE OR L EGI S L AT I V ECANDI DATES , L I S T T H E C ANDI DA T E I DENT I F I CAT I ON NUMBER I N T HE DES I GNATED COLUMN AND T HE CHECK T HI S BOX I FPAC CHECK NUMBER FOR EACH EXPEND I TURE . A L I ST OF I D NUMBERS I S AVAI L ABLE FROM T HE I OWA AMENDI NGFORMET HI CS & CAMPAI GN D I SCLOSURE BOARD .COMMI TTEE NAME ( Mu s t b e s ame a s o n S t a t e me n t o f Or g a n i z a t i o n)

e ( - e ( Sbn 5 e Gr e ~ OF v i ~ - u . - r e -CANDI DATE NAME ANDf ADDRESS TOWHOM PURPOSE AMOUNTDATE I D NUMBER EXPEND I T URE ( D ESCRI B E TRANSACT I ON) EXPENDEDEXPENDED ( i f a p p l i c a b l e ) ( D i s b u r s e m e n t ) WAS MADE( MMI DDI YR) AND PACCI - I ECKNUMBER

I D# 5 BCl . r 1 I L e GI Gt ' n ~r c a c , ~ r r t +R l o s n d e T - ' l S6 ; , 1 sI D# L ( ` o c c (t o q 5 I v DS F4 . Doc t c So So f o?QD . ~dI D# e s b a n k ~ (( D I 3 t ( o S CK# a i ' 50F - { - . po d e , - ZA So t

)~, , ( 5

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SUB - TOTAL $TOTAL ( i f l a s t p a g e o f t h i s s c h e du l e ) i $ i . 3


6/7

FOR I N S TRUCT I ONS , SEE BACK OF FORMCOMMI TTE E NAME( Mus t b e s am e a s o n S t a t e m e n t o f O r g a n i z a t i o n )p~ e i ( s v 0 ~_v- Se c r e ~a r j o f n 1 ~ ' r i c u l&r cNOTE : T h i s s c h e d u l e r e p o r t s m o n e y l o a n e d t o t h e c o mm i t t e e w h i c h i s d e p o s i t e d i n t h e c o m m i t t e e a c c o u n t .TOTAL UNPA I D LOANS FROM LAST REPORTI NG PERI OD $PART I - MONETARY L OANS RECEI VED T H I S REPORTI NG PERI OD( O r i g i n a l s o u r c e o f l o a n , s u c h a s a b a n k , m u s t b e s h o w n i f a t h i r d p a r t y i si n v o l v e d . I n c l u d e l o a n s f r o m c a n d i d a t e ' s p e r s o n a l f u n d s . )

TOTAL ( PART 1 ) $ )obb

` 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 m m 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 em a k i n g a c o n t r i b u t i o n t o t h e c o m m 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 w n t o t h e t h i r d d e g r e e o fc 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 y m a r r i a g e ) I f s u r n a m e o f c o n t r i b u t o r i st h e s am e a s c a n d i d a t e , b u t t h e r e i s n o 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 er e l a t i o n s h i p c o l u m n w h e n i t a p p l i e s .

R. Cw t Far m

PART 1 1 - MONETARY LOAN REPAYMENTS MADE T HI S REPORTI NG PERI OD( L o a n s f o r g i v e n m u s t b e r e p o r t e d o n S c h e d u l e E- I n - k i n d C o n t r i b u t i o n s . )

TOTAL CASH REPAYMENTS ( PART / 1 )F r o m S c h e d u l e E - TOTAL LOANS FORGI VEN $

TOTAL OUTSTANDI NG LOANS EN D OF REPORT PERI OD $ SCR 3 B

PagoI( f o r S c h e d u l e F )

SCHEDULEF LOANS( R e v . 0 7 / 0 3 ) RECEI VED& REPAI DCHECKT HI S BOX I FAMENDI NGFORM

DATERECEI VEDMM/ DDI YRNAME AN D ADDRESS OF LENDER( I n c l u d e E n d o r s e r ' s Name , I f A p p l i c a b l e ) RELATI ONSHI PTO CAND I DATEI f l i v a b l e "

AMOUNTOF LOAN DATE P A I D( M M / D D I Y R ) NAME AN D ADDRESS OF LENDER( I n c l u d e E n d o r s e r ' s N a m e , I f A p p l i c a b l e ) R E L AT I O NS H I PTO CANDI DATE'I f l i v a b l eAMOUNTREPAI D


7/7

FILED"-" 1EE NAME

( Re v . 0 7 1 0 3 )

WHEN TO F I L E :Th e N o t i c e o f D i s s o l u t i o n mus t b e f i l e d w i t h i n t h i r t y ( 3 0 ) d a y s o f c o mp l e t i o n o f a l l t h e f o l l o w i n g1 A l l d e b t s , l o a n s a n d o b l i g a t i o n s h a v e b e e n p a i d o r t r a n s f e r r e d ;2 A l l c a mp a i g n f u n d s h a v e b ee n s p e n t3 A l l c a mp a i g n p r o p e r t y s o l d o r t r a n s f e r r e d ( c a n d i d a t e s o n l y ) ; a n d4 A f i n a l r e p o r t d i s c l o s i n g a l l t r a n s a c t i o n s c l o s i n g t h e c o mm i t t e e

F o r s t a t e c a n d i d a t e s a n d s t a t e PACs , a f i n a l b a n k s t a t e m e n t mus t b e f i l e d w i t h t h e N o t i c e o f D i s s o l u t i o n o r a s s o o n a sp o s s i b l e i f t h e b a n k s t a t e m e n t i s n o t a v a i l a b l e a t t h e t i m e t h e N o t i c e o f D i s s o l u t i o n i s f i l e d

S i g n a t u r e o f C a n d i d a t e o r T r e a s u r e r ( i f c a n d i d a t e ' s c o m m i t t e e ) / S i g n a t u r e o f C h a i r o r T r e a s u r e r ( i f PAC)

Da t e S i g n e d

FOR I NSTRUCT I ONS , SEE BACK OF FORMThe f o r m i s n o t a p p l i c a b l e t o 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

- 66' S6n Sec r e ~ a , r b~ ~~-O f f i c i a l Na mev n 3S ~

S t r e e t4 c - v - C UC ' V- C i t y , S t a t e , Z i p C o d e

(s6- ) 3SLq-53 ; ,- ~ t - oAr e a T e l e p h on eC o d e

No t i c e o f Di s s o l u t i o n FORM DR- 31 Fm NOTI CE OFMa i l t o : DI SSOLUTI ONI ECDB5 1 0 E a s t 1 2 ~ h , S u i t e 1 A I F o r O f f i c e Us e O n l yDe s Mo i n e s , I o wa 5 0 3 1 9 Comm . #I A E T HI C S&CAMPAI GN

I n d e x e dDI SCLOSURE BOARD A u d i t e dJ AN 1 0 2 0 0 6 C o m p u t e rC e r t i f i e d D a t e o f D i s s o l u t i o n

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