06/13/2005 11 44 FAX 202 962 3663 ICMA it001/001

Revised 07/0"
Form DR-OTC
'HICS AND CAMPAIGN DISCLOSURE BOARD
510 EAST 12 TH , SUITE 1A ONETIME CONTRIBUTION IN
DES MOINES, IA 50319 EXCESS OF $750 BY A
PERMANENT ORGANIZATION
Fax: (515)281-3701
www.lowa_goviiethlcs For office use only
Indexed
llriME CONTRIBUTION IN EXCESS OF $750 Audited
BY A PERMANENT ORGANIZATION Checked
Computer
Iowa Code ; n :i 68A .402(9) requires a permanent organization that contributes In excess of
$750 to regi ti .: d file reports as a PAC. This form is intended to serve those purposes . The
form must b .11 Nith the Board on or before tho tenth day of the date the check was issued,

ORGANIZA (;r MAKING CONTRIBUTION :'

In- ! ._ ational City/County Management Associatio n

Name 7'_
, Capitol Street N .E ., Washi ngton, D .C . 20002
Malling Ad :v City, State, Zip Code

_ 202-962-4262
Email Addr : i Aional) Area Code & Telephone No .
I N1 .

CONTACT 1 EI Z ON FOR THE ORGANIZATION :

,L the L . Perego
Name r,_ N, Capitol Street, N .E . Washington, D_C_ 20002
Mailing Adk s City. Stale, Zip
_, : pereao@icma .orc7 202-962-3668
Email Addr  t Aonal) Area Code & Telephone Number

CANDIDA7 ! i I COMMITTEE RECEIVING THE CONTRIBUTION :

i 01-0

Citi, :? .~ for a Better Cedar Rapid s

Name of C, Ii I or Committee
IF.

1211 ! 71 ey Blvd, Cedar Rapid s, IA

Maning Adc ! si City, Stale, Zip Code
52404
319-396-8461
!mail Addr T f vailable) Area Coda & Telephone Number

If coninbuh 4- _c ididate, disclose source of orlglnal funds used to make

such contril It o attach additional pages If necessary) .

1. 'n impalgn contribution In excess of $750 was made to a state or local candidate, party, political committee (PAC) for either a
tr l ate or a begot issue, or any otherorganization that advocates the election or defeat or a candidate or ballot issue.
2. -u t ~a a permanent organization not established for election purposes .
9. 17jn son gave money to the organization for the purpose of the organization then using the money to make the contribution,
4. th ontrlbutlon was made to a candidate, no funds from a corporation or other prohibited contributor under Iowa Code section
)v 13 were used to make the contribution (this does not apply to a contribution made to a ballot issue committee) .
is contribution to any campaign committee except for a ballot issue committee was made in a calendar year . No more than one
ii r ~ltion may be rnade to any one ballot issue committee during a ballot issue election . If more than one contrlbullon and the total
nt I of the contributions exceed $750, the organization must register with the Board as a polldcal committee (PAC) within 10 days of
0< is the $750 threshold.

Statement it a, I f ination:

I , Marth rego afflnn that the contribution reported above is accurate . I further affirm that the information concerning the organization i6
correct and to a' t best of my knowledge. I understand that by fling this form, I am subject to the laws found in Iowa Code chapter 68A and
administrative lo. ; Fund In chapter 351. I also understand that the failure to timely file this form leads to the imposition of civil penalties and the
intentional fag I la the form may lead to additional civil and criminal sanctions.

6/13/05
1 rl, i ire r Date

"Contrlbutlor ill t as goods or services that are provided for free or otherwise less than fair market value.