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CEDAR VALLEY COR is 0 01

02/11/05 15 :02 FAX 3192357198


FEB-11-2005 FRI 02 :50 PM FIRST SECURITY ST, BANK FAX N0, 319+233+1810 P, 02

Form DR-OTC

.IOWA ETH1.CS AND CAMPAIGN DISCLOSURE BOARD


510 EAST If " , SUITE 1A ONE-TIME CONTRIBUTION IN

_ DES MOINES, 1A S0319 EXCESS OF 5750 BY A

.1 2005 Fax: (515)281-3701


PERMANENT ORGANIZATION
F F$
www.lowa.gov/ethic s For office umqe only

indexed
r~ B-T CONTRIBUTION IN EXCESS OF $750 Audited
BY A PERMANENT ORGANIZATION Checked
Computer
Iowa Code section 68A .402(9) requires a permanent organization that contributes in excess of
$750 to register and File reports as a PAC . This form is intended to serve those purposes . The
form m ust he filed with the Board on or before the tenth day,, of the date the check was issued .

ORGAN17-ATION MAKING CONTRIBUTION,'

_Cedar Valley Corp,


Name
PO Box 1740 Waterloo TA 50704
Mailing Address City, State, Zip Code
319-235-9537
Area Code 8 Telephone No .

CONTACT PERSON FOR THE ORGANIZATION :

Stem _Jacwtn
Name
PO Box 1740 Waterloo IA 50704
Mailing Address City, State, Zip
319-215-9537 _
Email Address (Optional) Area Code & Telephone Number

CANDIDATE OR COMMITTEE RECEIVING THE CONTRIBUTION :

I Metro Coalition for Better Strects


Name of Candidate or Comm1hee
P .O . Box 1 0 01 Waterloo, lows 50704
Mailing Address City, Slate, Zip Code
319/235-0050 Date or Contnbuution
Marc11 l, 2005
Entail Address (if available) A7T6ii d~ Telephone Number
Date ofElection County (If Applicable)

If contribution to candidate, disdose source of original funds used to make


such contribution (attach additional pages it necessary), If In-Kind Contribution, Describe

Crlleiia to use this form :

One campaign contribution in excess of $750 was made to a stale or lor'al candidate, party, political committee (PAC) for cillier a
c%+nLlidyttk or a b!)ltot issue, or any corer organization that advocates the election or defeat of a candidate or ballot issue .
2, Must be a permanent organizatirul not esiablished Rrr election purpohes .
3. No rerson (lave mnru:y to the, organ"Ilon for the purpose of the organization then using the money to make the contribution_
4. If the contribution was made to a candidate, no funds from a corTmration or other prohibited ourllribulor under Iowa Code si :-ctinn
6011503 whru used to make lire contribution (this does not apply to a contribution made to a ballot issue committee) .
5. Only one contribution to any campaign committee except for a ballot issue committee was made in a ca. lend:+r year. No more tl tan or,e
corl0butiort inay be made to any one ballot issue committee during a ballot issue election . If more than one contribution and the total
amount of the contributions exceed 3150, the oryariil :Aun mu3l rrgistcr with Vie Board as a political committee (PAC) within 10 days of
crossino the $750 threshold .

Statement of Affirmation :

Lh;U R " -]1AC1<L- affirm that the cattnbution reported above is accurate . I further anirm that Ule information concoming the organization Is
nd lnuo to the best or my knowledge_ 1 understand that by filing this fomt . I am subject to the laws found in Iowa Code chapter 6811 and
tivc rules found in chapter 351 . I also understand that the failure to timely 61e this form leads to Vie inipoAion or civil penalties and the
fail~te to rO} fgfrirr'Vlay lead to additional civil and criminal sanctions .

O "Os-
Date

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