09/19r"007 WED 11 :47 FAX 5637854719 LIBERTY TRUST & SAVINGS 1002

1~ TI`'1r. " ) n k

FOR INSTRUCTIONS, SEE BACK OF FdRM FORM STATEMENT

of
g This is
CHECK ONE:
This is an initial' Statement of Organization
an amended' StatQmont of Organization
DR-1
,_ 0112005)
For fft e Use Only
~RGANIZATION

An initial Statement of Organization must be Nod within 10 d0ya of the committee's accepting contributions. Con-an. #
making expenditures, or incurringindebtedness exceeding $750, Amendments must be flied within 30 days of Indexed
a change. Penalties maybe imposed for lete-filed Statements of Organization . A candrJ8(e with an open Audited
committee that exceeds $7.50 in activity foranother office she# file within 10 days either anew or amended Computer I~Z~'Lr
DR-1 disclosing infomtation concerning the campaign for the now ol!rce sought.

COMM ITTEE NAME 1 1 (A candidate's committee must Include the Candidate's last name in the name of the committee.)
Paustian for State House
IMPORTANT: Indicate type of committee you are reporting fix: 11
(1 JSatawldelt.egisIttttvWJudge Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )5tata Party ( 4 )Courtly Central Committee
(3 )County Candidate (8 )City Candidate ( 7)Schoot Board or Othor Political Subdivision Candidate (8 )County PAC (9 )City PAC
f 10 )$CJ1opl Board or Other Political Subdivision PAC (11) Local Ballot Issue(including committee Involved to multiple citylcounty ballot issues)

COMMITTEE TREASURER (rnandMory for ail commMees)

Narf
c1iael R. Hein
Malting Address 1
PO Box 111A
CilySIHIe t~ Z (;tx1n 1 2
an 747

Phone (563)---119---4441

e.Mal mhein@mylibertytrust .cam

INDICATE PURPOSE OF COMMITTEE - Check One BOX Advocate fodecainstcandidate(s) U Advocateforballotissue(s)
Comment or description: 0 Adv=ta against ballot issuo(s)
AllCaoIdaMs
S Eider: m
Office Sought _, State
Representative
~ .....-.
Courtly :
Poetical Party (,f applicable) Republican (Ifactive in rnulbple ballot issue e e ns, auact list oTcouWs

vetrict: Date of Eiedon :

Year Standing for Eladon : '_ 2QQg _ ,
Bank ~ttntNar, Canttii~e"Hriama&Address or Pal'enf~ntlty(PACs.ifaboligtilal . ~
11
Paustian For State House Rosa C. Paustian
Name of Financial insftulloNtype of Account .I. 1
Liberty Trust & Savings 8w1k
1 1
Mailing Address
502 8th Ave., PO Box 1118

STATEMENT OF AFFIRMATION : By filing this document the committee affirms the following:

1 . The committee and all persons connected with the comrrdttee undorsiand that they are subject to the laws in Iowa Code chapters 68A and 68B and the administrative
rules in Chapter 351 of the Iowa Administrative Code.
2. That Iowa Code Section 88A.402 and rule 351-4.8 require the filing of disclosure reports andthat the failure to ale these reports on or before the required duedates
subjects the candidate a chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
bnpoeltion of othercriminal end Civil sanctions.
3. That lows Code section saAAo5 and rules 351- "4.38 through 4_43 require the placement of the words "paidfor by' and the name of the Committee on all political
rateriata extaspt for stow Items exempted by statute or rule . A Committee that wishes m ra4aw a conunittee name for purposes of usingthe shorter 'paid for by" and
does not intend to cross the $730 filing threshold Shall file the Fort DRSFA form,
4. That Iowa Cctde section 63A.503 and rules351-4.44 through 4.32 prohibilihe receipt of corporate contributions by all Committees except for statewide and local ballot
issue PACs.
3, A Candidate and a candidate's committee may only expend campaign funds as permitted by Iowa coda sections 63A.301 through e8A,3o3 and rule 331--x .25.
e. Tftel thecomnitKp will continue to file disclosure reports until all activity has ceased, commitm fundsspent, debts resolved, and a final moon and a slaloment or
dissolution (DR-3) has been died .

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