i3ISGLUO aE ao-

It, EVIcs Also

F W TATEMENT
FOR INSTRUCTIONS, SEE BACK OF FORM CAMp~'`~aN
CK ONE: .~. _ DRA OF
ORGANIZATION
This is an initial" Statement of Organization -5 7 ,, ~, Rev. 01/200
I
U This is an amended" Statement of Organization W
01
An initial Statement of Organization must be filed within 10 days of the committttea s accepting contributions,
Office 17 1"WoM
comm, #
making expendliums, or Incurring indebtedness exceeding $750, Amendments must be fried within 30 days of Indexed ' - -T -
a change. Penalties may be Imposed fbrlale"Sled Statements of Organkebon . A candidate with an open Audited
committee that exceeds $750 in activity for another ofe shall No within 10 days either a new or amended Cort, uter
DR-1 disclosing information concerning the campaign for the new ote sought - --- --- - -
COMMITTEE NAME 1 1 (A candidate's committee must Include the candidate's last name In the name of the committee,)

Fr
I t? Yti Ot S top QS o n 5-C k" ('-r-
IM JRTANT: Indicate type of committee you are reporting fin W
(1 )Statewide/Laglsla"Judge Standing for Retention Candidate (2 )Statewide PAC (3 )State Party ( 4 )County C Committee
(5 )County Candidate (6 )City Candidate (7 )School Board or t0drar Political Subdivision Candidate (B )County PAC (9 )City PAC
10 drool Board or Other Political Subdivision PAC 11 Local Ballot l"us ncludn committee involved In mulb /county ballot issues

COMMnrrEE TREASURER (mandatory forall committees) COMMITTEE CHAIR mandate except ra candidate's committee

AM k
Name Name
5C u I , i?
Mallsng~Address 1 1 Mailing Address
ox '15
City stat? ~. a zip code'Z .1. City, State I I Zip Code 1 1
' SC lP .S :~d r~} S s~ 1

a
t!.
I ( 7 /.2) l~ 7 c/, D9 Phone ( ) _

e-M~dl ~r~~ndSO~ Gytc~~f '~' ' Qhas .~DM

INDICATE PURPOSE OF C@MMITTc -Check !e -i~a~~
- 1111i Advocate for bat . issus(s)
Comment or description: W Advocate against ballot issue(s)
111 Candidata4Entw. Local
Cou Lc:.-_~ n7 ~s and " m Enter:
Office Sought 14el
County .
Political Party (if applicable) (If acave in multiple ballot issue elections, ff7 ::"3t list of counties
District : ~~
Data of Election:
Year Stands for Scotch :
Bank Aggount Name 1. 7 I 7, iTIrJS 7T!.1;7; 7

Fle~c(s a~J~.san ~chu a so

Na e of Financial InsMubonhype of Account .l, J. Mailing Address J. ~.
lr feCX 8a V1 tit 1Gu~a CA eckfu D
Mailing Address I ' City J. ~. State Tip
0,. qZ-~ 1~s ck ~N ~JI
city State .L ~ zip
Phone ( ~(~ ) -
~c k le s w t ~ -rd .5lglo / ;Pr-,"N
e-MOW J v s ~1 u Q oc C v r~t

STATEMENT OF AFFIRMATION : ey filing this document the committee dam" the following:

1 . TV* committee and all persons connected with the Committee understand that they are subject to the laws in lows Code chapters 68A
WB and the adminlabatlve
rules in Chapter 351 of the Iowa Administrative Code .
2. That Iowa Code section 68A.402 and rule 351--4,9 require the filing of disclosure
reports and that thefailure to file these reports on or _ ore the required due dates
subjects the candidate or chairperson (In the case of committees otherthan a candidates committee) to the sutWnatlc assessment of advil penalty
and the possible
Imposition Of other criminal and civil sanctions .
3 . That lows Code section a6A.405 and rules 351-4.38 through 4.43 require the placement of the words "paid forby" and the name of th
materlsls except for those items exempted by statute or rule . A committeethat wishes to committee on all political
register a committee name forpurposes of using shorter "paid for by" and
noes not intend to cross the $750 filing threshold shall file the Form DR-SFA tone,
4, That Iowa Code section 68A.503 and rules 351--4 .44 through 4.52 prohlbitthe receipt of corporate contributions
by all committees exce~t forstatewide and local ballot
issue PACs .
5. A candidate and a candidate's committee may only expend campaign funds
as permitted by Iowa Code Sections 68A.301 through S8A.3Q3 and rule 351-.4.25.
6. That the committee will continue to rile disclosure reports unlit all activity has
ceased, committee hinds spent, debts resolved, and a final'report and a statement of
dissolution (DRS) has been filed .
1
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