Professional Documents
Culture Documents
Warren Family Farms - 2006 - Polk - OTC
Warren Family Farms - 2006 - Polk - OTC
001/001
Revised 12105
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Name I
~r~ .r`3atc ~5: ~~~aoa _ .Sorrrp~
Mddng Address T Ctbr. state, zipCede
Name
Milling Address City . slate, Zia
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_ Addtew (aptlorW) _Area Code aTefepTtom nuneer
1. Onecampalon cordr1bason In excess of 5750 was made to a stab or local candldeta, par% ponfeat committee (PAC) for afther a
candid ate ore ballot issue, crony oiharot9anfsatlon that advocates theelection or defeat of a candidate or ballot isauo.
2. Must be a pwmened organization not estabtieW for election purposes.
S, No person gave Moneyto theorganisation forcite purpose at thewpanRmtion then using the money to make the cor*tbugon.
4. If the contr4bullen was made to a candidate, no fundsfrom a corporation or aner prohiblled conMqutor tstdrlowa Cede section
.543 were used to mdta the contilbuflon (this does not apply to a contdbtbon made to a ballot Issue ccmmtttee~
6&A
5. Only one contribution to any campaign committee except tar a ballot issue comrudtaswasmade In a calendar year. No mart: than one
conhlbugon may be made to any one ballot issuecommittee dulng S hollet law* Shadow. If more than one cartMbution andthetotal
amount of the wntilbudoneexceed $750, the organization must raoktarwith ft Board as apofal oommidee (PAC) Within 10 days of
crosstna the S7ti01hroehotd .
Statement of AMrmaBon :
f.) r FAlrm that the cantribudon reported ,bays is accurate. I further atrirm that the Infarmadon concerning the arold don is
true to the bW ofmY kfi . t und6reterd that bY ferry 06 brat, lam subject to the Iowa found In Iowa Code chapter 55A and
- lWas found in d-ler 1 also understand that thealreoepesormeasoempeenion
fi4 t Bml R fill f ld t th It of avd p-Was end the
failure to toe1hhtaotymsy Io addltlof civil end pimknW sanctions.
"Contrlbuiion'4ndudes goods or services that are provided for hasor otherwtap law than fair madeat value,