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FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE!
:3 This is ar Inltlal` Statement of Organization
'This is ar amended' Statement of Organization

'An initial Statement of Organization must be 6ied within 10 days of the committee's accepting contributions,
making exporp airums, or incumng Indobt9dnesS exceeding $750. Amendments must be tiled within 30 days of
3 change Pennines may be imposed for 1.1ro" Med Stafements of Organization . A eaneltdate with an open
cnmrnrtfee that exceeds $750 inactivity far another office shall file within 10 days either anew or amended
OP-1 discicsing informaiion concemlng the campaign for the new office sought.

COMMITTEE NAME 1 I (A candidate's committee must irclude the candid3

.-

IMPORTANT : Indicate type of committee you are reporting for :

( 1 )StatewldWLegislatlve/Judge Standing for Retention CandidateLZLJ
(2 )Statewide eel Committee
( 5 )County Candidate ( G )City Candidate ( 7 )School Board or Other Political Su C (9 )City PAC
( 10 )School Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issuefincl in multiple citvlcounty ballot issues

Name 1 " ~
IM (JIJJV r~'fl
Malt rig 1 1 S) _Adres
S; S7xrTF r
Ciry, State 1 i Zip Code 1 1

Fr,% (
:31g) X27-3577

e-mail
INDICATE PURPOSE OF COMMITTEE - Check One 3o forlagainsi candldate(s)Advocate for ballot issue(s)
Comment or desrcrloton : 11
Advocate against ballot issuers
All endidate5 Enter ounty ocal Cand ales and Loca
0111ce sought :
County
PC) dIcal Patty (i1 applicable) (If active in multiple ballot issue elections . attach lust of counties
Disnicr _ Date of Election :
Year S1and,ng for Election :
Bank Account Nome 11

~f
~zt,fl
Name of manciaif ;tit ionAype of Account
AccojLy
j 1
~w~c UUD J ~ ~nrc cl., r
Mail rig Address i 1

City d 1 State ;. j Zip I 1

STATEMENT OF AFFIRMA71ON : By filing thin document the committee affirms the following :

1 Tne committee and all persons connecec with the committee understand that they are subject to the laws in Iowa Code chapters 68A end 688 and the adminislralive
rules in Chaste, 351 of the Iowa Administrative Code .
2 Tnat iu .va,ocjo soctlon 8BA .402 and rule 351 -4 .9 require the Mng of cilsoosuro repors and that the failure to file these reports on or before the required due dates
;uDlerts the candidate or chnirper .or (in the case of committees other than a candidate's committee) to the automatic aaaesement of a civil penalty and trio possible
imposition of ether criminal and civil sanctions
3 fiat Iowa Code section l and rules 351 -4 .38 through 4 49 require the placement of the words "paid for by' 3rd the name of the corrimidoo on all l
materials ex-ept fir thc, ;a itema exempted by statute or nile . A oommittee that w9hes to register a committao name lot purpasos or using the shorter 'paid for hy" And
Jcec nut inlecd lit cross it u ?,750 Wing utrosnuld :hall file Ihq Porn DR-SFA torn.
4 Tnat Iowa Code Section 68.A 503 and rules 351 -4 as througn 4 .52 prohibitthe receipt of corporate contributions by all committees except for statewide and kcal ballot
issue PACs
A rranaidato aiA a candidate's committee may only expend campaign funds as permitted by Iowa code eect,ons 6t3A .301 ttuouyn 68A 303 and rule 351-4 25
5 That the committee VAll connnue to file disclosure reports until all acbvify has Dewed, committee! uncs spent, debt.% re olved . and a final report and a statement of
di ;Ioluticn (DR-?,f has heen filed

°~sa gne

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