:_~, SEE BACK OF FORM FORM STATEMENT

DRA OF
an Initial* Statement of Organization (Rev . 05102) ORGANIZATION
rn s is an amended* Statement of Organization For Office Use On
ly
An initial Statementof Organization should be filled within 10 days of the committee's accepting conUibubons, Corm . #
maidrlg ependitures or incurring indebtedness exceeding$750. Amendments should be filed within 30 days. ofa Indexed
change . Penaifiees may be imposedfor late-Sled Statements of Organization. - Audited . f
Computer

COMMITTEE NAME (Required by law)

VOTE NO COMMITTEE

IMPORTANT: Indicate type of committee you am reporting for Lii

(1)StatewidaILegislathreCandidate (2 )Statewide PAC (3 )State Party (4 )CountyfLocal Candidate (5 )County PAC (6 )Ballotlssue/Franchise
Corrunittee (7 )County/City Central Committee ( B )Support slate of candidates (list. candidates under purpose of committee)
COMMITTEE TREASURER This address used for all reminders and COMMITTEE CHAIR (Ust additional. officers on separate page)
(Required by law) conwpondence) -.
Name Name
Dan W . KratoskA Mark Beardmore
Mailing Address Mailing Address
905 West 19th St . Carroll, Iowa 51401 2625 Forest ST . Carroll, Iowa 51401
City, State Zip Code City, state Zip Code

Phone (712) 792-5668 Phone( 712 ) - 792-5076

e-mail kratoska@iowasavingSbank . con e-mail
_NDICATE PURPOSE OF COMMITTEE - Check One Box U Advocate fbdigainst 6i~Wte(s) -p-Advocate ioryagj_,~~;I*s V~_
description:
All Candidates Enter i
Office Sought District
C0UWYAUDR
Political Party (ifapplicable) Year Standing for Election: OR
County/Local Can0fdates and Local BaUotfFranchlse Committees Enter:
County: Date Jq R-00- of Election : 9 -~ ro D-
Bank Account Narne ' -14, Candidate name & ress or Parent Enft (PACs. andicable) .
1 1 Affiliate: or Sponsor
Vote No Committee
Name of Financial Institutlonltype of Account 1 1 Mailing Address 1. 1
Iowa Savings Bank
1 1
Mailing Address City 1 1 State 1 1 Zip 1 1
510 Hwy 30'West
City 1 1 )
ate 1 1 Zip .1 1. Phone(
Carroll Iowa 51401
e-(Mail .
DISPOSITION OF BALANCE OF FUNDS UPON DISSOLUTION (Statement intent require y committees, except state parties an ken
indicate dis itim of funds by marking appropriate mrnber in box: 03 committees and Canmittees using only personal Nnds .)
(6) PRORATED REFUND 10 CONTRIBUTORS
(2) DONATED TO LOCAL/STATEMATL POLITICAL PARTY (urdwfneors) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE
(3) DONATED TO CHARITABLE -ORGANIZATION (CANDIDATES ONLY)
(S,
.Cify)
Carroll Fire Station Renovation (8) RETURN TO PARENT ENTITY GENERAL. FUND (PACS ONLY)
(4) CITY/COUNTYISCHOOUSTATE OF IOWA GENERAL FUND (underline one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC
(5) PARTISAN, CONGRESSIONAL DISTRICT FUND

STATEMENT OF AFFIRMATION BY TREASURERAND CANDIDATE; OR POLITICAL COWTTEES, BY CHAIRPERSON

I am awarethat I am required to file disclosure reports if the canmittae receives contributions, makes expenditures, or hours indebtedness . in excess of
$750 .00 In a calendar year to egiresslyadvocate for any candidate or ballot issue. I understand that although thetreasurernormally prepares and files
reports, the candidate or chairperson (PACs) Is responsBfte under the lawforaccurate and timely disclosure reports ahd that IatsTfled reports are subject
to civil penalties and possible otherlegal, action. 1 understand that by filing this form, I am subject to the laws found in Iowa Code chapter 56, chapter 68B
and admin" rules found In r ~1~ffrm that allcommittee officers have been Informed of theirappanttnent and obliga"ARROII
f_iy~aa Qca r
COUNN
IT
Date Signed
`.
b- % Q ii t It~
Date Sg 2002

COUNTYAUDITOR