NSTRUCTIONS, SEE BACK OF FO FORM" STATEMENT

K ONE : DR-1 I OF
(Rev. ORGANIZATION
This is an initial* Statement of Organization 07/2003)
This is an amended * Statement of Organization For Office Use Oniy

An initial Statement of Organization must be filed within 10 days

expenditures, or incurring indebtedness exceeding $750. Amend
Penalties may be imposed for late-filed Statements of Organizati

COMMITTEE NAME 1 1
W/-Ii
omrnye Pe - &l-e~~ - cl ia nV

IMPORTANT : Indicate type of committee you are reporting for:

( 1 )StatewidelLegislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate ( 5 )County PAC ( 6 )Ballot Issue/Franchise
Committee (7JCoumty/Cit y Ce n tral Committee
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name ~ 1 Name

Mailing Address 1
u rYl mt t?s ____
Mailing Address

6D 9 Yv9 /11,1 "~

City, State 1 Zip Code City, State 1 1 Zip Code

Ld_'ecl)r /le, Sofia

~.

C eo derv ; A,P, -l-owa -3S2SY ~(

Phone (6 - Phone

e-Mail -7 - Oh~h I OU)~~ OG EQh CG -

e- Mail_-_____
INDICATE PURPOSE OF COMMITTE - Check One Box u Advocate for/against candidate(s) u Advocate for/against ballot issue(s)
Comment or description : ; ~l ec n
All Candidates Enter:
Office Sought: _---_- a ~ r
- ----- -_ District: -Cen7,elL
U , ~---_

Political Party (if applicable) --- ----- Year Standing for Electi n : _~~QP3-
County/Local Can dates and Local BallotlFranchise Committees Enter :
County: Date of Election : _ 0 V' 7
t7

J"
Bank Account Name 1 1 Candidate name & Address or Parent Entity (PACs. if amlicable) .
1 Affiliate, or Soonsor

_eomml h?e ~`Ele Lt ~' ~~K ~ ms

Name of Financi Institution/type of Account 1 1 Mailing Address 1 1

__a5_ ba' f1 1
Mailing Address 1 City 1 State 1 1 Zip
_job _~__. Ja,~C.SD n _ Cet,kefal/lie S~sv~
City ~ 1 State 1 Zip ~. Phone (Vr fl )_-~ ~
CenferuAe -:T-
OCX) a SaS-YV e-Mail_--_-_-_-_-_ _--

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

1 . The committee and all persons connected with the committee understand 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 68A .6 and rule 351-4 .9 require the filing of disclosure reports and that the failure to file these reports on or before the required due dates
subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
imposition of other criminal and civil sanctions.
3. That Iowa Code section 68A14 and rules 351-4.38 through 4.43 require the placement of the words "paid for by" and the name of the committee on all political
materials except for those items exempted by statute or rule .
4. That Iowa Code section 68A .15 and rules 351-4 .44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statewide and local
ballot issue PACs .
5. A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A40 through 68A42 and rule 351--4.25 .
6. That the committee will continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of
dissolutiom(W-3) has beeryjled .

nature of Treasurer
-
nature
of Candidate . OR, for at other committees, Chairperson Date Signed