FES=14-2004 02 :39 Am

P- 02

FOR INSTRUCTIONS, SEE BACK OF F OI FORM STATEMENT

DR-1 OF
ECK ONE: (Rev . ORGANIZATION
This la an Initial' Statement of Organization 0712003)
r= Thls is an amended' Statement of Orgenizaton for ca Use my

'An initial Statement of organization must be Algid within 10 days of the oom comm. e aZ /02.
axpendttures, or Incurring Indebtedness exceeding 1700. Amendments must be filled wi Indexed ,422 r.
Penalties may be imposed forlate-Algid Statements of Organization. Audited
Cc Cuter _ Y1
i r%Ve s.eAi 1119 " G't

COMMITTEE NAME J"

I~~ze,ri <. AI" at n r. -for

IMPORTANT: Indicate type of committee you am reporting for.
( 1 )StutewldelLegislatlve Candidate (2 )Sfali vvlde PAC (3 )Stab Party (4 )CountylLocal Candidate ($)County PAC I S )Ballot Issueffrenahlse
Committee T Coun ICI Genteel Contmktee

COMMITTEE TREASURER (me ndefory for alt committees) COMMITTEE NAIR (mandatory except for a candidate's committee)

Name W 1 Name 1 J"

&Y'.,14
Mailing Address I J. Mailing Address

2LI 55 I SO S ~7 -70 'r

r Ave
CGty, State y 1 Zip Code City, State -T-1 Zip Code y b

TA .Stay K M~ 18 .592144

Phone (Flit ) -,~ N7 Zg'f0 Phone (6Nl) 5)?7 - 2l4 q3

.-Mall bnrc'Ir,er i e-Mall a lrOrt^ ^1 ~~G-h . r1Gt

INDICATE PURPOSE OF COMMITTE Advocate for/agetnat candidate(s) Advocate foNagainst ballot issue(a)
Comment or descrlptlom _
-
All Condidetoe enter; -
UOce Sought : District :

Political Party (If applicable) _ Year Standing for Election :

CountylLocal Canqtdptes qrid Local BsllolifFronchlee Committees Enter:
County : W f4rht Date of Election : MA,-,,b- -I -2D o

tank A99 unt Non" C~ dai name or ~e ()tlty I, ;pjl~,

C Ag5
W Afflllg or3nonagf

- 2
Name of lnalftutionltype of Account Mailing Address b

L ; bar
MaIIIng Address J( d. City state tip

1`7S -r ?'9D _ PO iZ9

City 1 J, State J. Zip d y Phone ( )_,

a t" nor 1A 8DU:8 e-Mall

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

1 . The committee end all persons connected with the committee understand that they are subyct to the lawn in Iowa Code Chapters 68A and "8 and the
administrative rules In Chapter 331 of trio lows AdminlstrsGvs Code
2. That Iowa Code section 68A. e and rule 351--1 .9 require the filing of disclosure reports and that the failure to file these reports on or before the rrtqulntd due dates
subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a dill penalty and the possible
imposition of other criminal and chill sanctions.

3, That Iowa Code section 61LA,14 and rules 351--4,38through 4.43 require the placement of the words 'paid for by' end trio name of the committee on all political
materials except for those Items sxempled by statute or rule.
4 That Iowa Code sedlon e8k15 and rules 351--4 .44 through 4 62 prohibit the receipt of corporate contributions by all committees except forstatewide and local
ballot Issue PACs.
5. A candidate and a candidate's committee may only expand campaign funds as parmlned by Iowa code sections 68A.40 through e5A.42 and rule 361-4.28.
and
6. That the committee will ~Vtnue to,gp dledosure reports until 911 activity hoe ceased, committee funds spent, debts resolved, and a final report a statement of
dissolution (DR-3) has OyllMled

- Signature
a w

2 4M
Signature delholdele, OR, for a4 Other commlaaw, ChelMorean