Sep 21 04 04 :17p Jim&iMar~j Krier 641-622-3207

FOR INSTRUCTIONS, SEE BACK OF FORM _ _} . . .__

FORlVI .S1ATf MENT-
CHECK ONE. Reset.Form,
V This is all initial" Statement of Organization VK-1 ()F
El This is an amended' Statement of Organization (REV 0712004)
IFor Office Use Only
__ ORGAN(ZA-f(ON

'Mrr initial Statement of Oro<uuzation must be filed 'with :ri 10 days of the conimrtlee
making expenditures. or incuriing iiidebtedriess e:ceedtnc $750 Amendments mi
a lunge. Penal(ies may be imposed for late-filed fate;r:c'r7ts cf Organization

_
COMMITTEE NAME
Committee to Re-elect SUpiewisor Mary Krier
IMPORTANT: Indicate type of cornrnittee you are reporting for: {i _
( i )StatewidelLegistativei'Judge Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )State Pariy rty Central Committee
i S )County Candidate ( 6 )Cit)r Candidate ( 7 )School Board or Other Political Subdivision Candidate (8 )County PAC (9 )City PAC
(_ 110 )School Board or _Other Political Subdivision, PAC ( 11. ; Local Ballet issue
-
COMMITTEE T REASURER (mandatory for all committees C OMMITTEE CHAIRdidte'sommittee
(mandatory except for a cana c ,
rNaine Name
Marilyn Wells Mary Krier
Mailin Address Mailing Address
520 Walnut I 2 BM 280th Street
City, State Zip Code City, State _; Zip Code
Si ourne towa 52591 Ollie, Iowa 52576-5523

622-3548 622-320'7
Phone (s., )_ . Phone ( 641 )

i e-mail jinciier4@yahoo.com
s e-Mall
INDICATE PURPOSE OF COMMITTEE - Ched( One Gox (!, .Advocate foriagainst candidates) Advocate forlagainst ballot issue=(s)
Comment or description Re-electi on of Supervisor Mary Knee b wf ite-in vote_
.KUCandidates Enter:
Cfticr; Sought. __ County Superviso r - 2nd tent)
District.
t -2)704
Rolitieat Party (if applicable) Year Standing for Election
County/Local Candidates and Local Baliottf''ranchise Committees
November 2nd, 2004
Keokuk Date of Election :
County :

Bank Account Narne Candidate name & Address or Parent Entice (PACs . if anolicab!;y

. ,. Affiliate, or Sponsor
Committee to Re-Elect Supervisor Mary Kner Mary Krie;

Name of Financial Institution type of Account . . Mailing Address

Keokuk County Savings Bank - Checking 28042 280th Street
Friailing Address W City State . Zip
201 South Jefferson I Ollie Iowa 5:576-8523
City State . Zip 1 I
) 622-3207
Phone (641
Sigounuay laNo 52591 1
)mcner4@yahoo coin
_ email

STATEMENT OF AFFIRMA'riON : By filing this document the committee affirms the following :

1 Tile committee and all parsons connected with "lie crnm :;tee understand that 'they are subject to the laws in Iowa Code chapters 63A and 6B13 and ih>- administrative
cukBS in Chapter 351 of the Iowa Ad'n~+dsirative Code
,.' T hat Iowa Code section GSA doe and rule 351--4 g require the filing of disclosure reports and that the failure to file these reports on or before tile raqured due dates
subjects the candidate or i~hairperson u1 the i:ase of committees ether loan a candidate's committee) to the automatic asssessrrk:nt of a cowl penalty arid ?!)e possible
unT,,osa!ofi of other criminal and civil sanctions
3 That Iowa Cod;. &action GBA 41,'5 and rules 35'. ._-4 36 through 4 43 le.qufr the placenieiii of the words 'paid for by' and the narrx= 01 life GCnnrnitLe o; : ail political
malenai%% except (01 those items exempted by stahile or ride A committee filing thus statement for purposes of using the shorter 'paid for by' and who lia;e riot crossed
the :750 shall notify the Board lh-v the 1,750 threshold ;viii not be crossed .
" 1 1 hat Iowa Code section (35A 50'j arid rules 351-4.44 through ": "2 prohibit the receipt of corporate contributions by all committees except for statewioe and local ballot
issue PACs
9 :'+ candidate and a cindictafe's committee may oily expend campaign fi :nds as pemdtlrad by Iowa ::ode section: 68A.301 through G8A103 and rule, 3 ,1--425.
o That the committee w,u continue to file disclosure repnris until all actwil;, has ceased, committee funds spent, debts resolved. aria) a final report and a !statement of
"sol )ion (DP 3) t:as been Ill-,

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