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ACCT AND TAX SEP 5639336416
NOV-10-04 02 c59 Pht QUALITY

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FOR INSTRUCTIONS, SEE r, ?)
BACK OF FORIW ' ' FORM STATEMENT
CH CK ONE :
DR-1 T OF
[_t~This is an inltla)' Statement of organization i4 0V 0 MIA (Rev . ORGANIZATION
[_ This is an amended' Statement of Organization , 07/2003)
Fo,EOffIge Use Oniv
'An Initial Staternnnt of Organization must be Mad wlihln 10 de)i
_ tlona, making 1-21
1.25
oxpdnditures, or Incurnng indebtedness ercoedlng $750. Amendnten'Jmust be Mod within 30 days COMM K
of s, change. Indexed T
Penalties may be imposed forlate " filed Statements o(Organizetion
Audited
Computer

COMMITTEE NAME 1

L if r1 7C'_I, : 0 P S) 41'a i,t! be. r r l~o t n t_

IMPORTANT : indicate type of committee you are reporting for:

( 1 )StatewIde/Leelalailve Candidate (2 )Statewide PAC (3 )state Party (4 )COUhlylLocal Candidate ( 5 )County PAC ( S )Ballot IosuelFranchlee
Committee ( 7 CCounitCity Central Committee

COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory excep t fo r a candldet4'a committee)
Name 1 b Name

Mailing Add ss b - Mailing Ac rass 1 d

City Slate 1 ~. ZIP Code 4 1 -_

_ _ ________
city, Stale 4 ZIP Code 1 1

____.`1 Y1th j, Cr_r_s~_ ,

_ !L _ _ 2Q2~C

Phone __ __ Phone
at-s6 iOli a"fele(_oM-
o,Mel' .l lief 0-Mall
INDICAT PURPOSE OF COMMITTEE -Check One Box Advocate for/again t cendldata(s) Advoc=ito forlegalnsl ballot Issues)
Comment or descri eltlon . C. I 'f I Z K i ~t~ : v C t~ t~ilF t~~fii'
Candidates Enter:
AllCandidates '?Yl e ~~[,cre p
Office Sought ----------------------------------------------- District :

Political Party (it applicable) ...... ................. _. ............... Year Standing for Election
County/Lo l Cendl ales and Local Ballot/Franchlse Committees Enter;
County ----------------------------------- Date of Election : G, ?Gn a ° ~~Nl ~~ 05
Bank A count Mama 1 Cand1dil me & Address or Parent Entity !PAC@. It aobtlcaolol.
A11111ate. or Sponsor

!Y7 1 ri~c' S
4~1b'_____~
___
:fit 1~1~C
_
L ____ i f1 _________..__
Name of Financial Instllutlonnype oflount 1 1 Melllng Address 1 1

PC 6o X 110
M-mn4Aear&R city I State ZIP

city W -L State 1 1 ZIP 1l Phone( ---------------------

e-Mall_ __ _ _ ___,
-------
__ -------------------

STATEMENT OF AFFIRMATION: By 1111ng this document the committee affirms the following :

1 . The commiuee end all persona connected with the committee understand that they ere Subject to Ins laws In Iowa Code chapters 68A and 6170 and vie
administrative rules to Chapter 351 of the Iowa Administrative Code .

2. That low@ Code section 68A,a02 and rule 351--4 .9 require the Iliing of disclosure reports end that the failure to Ale these reports on or before the required due
dotes subjects the cendldete or enelrperson (in the case of committees other then a candidate's commitlee) to the automalle easessment of a civil penalty end the
possible !mposllion of other criminal and dvll sanctions .

3, Thm Iowa Code section 68A,405 and rule@ 351-4.38 through 4.43 require the placement of the words 'paid for by' end the name of the commlttae on all polltio8l
malortals except for those items exempted by statute or rule . ,

4. That Iowa Code section 68A.503 end rules 331-4 44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statewide and Icca!
ballol issue PACs
3, A candldale and a candidate's committee may only expend campaign funds as permitted by Iowa code socllons 88A,301 through 88A.303 and ruis 351-4 23
6. That the committee writ conunulrr to file disclosure reports until all activity has eeseod, committsta funds spent, debts resolved. end a final report and a statement or
dleablutW (DR-31 IS .. been flied .
Y. APCB1
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