.

1,,17,,2005
(J 09 :26 Fill 319 298 7799 McLeodUSA 002

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE : FO
MR STATEMENT
This is an Initial' Statement of Organization W-1-0-ME OF
DR-1

El This Is an amended' Statement of Organization `-' (REV . 07/2004) ORGANIZATION

i
eat; For Office a Oni~
'An inlflal Statement of Organization must be f116d within 10 days of the corn%Mfiy  Comm . # J
making expenditures, or incurrlng. indebfednsss exceeding $750. Amendments mt4i.ppy Indexed
a change . Penalties may be imposed forlate-filed Statements of Organization. Audited
Computer

COMMITTEE NAME I 1

IMPORTANT: Indicate type of committee you are reporting for.

( 1 )StatewidelLegislailvelJudge Standing for Retention Candidate (2 )Statewide PAS Party (4.)County Central Committee
( 5 )County Candidate ( 6 )City Candidate (7 )School Board or Other Political Subdivision didate (B )County PAC (9 )City PAC
( 10 )School Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issue
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name -~ Z Name b 1 ~ A r`~c
lbav~A hhil ~> tt~ ~5
Mailing Address 1 1

City S le ~ J. Z ode
D
Oka
-
Mailing Address 1 1

City, Stale .l b
3 bLZ
Zip Code ~. 1
S-f- ~~~P.rs oa~C
p

ur iu e... M A r ion t Iqr .~ --z J~ OZ

Phone l 4 il - 01-\ 0-
9- Phone (319) y2 -Z1Z~

e-Mail o~C ~ ~lfJl.1Gt .~~ `f~ ~~t'v~~Gs . COW e-mail -~ htemct-ds Q n e.+ j rZS _ n e-t
INDICATE PURPOSE OF COMMITTEE- Check One Box C Advocate forlagsinst candidate(s) X7 Adv r/against ballot iasue(s)
Comment or d escr ption : ~i f`~ ~ti o o\ b n
All Candidates Enter.
Office Sought:
District:

Political Party (if applicable) Year Standing for Election :

CountylLocal Candidates and Local BallotiFranchise Committees Enter.
Date of Election : 0/

Bank Account Name y I. Candidate name & Address or Pamnt Entity (PACs, if applicable) .
.6 1 Affiliate, or Sponsor

LAA,~il -1k i~il

Name of Financial Insftudon/type of Account 1 t.1 J Mailing Address

FAT-Ale-5 f:; -
Mailing Address 1 1
r Ill-
City 1 d
`PO j3
tl 5r.09 Slate 1 y Zp I d

City 11 1 State .4 J.
Phone ( )

e-mail

STATEMENT OF AFFIRMATION: By fling 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 66B and the administrative
rules In Chapter 351 of the Iowa Administrative Code .
2 That lovea Code section 6BA402 and rule 351-4 .9 require the filing or disclosure reports and that the failure to file these reports on or before the required due dales
subjects the candidate or rltalrpetson (in the case or committees other than e candidate's committee) to the automatic assessment of a Civil penalty and the possible
Imposition of other crirnlnel and civil sanctions .

3. That Iowa Code section 66A405 and rules 351-4 .38 through 4.43 require the placementof the words 'paid for by' and the name of the committee on all political
materials except for those Items exempted by statute or rule. A committee filing this statement for purposes of using the shorter'pald forby' and who have not crossed
the $750 shsll notify the Board that the $750 threshold will not be crossed .
4. That Iowa Code section 68A503 and rules 351-4.44 through 4.52 prohibit the receipt or corporate contributions by 311 committees except forstatewide and local ballot
issue PACs .
5. A candidate and a candidate's committee may only expend campaign funds ae permitted by Iowa coda sections 68A301 through 58A,303 and rule 351-4 .25.
6 . Th mmittee will conUnu , . rte until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of

i/G o~
dissolution tDR- n4.been fII%

(Data Signed

Date Signed