04-13 :05 13 :41 $563 336 3330 EICCD-URBAN CTR .

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FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM STATEMENT

T-1 This is an Initial Statement of Organization ,; - DRA of

E This is an amended Statement of Organization ( REV, 0712004) I ORGANIZATION

For Offiye Use Only
'An infiai :3t.9tement of Organization must be tiled within 10 days of the committee's accepting contributions, Comm a
marung expend,turos, or incurring indnbtcdness exreeding $750. Amendments must be filed within 30 days of Indexed ,_
a mange Penalties may be imposed for /are-filed Sfaromenrs of Organization Audited
Computer

COMMITTEE NAME 1 1

FRIENDS OF EICCD
rIMPORTANT: Indicate type of committee you are reporting for.
( 1 )Statewido1Loglslatlve/Judge Standing for Retention Candidate (2 )Statewide PAC ( 3 1Stato Party ( 4 )County Central Committee
( 5 )County Candidate (6 )City Candidate (7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC
( 10 )School Board or Other Political Subdivision PAC ( 11) Local Ballot Issue
. COMMITTEE _ TREASURER (mandatory for_all committees - R fmandatory *oxcept for a candidate's committee
COMMITTEE CHAI
I Name 'L
r Nam y
LAMA J . DETTBARN GAR MOHR
A
I PAiu3.A~q :es~Zf,kR I MailiVd(PSS
DRIVE RIVER DRIVE

citllAVEP1POR.T zip lAde 52801 I I C~

,
RVE\;PORTP C 4A ~ 52801

Phone ( 56~ 336-333 5 Phone (563) 336-3322

e-Mail Idettbarn@eicc .ed u t e-Mail

INDICATE PURPOSE OF COMMITTEE -Check One Box Advocate fortagalnst candidate(s) ~C Advocate for/against ballot issues)
I Comment or description . .
f All Candidates Enter:
Office Sought* -
District :

?oiltical Party (it applicable) Year Standing for Election,

CountylLocal Candidates and Local Ballot/Franchise Committees Enter:
Date of Electlom
Counts .

Bank Account Name y y Candidate name & Address or PaLynt Entity (PACs, if applicable) .
1 Affiliate, or Spanner
FRIENDS OF EICCD EASTERN IOWA COMMUNITY COLLEGE DISTRICT
Name of Financial Instilutlon/type of Account J. 1 1
Mailing Address
1

WELLS FARGO/CHECKING 306 WEST RIVER DRIVE

Mailing Address 1 1 City w 1 State 1 . . Zip ~. t.
203 WEST THIRD STREET DAVENPORT , IOWA 52901
City y 1 State : 1 zip .! . 1
Phone (563) 336-3300
DAVENPORT, IOWA 52801
e-Mail

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

i The cammidee and all persons connected with the committee understand that they are subject to the 13ws in Iowa Ceee chapters SBA and 688 and the administrative
rules In Chapter 351 of the Iowa Administrative Coca,
2 That Iowa Code section 08A 402 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 dales
sublects the candidate or chairperson (in the case of committees other Iran a candidate's committea) to the automatic assessment of e civil penalty and the possible
?iiPosftion of ether c:lminel and civil sanctions,
3 That Iowa Code section 6EA.405 and rules 351-4 38 through a.a3 require the placement of trio words 'paid for by' and the name of the committee -in all poXcal
materinis except fw those items exempted by salute of rule . A comRllnee filing this statement for purposes of using the Shorter "paid for by' and who have riot crcs.od
tic 5750 shell notify the Board that the $750 threshold will not be crossed.
4 Thai Iowa Code section 68A,503 aria rules 351-4 44 through 4 .92 prul tuil the receipt of corporate contribuliona by all committees except for stainwide and iacal ballot
~SSLR- RACs .

e may only expend campaign funds as permitted by Iowa rode sections 6BA .301 through 6EA.303 aria rule 3511 25 .
d~s , losure reports
q until all activity has ceased . committee finds spent, dents resolved, and a final report ano a statement of

Oat Signed

D
D n Signed