Apr 27 05 04 :06p HLC 319-396-3380 p .

2
JJrm Dtduley ol Riley
April- LuuO 3 , III U-OIJS

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM STATEMENT
This is an initial , Statement of Organization DR-1 OF
[] This is an amended' Statement of OrganIzztlon (REV. 0T121104) ORGANIZATION
For t]ffes Use Oniv ,,

74r AnVsl Statement of Org'ertlzaifan must be (dbd wtrMln 10 days of dfs cdnndftas's acpepGfng cortMDudans, ~ Convn. e
maAdnp oxpaneRures, or incurring Mdabsodnavo awieseding $760 . Amendrnsnfe must be ('lied within 30 days OF lnda:od _,
o sharps_ Penalties maybe imposed tbrlete-Nod SfatWnsnta o10/yortWUon . Audited
Computm --
,. '? 2
COMMITTEE NAME 4 1
Citizens for a Better Cedar Rapids : Vote Home Rule
IMPORTANT Indlcab type of committee you ore reporting for. I 1
( 1)6tMewId%fLaglsIa1IwWudge Standing for Retention Candldab (2 )Shlewide PAC (3 )Sbta Pert' (4 )County Central Committee
(5)County Candidate (6 )City Candidate (7 )School Board or OtherPollttcal 8ubdiviolon Candidate (6 )County PAC (Ill PAC
10 Lhooi Board or Other Political Subdivision PAC 11 Local Ballot Issue
COMMrTTEE TREASURER mandate for all committees COMMITTE CHAIR mandate except for a randidats's committee

Tyler Olson Nfus Iri Shields

I
~ iI wne~auleverd SW N1211 wlleros 9ou evard SW
City, State 1 l. Zip Code City State 4 Tip Cods d 1
Cedar Rapids, Iowa 52404 Cedar Rapids lows 52404

389-0101 39648461
Phone ( 910) Phone ( 312 )

IdsonlecDhotmaiLcom )ahtelds@hawkeyelabor.org
e-mail aMan
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate forlagainst cencildste(s) Advocate Wagsinst ballot issue(s)
Comment or description : Home Rule Charter ballot issue
All Candidates Enter :
Offlos Sought
District

Political Party of epplicabs) Year Standing for Eladlon:

County/Local Condldetea and Local BalkWFranchlso Committesa Enter.
Date of Eledlw :
County :

Bank Account Name 1 1 n i

O rr me LAdgMia or Parent Entity tPACo. If aenUrabial
AMIla1a, or Sponsor
Citizens for a Better Cedar Rapids
Name of Financial Inettufloni%rpe of Atoount 4 1 Mailing Address 4
Farmers State Bank

Moiling Address 1 1 City 1 4 Stab 1 zp 1 1

2755 Edgewood Road 8W
i
City 4 1 state 1 Zip 1 1 ( )
Phone
Cedar Rapids, Iowa 52404 .
*-Mall

STATEMENT OF AFFIRMATION: By filing this document the commlttse afflrnta the following:

1 . The commefee and all persona eonnadej with the oonxnl0es underaland that they an subject to We Is" in Iowa Code Chapters SBA and 8AB and the sominietrawe
rules In Chapter 351 of the love Administrative Code.

2, That Iowa Code section 34AA92 and rule 351-4.9 roWlre the filing of disclosure reports end that the failure io fib those reports on or before the required due datum
subjects the Candidate or chalmeraon (In the use or comrnlRSas other than a candtdets's committee) to the sutomatlo aassaement of a civil penalty end this possible
impoellon of other criminal and civil sanodons.

3. That Iowa Code section OBA406 and rules 351-4 .36 through 4A9 require the placement of the words 'paid for Wand the memo of the committee on sit pal ltiral
materials except for those Items exempted by stMts orwill
rule, A committee filing this statement for purposes of using the shorter *Paid for by` and who haw not crossed
the 1;750 shat notify the Board Viet the $750 threshold not be wossad .

4. That laws Code section ®&A503 and rules 351-4 .44 through 4.62 prohlbt the rill of corporate contributions by all committees except for statwade and local ballot
issue PACs .

S . A candidate and a oandldsta°s eomrnlnea may only ***me Cengsign funds as psrmlited by Iowa code sections SM301 through ABA .303 and rule 351-4 .25.

6. That the committee VIII continue to file disclosure reports unto ell activity has eased, committee funds spent. debts resolved, and o trial report and a statement o'
dissolution (OR-3) has beep Atari .

Data signo

Date fnad