U .S . BHNK ID=7124765715 MRY 13 , 05 12 :32 No .002 P .

02

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM' ~^ STATEMENT
2~fhis is an initial` Statement of Organization ;oex7u: :~ . .`sti , c. .
DR-1 OF
This Is an amended' Statement of OrganIzatlon (REV . 07/2004) .. ._ -. . O RGANIZATION

n.
For Off)c4 Use Only
*An Inhlal Stafomont of Organization must be filed within 10 days of the committees accepting contributions, Comm . #
making axpondlfuros, or incurring Indabtodness oxcooding 5750. Amendments must be Mad within 30 days of Indexed
a change. Penalties may be imposed for late-filed Statements of Organization_ Audited
Computer ,01'11

COMMITTEE NAME-

t'co~~ e c.}' aOoS

IMPORTANT. Indicate type or committee YOU arc reporting for : 4Lj
(1 )Statewiciall-eglstetlvo/Judge Standing for Ratention Candidate (2 )Ststewldo PAC (3 )81ats Patty (4 )County Central Commltteo
(5 )County Candidate (9 )City Candidate (7 )School Board or Other Political Subdivision Candidate (e )County PAC (9 )City PAC
(10)School Board or Oth er Pol itical Subdivision PAC (11 ) Local Ballot lasue
COMMITTEE TRt SURER (mandatory rorallcomml COMMITTEE CHAIR mandate except tore candldato'a commltlea
Name , ~
`'Tit V 4~ YY ~c~
Mailing Address Mailing Add es
E ),r. wco& Ac-
CjkA State 1. J- Zip Code 1 d to D . Code
.
City oc. t .1l~ i a. r7

Advocate for/against ballot Issues)

Poliucai Party (if applloable)

County/Local Candidates and Local Ballot/Franc
County . --- . .

fl(~ldety nemv 8 Address or Parent Entity (PACsj if applicable)

y Affiliate . or Stmt-or

Name of Finandal Iru¢6lulinn/lype of Account

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

i . Tlto eommluoo ano oil persons connected with the committee understand that they are eubiod to the lows In Iowa Code chapters 60A and BOB end the adminislrative
rulen in Chaptwr 3511 of the Iowa Administrative Code.
2 That Iowa Code section 68A .402 and rule 351-1 .8 require the filing of dleclosune reports and that the (allure to file these repurtx tin or belare the roquirod due dales
sub)ecls tfto candidate or chalrpomon (In the case of committees other than a candidate's committee) to the alltomaUc assessment of a civil poilolly and the pcmi:iblu
Imposition of other criminal and civil sancliona.
3 . Thai Iowa Code section 66A,405 end rules 351-4 .38 lltrough 4.43 roquiru the plewmunl of the words 'paid for by' and the name of the commluoo on ell political
materials except for those items exempted by slalute or rule. A committee filing this statement for purposes o1 using the shorter "paid for try and who have not crossed
the $750 shall notify the 8oardthat the $750 threshold will not be crossed.
4. )hat Iowa Coda soctlon 6aA,503 end riles 351-444 through 4S2 prohlW the racoipt of corporate contributions by all aommatu.ur oxcopt for 6tatewide 8nrl Inv+l bolloi
issue PACs.
5 . A candidate end a candidate's committee may only expand compalgn funds as permitted by lows coda centlnnp 68A .301 through 68A.303 and rulo 351-4 .25 .
6 . That the committee will oonunun to Y
.dlsoiosure reports until all uctlvily ham ceased, committee funds speni, t1Hbt8 relaotVetl, and a final roparL anal a statement or
diesolujpn lU3nl has been Oled .. "

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