Jul 21 05 05 :17p HLC 319-396-3380

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: fk- P FORM STATEMENT

This is an initial' Statement of Organization DR-1 of

LJ This is an amended - Statement of Organization (REV.05/2005) ORGANIZATION

An initial Statement of Organization must be filed within 10 days of accepting contributions, For Office Use Only
making expenditures, or incurring indebtedness exceeding 1 . , nts must be filedwithin 30 days of Comm .
a change . Penalties maybe imposed for late-riled Statements of anizahon. A candidate with an open Indexed
committee that exceeds $750 in activity for another office shallfile within 10 days either a new or amended Audited '
DR-1 disclosing information concerning the campaign forthe new office sought. Computer

COMMITTEE NAME 1 1

~ti ;ids - Ceda~--

IMPORTANT: Indicate type of committee you are reporting for.
( 1 )StatewidelLegislativelJud a Standin for RetQrrtion Candidate ( 2 Statewide PAC (3 )State Party (4 )County Central Committee
( 5 )County Candida ity Candidate 7 )School Board or Other Political Subdivision Candidate (B )County PAC (9 )City PAC
10 )School Board or er o r a u division PAC ( t t ) Local Ballot Issue
COMMITTEE TREASURER (mandatory for all committees COMMITTEE CHAIR mandato except for a candidate's committee
Name 1
1Sz,..a
h
/~
L~
Name 11
Mailing Ad¢rs~
r- Z)P V,e- Al tA/
c4;'IS
, Mailing Address 1 1 Z
SeS- er
1
COQW KZPtd~ ,
City, State 'p Code
Sam" .i ~'Iv S S-
Zooo

Phone (31-A 37 Phone (319) J9 3

e-Mail e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One Box Pd Advocate for/against candidates) Advocate forlagainst ballot issue(s)
Comment or descri tion :
All Candidates Enter,
Office Sought Zp4rss
'_

Political Party (if applicable) Year Standing for Election :

CountylLocal Candidates and Local BallotlFranchise Committees Enter.
County : -
Date of Election : ' LlQ'se'- lJ, ZAgj
Bank Account Name 11 Candidate name & Address or Parent Entity (PACs, if aoolicable),
1~ J. Affiliate, or Soonsor

Name of curl InstltutloNtyp fAccount 11 Mailing Address 1

Mailing Address 4 4 City
320/
1 1

2-755 d 'W SL4/ &-da.-

City,, 1 1 ~1 `-' State 1 1 zip 1 1 =-
Phone (3 ) _39b .3098

e-Mail i eMr 3-7A /h GASI " COv-))

STATEMENT OF AFFIRMATION: By filing 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 68B and the administrative
rules in Chapter 351 of the Iowa Administrative Code .

2 That Iowa Code section 68A.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 dates
subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
imposition of other criminal and civil sanctions,
3. That Iowa Code section 68A.405 and rules 351--4.38 through 4.43 require the placement of the words 'paid for by' and the name of the committee on all political
materials except forthose items exempted by statute or rule. A committee filing this statement for purposes of using theshorter "paid forby' and who have not crossed
the 5750 shall notify the Board that the 5750 threshold will not be crossed .
4. That Iowa Code section 68A.503 and rules 351-4 .44 through 4.52 prohibit the receipt of corporate contributions by all committees except forstatewide and local ballot
issue PACs.
5. A candidate and a cand'idate's committee may only expend campaign funds as permitted by Iowa code sections 68&301 through 68&303 and rule 351-4.25.
6. That the committee will continue to file disclosure reports until all activity hasceased, committee funds spent, debts resolved, and a final report and a statement of
dissolution (DR-3) has been filed .

v bs
Date Signed
,7/-
2116,,
I other`eon`v~Uees,Chairperson - Date Signed