NOV-17-2005 THU 03 ;43 PM CARTER INTERNATIONAL FAX NO, 16416738494 P.

01

FOR INSTRUCTIONS, SEE SACK OF FORM

CHECK ONE: FORM STATEMENT
This is an Initial" Statement of Organization DR-1 of
L This is an amended' Statement of Organization (REV. 05/2005) ORGANIZATION
An Initial Statement of Organization must be filed within 10 days of the commhlee's accepting contributions, For Office Use Only
making axpendrlures, or Incurring indebtedness exceeding $750 . Amendments must be filed withln 30 cloys of Comm . 6
a change. Penalties may be imposed for late-teed Statements of Organization . A candidate with an open Indexed
committee that exceeds $750 in adivrty for anotherafe shall file within 10 days e0er a new or emended AudW
OR-1 disclosing information concerning the campaign for the new office sought Corn utar

IMPORTANT: Indicate type of committee you are reporting for.

(1 )StatewidelLogislatIvel ludge Standing for ResenHon Candidate (2Atatevride PAC (3 )State Party (4 )County Central Committee
( 6 )County Candidate ( 6 )City Candidate (7 Jschool Boats! or Other Political Subdivision Candidate (6 )County PAC (g )City PAC
11o )School Board or OtherPolitical Subdivision PAC 111 ) Local Sallotissus
COMMITTEE TREASURER manda for all commtttosa COMMITTEE CHAIR manda except for a candldats's committee
Name Rab QCCJ0L+ ~. Name

Mailing Address

City, fete v~1

4P. (D . cox
Zip Code W J.
I it) Mailing Address Z Z

City, State J. 1 Zip Code 1 .,

0eni50" Is-- T1

Phone 41 Phone ( L-

e-mail
INDICATE PURPOSE OF COMMITTEE- Check One Box Advocate for/against candidate(s) 0 Advocate forlagainst ballot issue(s)
Comment or description :
All Candldalas Enter
OfflcsSought: CZ~~
, ~~,~ ~
A
~VWt-11L L~uraQ- District:

Political Pony (If applicable) Year Standing for Election :

CountyiLocat Cgr~Idgtoo and Local BaltolfFranchlao Committees Enter:
Date of Election: /1-X-af

_
or Parent Entiy (PAQ, if sooJcable1 .
Affiliate, or Soonaor

rn L4
Maling Address ~.
61,
b

i.PD . &x IbI5

Mailing Address .L 1 City I .~ _State y Zip

C)5ka,iOOSa- -J.-6 5R 5"17

City 1 1, State 1 I ZIP l 1 Phone ((04'~ ) ~~ " D i1
I e-mail

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 ¢SEA and sell and the adrninlatrative
rules in Chapter 361 of the loom Administrative Code,
2 . That love Code sedan 88A.402 and rule 351--4-0 require the filing of disdocurs 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 then a candidate's committee) to the automatic meeement of a civil penalty and the possible
Imposition of other criminal and civil sanctions,
3 . That Iowa Code section tt8A 406 and rules 361-4.38 through 4 .43 require the placement of the words'peld for by' and the name ct the committee on all political
materials except for those items exempted by stoma or rule. A committee Mmg tills statement for purpoes of using the ehoner'paid for by' end who have not crossed
the $750 shall notify the Board that the $760 threshold will not be crossed.
4. That Iowa Code section 86A.503 end rules 351-4.44 through 4 .52 prohibit the receipt of corporate contributions by all commlttesa except for statewide and Igoe ballot
issue PACs.
5 . A candidate and a candidate's committee may only expend campaign funds as permitted by love code sections 66A.301 through 58A,303 and rule 361-4 .25,
8. That the commht" vAll continue to file disdosure reports undi all aetivrty has ceased, committee funds spent. debts reserved, and a final report and a statement of
dlssohAory(6Jt-3) has been filed .

Doe signed