FOR INSTRUCTIONS, SEE BACK OF FORM FORM STATEMENT

CHECK ONE: DRA OF

ORGANIZATION
tS Thin is an initial" Statement of Organization (Rev. 05/02)

0 This is an amended* Statement of Organization For Office Use Only

An initial Statement of Organization should be filled within 10 days of the committee's accepting contributions, Comm . # /3 S V
making expenditures or incurring indebtedness exceeding $750 . Amendments should be filed within 30 days of a Indexed T1
change . Penalties maybe imposed for late-riled Statements of Organization. Audited
Computer _a -~l

COMMITTEE NAME (Required by law)

v
bg
Z4_

(
IMPORTANT : Indicate type of committee you are reporting for.
1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate ( 5 )County PAC ( 6 )Ballot Issue/Franchise
CommitteeT7 )C ounty/City Central Committee(8)Support sl ate of candidates (list candidates under purpose of committee)
COMMITTEE TREASURER This address used for all reminders and COMMITTEE CHAIR (List additional officers on separate page)
(Required by law) correspondence)

M
Name Name

S,~AW.W . . qyN,4rb ~ot+N C ~w IC'

Mailing Address Mailing Address

/w Z E. 5--~ s -
City, State Zip Code _ City, State Zip Code

Jl rX,r&, N, 97R 5 a349 JfsrV1Arr . 5"A 52 3~f

,
Phone( 3/ 9 ) 517223Z-2- Phone (-!I) 7z ' c
l
7

e-Mail e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate for/against candidate(s) Advocate for/against ballot issue(s)
Comment or description :
All Candidates Enter :
Office Sought: T-'1- 1r CvuNCSL - VSNToIV District : Wfq"2D J~
Political Party (if applicable) Year Standing for Election : -7 V0 5
County/Local Candidates and Local BallottFranchise Committees Enter :
County: 9~_nITD~d Date of Election : IJ - 0 0 "O S

Bank Account Name 1 1 Candidate name & Address or Parent Entity (PACs . if applicable) .
Affiliate, or Sponsor

fs"J u I
Name of Financial Institutionltype of Account 1 1 Mailing Address 1 1
V0,;"4 W, / b-th s-;
Mailing Address I 1 City 1 1 State I 1 Zip 1 1
_,,r- 0W'+ -Z
City J. 1 State Zip y 1 Phone (31,9 ) 'V7Z - Z 3 Z Z-
e-Mail /yl/rl~Y.~IAQOJ'rz ~7~ LGot-v~
DISPOSITION OF BALANCE OF FUNDS UPON DISSOLUTION (Statement of intent required by law for all committees, except state parties and central
Indicate disposition of funds marking appropriate number in box: committees and committees using only personal funds.)
(1) DONATED TO COUNTY CENTRAL COMMITTEE (6) PRORATED REFUND TO CONTRIBUTORS
(2) DONATED TO LOCAUSTATE/NAT'L POLITICAL PARTY (underline one) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE
(3) DONATED TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)
(specify) (8) RETURN TO PARENT ENTITY GENERAL FUND (PACS ONLY)
(4) CITY/COUNTY/SCHOOUSTATE OF IOWA GENERAL FUND (underline one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC
(5) PARTISAN CONGRESSIONAL DISTRICT FUND

STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE ; OR POLITICAL COMMITTEES, BY CHAIRPERSON

I am aware that I am required to file disclosure reports if the committee receives contributions, makes expenditures, or incurs indebtedness in excess of
$750 .00 in a calendar year to expressly advocate for any candidate or ballot issue. I understand that although the treasurer normally prepares and files
reports, the candidate or chairperson (PACs) is responsib u der the law for accurate and timely disclosure reports and that late-filed reports are subject
to civil pens ' possible other legal action . I unde to that by filing this form, I am subject to the laws found in Iowa Code chapter 56, chapter 68B
and admini ativ les jpynsljn chapter 3§4 . ~affi h all committee officers have been informed of their appointment and obligations .
5 6 - 015-
Date Signed
--Z 61 - O S .__
C, Central Committee or Local Ballot Issue, Chairperson Date Signed
Attn : I.E.C.D.B.

As a recent nomination for the position of Vinton City Council: 3`d Ward, I have
formed the Maynard for Council Committee. I am filing this `Statement ofOrganization'
for the upcoming election, November Stn .
As of now I have filed this `Statement' for disclosure purposes only. It is not my
intent to exceed the $750 limit. If circumstances arise that I must approach or exceed the
$750 threshold I will take the appropriate measures, by filing an amended `Statement'
with all required information and begin filing disclosure reports .
I understand that I must still abide by all rules set forth for by the Board
pertaining to the election process .

NSU Max `Bud' Maynard