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'' RUCTIONS SEE BACK-OF FORM
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Is Is an amenihd' Statement of Organization (REV.12J200ty) I ORGANIZATION

dW StaMment of Orgstfolion must be /fled w(MFn 10 days al Me conun&ee's soce0no oontutorm For Offlee Use On)v
'ng expertditum% or irrcurrtng Md0btedrtesa axceeo?tng 3730. Amendments must be Nod wdthin 30 oteys of Ctmtm.a
con"
e penMfes Maybe imposed Ibr laWIBkd Statement$ of Orgen4stlon. A cardldate with an open Indexed
that exceeds $750 M aedrfryfbranother of os shat! tits wWn 10 days either a new or emended
Audited
VRwl1 disclosing lrtfbnneHon com,eimirt9 the cumaign forthe new Ofa sought. Co m"r

CO MTTEE NAME 1 d
I

101 TMfT : Indieste type of common god are mporung for. LLQJ
(1 tateMdalLaOIahMwIJudfle tDgm~ng for Ibumlon 4ndldabe ( Z ~bl6awlde PAC ( 8 )Sdb Parry ( 4 )Coufrty Central CommNba
1 S uMy Candldasae ( 8 )City Ce,ndl4rb ( y )0~~ BoaM or Other Political Subdivision Candldaoa (S)County PAC ( 9 )Cny PAC
10 cot laae"d or Otlw PolliMoal SubdWlslon PAC 11 Local Ballot bous
WWAITTEE TREASURER ndplto for all_eommtittwo COM011TME CHAIR men_dato . ox;-for candideWs cornmlttsip)
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Na a me

Me ng Address 1b
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tong Address 1 d.
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State I ~ Zip Code - 1 - 1 , State l y Zip Code I 1

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Ph e ( r~ rte ( )

a oil D all
Advocate
IN CATL PURPOSE O " M x Advocate for/against candidate(s) for/egairrst ballot issue(s)
,Meant or descrWon :
All ~andldaba ~tars +_:`..^ i
tSougM:
District; "i>, rw:i f R 64 5
Pot cal PsRy (M apPOeabls) Year Standing for Election:
co ntytLocal C~ftdldtllaa and lOgl EallotOnnchlae
Co
Comntltbee ffnter:
Date of Electdon : ~2Rr ' t I

~"l~tf3eFi l
Ns of Financial (rrstjttutiorrRype of Acebunt MGNIng Address
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Pe .r f.7i l .L
Ms ing Address ~ state 1 1 Zip 1

Zip
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1101R ` !51-5 d
State
Phone (7/z) Z2-
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ST~TMENT OF AFFIRMATION : By sling Oft deawaent the committee alllrnra the ruaowkv:
i
1 . the committee and all persons connected wtth the committee understand that they are subject to the laws, In Ivaa Code chtsspters 68A and 88B and the adrrvnis
rules m Chapter" 3151 of the Iowa Administralive Coda.

2. M Iowa Code section et1A.402 and rule 381--4 .9 require the filing of disclosure reports. The failure to file these reports on or before the required due dates aubj
the webs or Chsirpwvon (in the case of commes otherthen e cendidale's comni tas) to the autanatie sesessrnect of a CM penalty and the poesfbie Irnposill
criminal and dvil sem2wro pursuarri to &m cum caution ana.32A(7) .
i
s. Iowa Code aselion BaA.406 and rules 361- .1,38 through 4.43 require the place-N4 of the wads -pab for M' and the r,wne d the committee on all political I
m s so=ap! for those Items exempted by statute orrule
. A ceewnitine ffling thin etatanerd for purposes of using the ahorter'pald for bY end who have" crossed
the 760 "l notify the Boardthat the $760 thtsahold VIII not be crossed.
4. '-hat Iowa Code aecsen 611A. 503 and rules 381-4.44 through 4.62 prcl1ibll the receipt of corporate oonMbudof by all cornmidem except forstNMaMde and Iocal ~ellot
Issue PACs,
s. candidateand a nttdldeta'a eommlllee may only expend ampaslgn funds as peanred by taAq code seetlorrs SeA.301 through 68A.303 aidrule SSI--".26.
8. at the eom.Mee will continue to tae disMOaurs reports until dl ectivlty hers ceased, committeefunds spent dents resolved, and a final report and a metement of
dlsa oluttoh (DR-3) has been filed.

Dais Mpnd