APR-OB-='OOh 14 :11 HEPIPY COIJh1Tr' ATTOPHEY 1 719 O85 0778 P .0_ .

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FOR INSTRUCTIONS, SEE BACK OF FORM `11 ~

CHRCK ONE: FORM STAr MENT

[U'This is an initial` Statement of Organization DRA OF

[] This is an amended` Statement of Organization (REV . 12J2005) ORGANIZATION

For Qf!Ice Use Only /
#
An inlfial Statement of Organization must be riled within 10 days of the committee's accepting contributions.
malting expenditures, or incurring indebtedness exceeding $750 . Amendmentsmust be filed within 30 days of
a change . PenstUes may be imposed fortats-filed Statements of Organisation
Comm. X017
Indexed
committee that exoaads $750 in activity foranother ofe shall file within 10 di Audited
DR-1 disclosing information concerning the campaign for the new office snug; Computer

COMMITTEE NAME L .',

IMPORTANT: Indlcate type of committee you are reporting for

( t )StatswIdWLegislative/Judge Standing for Retention Candidate ( 2 )Statewide PA (4 )County Central Committee
($ )County Candidate ( 6 )City Candidate (7 )School Board or Other Political Subdivision C'a s (8 )County PAC (9 )City PAC
_L10 LSchool Board or other Political Subdivision PAC (11 ) Local Ballot Issue
COMMITTEE TREASURER (mandatory tar all committees) COMMITTEE
Name Name
~ON~ ~EET~
Mailing Address Mailing Address 1
i~.V 21 ax. S~
City, State Zp Code 1 b City, State J. ~. Zip Code b 1
~I~k - -~ A~ c aN.lI t!~ ~Zls a 1

Phone (3(~) 94'6-63g~ Phone ( )

e-Mail __ e-Mad m
INDICATEPURPOSE OF COMMITTEE - Check One Box Advocate for/against candidate(s) Advocate for/against ballot issues)
Comment or descnption :
All Candidates Enter.
Office Sought I u,iY ("a tcv Q-rMZ,_, y
District :

Political Party (if applicable) Year Standing for Election :

CountyfLocal Candidates and Local BallotfFmnehise Committees Enter:
Date of Election: 3upx (a - Pft
County : (- iz7
~,~lslLawel.I 7 (
B#nk_Account Name .L 1 Candidate-name & Address or Parent Entity (PACs. 6 applicablQ) .
1 I Affi)-or Sponsor

Name of Financial Instttutlordtype of Account 1 Malllng Address

~o t S (.y~-t_~~ ~-r
Mailing Address City .'" .L

30~ S /IAAiAj ST 1.~ A-n 1lA `~ I

City 1 State _ Zip !
Phone (319 ) °ISb - 55 3 3
r Q s~JT IA 7 41 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 68A and 688 and the acirrunistranve
rules in Chapter 351 of the Iowa Administrative Code .

2. That Iowa Code section 66A.402 and rule 351--s .9 require the filing of disclosure reports. 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 assessment of a civil penalty and the possible imposrhon at
other criminal and crvml sanctions pursuant to Iowa Code section 688.32A(7),

3. That Iowa Code section 66A405 and rules 351-4.38 through 4.43 require the placement of the words 'paid for by- and the name of the committee on ail political
materials except for those items exempted by statute or rule. A committee filing this statement for purposes of using the shorter 'paid for by" and who have not crossed
the $760 shall notify the Board that the $750 threshold will not be crossed.
4 That lovrn Code section 68A,503 and rules 351-4 .44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statevide and local ballot
issue PACs .

5. A candidate and a candidates committee may only expend campaign funds as permitted by Iowa code sections 68A301 through 88A303 and rule 351-4.25.
6. That the committee wilt continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of
dissolutorLJOR-3) has been filed .

orate Signed

TOTHL P .01