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-rte-_
FOR 1N$TRUCTiONS, SEA BACK OF FORM
CHECK CNE. FORM j STA7EMEINT
This is an initial" Statement of Organization DR-1 OF
7 This is an amended - Statement of Organization -r (REV . 0512005) ORGANIZATION
',An initial Statement of Organization must be filed within ' 0 days of 'he6rnm j For Office Use Only
maKing expenditures, or incurring indebtedness exceeding $750. Amendments must Comm .
a change . Penalties may be imposed for late-filed Statements of Organization . A candidate with an open Indexed
committee that exceeds .3750 in activity for another ofce shall file within 10 days either a new or amended Audited
DR-' disclosing information concerning the campaign for the new office sought. Computer

COMMITTEE NAME

THEiZ~ IS A gc(TEA wt1~ c~~~, f~~

IMPORTANT : Indicate type of committee you are reporting for. I
{ 1 )StatewideiLegislativeiJudge Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )State Party (4 )County Central Committee j
{ S )County Candidate ( 6 )City Candidate (7 )School Board or Other Political Subdivision Candidate (8 )County PAC (9 )City PAC
( 10 )School Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issue
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name y 1- Name 1 J.
P06,00L AA-) 0i/LS~^l (= ft- A N trXS t;A! (Z OC7 0

Mailing Address 2Z Mailing Address I 1

.' T 2'-~
o - Z -Z I2-U 4 W L
City, State ~. Zip ode -. 1 City, Stag 0` ade`Wn - '
;TA
1
1A tiac~w0vn - ?tpc..:

Phone (~(2) sw~o'- 2 ~c:,3 Phone ('71Z-) ~~ G " 2

E.-Mail e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One Box L Advocate forlagainst candidate(s) Advocate for/against ballot issue(s)
Comment or description :
All Candidates Enter :
Office Sought: ~( A.) 1) t_, t2 w i.9 0
District:

Political Party (if applicable) Year Standing for Election :

CountylLocal Candidates and Local BallotlFranchise Committees Enter.
County : PC r/4t- At 1-T4 M is Date of Election :

Bank Account Name ~. 1 Candidate name a< Address or Parent Entity (PACs, if applicable) .

12 a&C/
i 1 1 Affiliate, or Sponsor
L. /4 A- D :N
F/LS ~

Name of Financial Institutionitype of Account 1 Mailing Address 1 1

Mailing Address 1 1 _ _ City 1 1 State 1 1 Zip

-. C) I 13 L iJ V 7' F

City 1 1 State 1 1 Zip 1 1

Phone ( )
Q Lc,, -f~s ; 4 Sr So
e-Mail

iTATEMENT OF AFFIRMATION : By filing this document the committee affirms the following :

I . 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
ules in Chapter 351 of the Iowa Administrative Code.
'. . 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 an or before the required due dates
ubjects 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
mposition .of other criminal and civil sanctions.
i . 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
iaterials 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
ie $750 shall notify the Board that the $750 threshold will not be crossed .
. That Iowa Code section 68A.503 and rules 351--4 .44 through 4 .52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
;sue PACs . _ -
. A candidate and a candidate's corn tee may only expend campaign funds as permitted by Iowa code sections 68A.301 through 6aA .303 and rule 351-X4 .25 .
Isclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of

S~~~l o
Signature of Treasurer Date Signed

Signature of Candidate. OR, for all other committees . Chairperson Date Signed