05108106 04 :1Spm P.

001

FOR INSTRUCTIONS, SEE BACK OF FORM

CH - K ONE :
This is an initial" Statement of Organization
RECEIVE FORM
DR-1
STATEMENT
OF
El This is an amended" Statement of Organization (Rev . 0112006) ORGANIZATION
MAY For Office Use Only
'An initial statement of Organization must be Red within 10 days of the committee's accepting contributions,
making expenditures, or incurring indebtedness exceeding $750. Amendments must be filed within 30 days of Corm . tt
a change . Penalties may be imposed for late-filed Statements of Organization. A candidate with an open Indexed
committee 'hat exceeds $750 in activity for another office shall file within 10 days either a new or amended Audited
DR-1 disclosing information concerning the campaign for the new office sought. Computer

TE E NAM E 1 J.,~(A candidate's committee must include the candidate's last name in the name of the committee.)

- _,1 Lk r. ~

IMPORTANT: Indicatetype of committee yo are reportingfor :

_ :--
r
( 1 )Statewide/Legislative/Judge Standing for Retention Candidate 2 )Statewide PAC ( 3 )State Party (4 )County Central Committee
( 5 )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(including committee involved in multiple city/county ballot issues)

COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (man datory except for a candidate's committee)
Name Z I-
_
Name 1
P
U 'ILA-
Mailing A ress ~. Mailing Address 1G .~
'0,
City, Slate 1 Zip Code l City, State zip COT 1 1,

'519 3t5 Le ('5;19 --

Phone ( Phone '~~~ ./r

e_ Mail e-Mail
INDICATE PURPOSE OF OMMITfEE - Check One Box
_Comment or des cription :
All Candidates Enter:
Office Souoht:
County : _
Political Party (if applir~lble) _ (If active in -mu Iple'~ballo> issue elections, attach list of counties

District: Date of Electron : l

Year Standing for Election : < t
Ba . Account Na . e Candidate name & Address or Parent Entity (PACs. if applicable) .
1 ,( Affiliate, or Sponsor_

of Finali'Institution/type Account
of Malting Addres .L

State .L y zip 1

'y e1S.,~~
State J. zip J. 1-
Phone ( 1 .9

e-Mail

STATEMENT OF AFFIRMATION: By filing this document the committee affirms the following:
68B and the administralwe
1 . The committee and =ill persons connected with the committee urrcierstand that they are subject to the laws in Iowa Code chapters 68A and
rules in Chapter 351 of the Iowa Admdtistrative Code .
file these reports on or before the required due dates
2. That Iowa Code section 68A.402 and rule 351- -4 9 require the fling of disclosure reports and that the failure to civil penalty and the possible
subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the autom atic assessment of a
imposition of other criminal and civil sanctions.
name of the committee on all political
3 that Iowa Code section 68A.405 and rules 351--4 38lluuugli 4 .43 requite the placement of the words "paid for by" and the
the shorter "paid for by" and
malenals ex(- ept for those items exempted by statute or rule . A committee that ,.vishes to register a committee name for purposes of using
does not inteno to cross the $750 filing threshold shall file the Form DR-SPA form .
except for statewide and local ballot
4. That Iowa Code section 68A,503 and rules 351-4 .44 through ,3 52 prohibitlhe receipt of corporate contributions by all committees
issue PACs,
and rule 351-4.25,
5 A candidate aad a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A-301 through 68A.303
ceased, committee funds spent, debts resolved, and a final report and a statement of
6- That the committee will continue to fire disclosure reports until all activity has
dissolution k0R-3) has been filed.