FOR INSTRUCT1ONS, SEE BACK OF FORM

CHECK ONE:
® This Is an InWer Statement of Organization
RECEIVED
[~ This is an wrmtdeti' Statement of Organization
JUL 18 2006
An Inlde/ Statement of Orgentzedon must be Ned wlMln 10 days of the comrrWse s eooepllnp conmudona,
maWg expenddree, or Mcwdnp Indabtednese exceednp $750. Antirrdnwntr moat be Nod wlflW 30 days of
& change. Penalties may be imposedfor late-IWd Statenlenfa of OrpwrlraWn . A oandldere wtlh an open
cornmttee blot exceeds $750 In acdvftyfor another aft* aW No wkhh 10 day* eldw a new or amended
DR-1 dbobskp bhbrmedon cawem/na Me campaign lpr the now omow sought.

`~- ShooK ~'Or- syt .qyoisor

i 111fPf7itTART: Inalcab" of conwMn.s,eau wfaponin0 lot:
(1 )8WasAde&.tglalafltn /Judge Standing for lbtvWon CandWat (z )Statewide PAC (a alma Pan), (4 )Cotgtty Ceeanl Canml%ee
(6 )County Candidabt ( " )City CaFWldale (7 "ool Bond or Olhar PeMlcal S1tbdlrlswn Candidate (o r4gt'tp PAC (Y )Clip PAC
10 Achool Dowd or tatter "ItIeal Subdhrislon PAC ill) Local Ballot Issue contrrKtee Inrdved co A
ballot iaewn

COMMTTEE CHAIR (rna for a candWata's aanwdllf

Nema

Maltrp Addrae~
01 ,o i~arson .Sfi, , P0. 43 Meelng Addraas 4 1

CIty, Such Zip Coda

ft.* (641 ) S~- ??69 Phone ( )_ .

0 Me!l 0-Mall
INDICATE PURPOSE OF COMMITTEE m-Chea-
One Box Advocate for/egoistcendtdata(s) Advcos* fa ballot 1a"s)
Co nrnent ofdescripiion : Advoca* v9shat ballot iaaua(s)
._ i Cartddatas ruler. CaardylLocal CandWebs and Labd Bdet CmrsaiMses !utter :
ON Sought: _..gyp
SOWN: ~,~ ~±~ pY v +5 o r
D
County : _, . o w e -'$!) N f-t
Political Party (If apobabls) _k, 'n'1 Q C YY.t f (If awe In mukiple ballot Issue orr, "fach IW of coun0ee
MOM: Nov . .
Dole of Eieaon : 7j . ld ° (o
Year StartdlrlM for Election :

~hooK S~odYlroIafAddMft or t,P1~Sa.

P,~-Y",l 6" SY\o0,

Mom of Fkwckl Inefullon/t)rpe of Account 11 Mallklp Address 1 1

i (~ H 'To'cKsd'n Siree t po fox

I%q Addrsas 1 city 1 1 'state , 1 1 Zip 1

~ Zzl 1 01'1~P 2u mot 5,0 I '1 I

Cky 1 1 State 1 1 Zip 1 1
Phone (~4, , (9 a3 - 51 1

e-Mstl 7lS ri N t1h~~ . P~

*TAT®!M OF A1rP~TIW4: sir mho this doorsnent the acownetae afftrrns the rotlowbro :

t . The oorrwr~w and 011 pennons omit ected with tM owrvnbao urderatand that they or* sUOeot to the lawn h Iowa Cod* chapillers to and NO and new edmtrdWadve
n"s in ChoO*r 361 athe lows AdmirsUapv0 Code.

2. Thai Iowa Cof secGon GEA.r02 arrd rule 961-4.o require the 111ng of dsdosure report end that the foaure to Me these rupof on or twlore 1M required due dew
aAlects the candidate a dvairponwn an the case of cornrnbaes other Ulan a oarrdldolo'n cornrrd "») to the outanatlo onaeeonwre of s dv1 pwmfy ono 11+* possible
frrosealon d other aAmtrool and oW sencuons .

3. That Iowa Code section e6A.406 and rules 961-r.30 through 4.43 require "ft plactirnent dOw waft 'oak for tar and the marls of theoornmd&e on al Pdocal
nretrW& emspt for "moo barns exempted by White or nAe. A corn nat" that wishes to rogloter n cornrMlaa name Ibr pufposst< dusing the 0hartw 'paid lbr 4y" and
bow not traane t QVw IM $7501111% threshold anal Ill* ft Farm DR-SFA tam.

4. T11at loam Coea secllon treA.503 and nilw 361-rl .da ehro"h 4th prnfk the rsoNpt or ewporale conalbWor+s by al oarnr,olves exoape ra aIMewlda and local ballot
Iqus PAC&.
3. A oarrdleate end s oanddate'a co"wnWe nwy or*y expend em, gn ford& as pennilpd by Iowa cod* wcttons 9S&301 fhropWr AA.303 and rule 361-4.215 .
e. That use rmnanb*e role a0rapum to go disclosure reports unMl a1 noWlty has ceased, oo nrry4e lUnds spent. debt& resolved, And aAnal r&port and a ssaternent d
R-3) b
haeen 1W.

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