FOR INSTRUCTIONS, SEE BACK OF FORM

STNTE%1Ei i
HECK 011E . Reset Form_ FORM
Tnis is an initial' Stxement of Organization OF
n This, is .3n amended St3tEn)ent of Organizat,7n ?
I DR-1
IRIj~J, O~+LJOr:) ORGAfi IU=.T'1-' .

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COMMITTEE NAME . , IA Cardir;ste'S r,'ttmMee must ircl JCe tre :ardidate's .ast name 1n the name o' the cor,n'iaee )

Brickner For Sheriff

IMPORTANT: Indicate type of committee you are reporting for: 1 5
( 1 )Statvwide1Legistative/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 Polit ical Subdivision PAC ( 11 ) Local Ballot Issue(ineluding committee involved in multiple citylcoun y ballot r;buer )

COMMITTEE
COMMITTEE TREASURER (mandatory for all comniittee ~s) CHAIR (mandatory except for a candidate's comm i reo)
Id3nva ~lame
Charles "Chuck" Painter
% Y

-
tJMal .ing Accres .,, . !
- 1~9CJ `'ueri Place

err~ ; , O~a~ y5 D0220

I
.a Star
C
. , 11 Zip (:,:dc

F -e !51 5 465-4345 P(',Jne ~

,?_r .'t3o _ _ 4-t.r l

INDICATE PURPOSE OF COMMITTEE - Check One Box ' " A,,7c :3t /aga'nstcjndicat6rs) ~AOvocateforball0'iS Ije(°,I
Co -rr'.en ", or description Sheriff's race A.;''OCdtP cG 8!r.~t C1'll :'1 Cut(',`
All Candidates En ,, : CountylLoesl Candidatesand Local Ballot Committecs Enter :
s r7 J:-l,'t Liallas County Sheriff
Dallas - Ccunr;:
P- I~t,CC, r^ .- r f 3RDIic,~'ae1 Deinocratic-Seeking nom in~`ba:is m rn'J~`iriC ~"9:ICl :SJe ClectlCnL, ~ttoch i0t Gt 9CE

Dhtri;;:.' D9 ^7 ct EI(".ction : Tanjja 1-y

;--r S'a ,:i -,,; for ElecG7n :
'v 2001
Bank Account Name Candidate name 8 Address rr Parent Entity (P'CS _` a^D ~ ~
w Afriliate . or Sponsor

Brickner For Sheriff Daniel E. Brickner

'r .tciling AcCry;s ..
Racoon Valley Bank 816' .15th St-
h'lallinq l.: ra ;s
- 1202 2nd St . Perry Iowa 50220

F-cnr (~~ 5) 465-5418

Perry, Iowa 50220
c-IJ, :~) Bric kner4S :mriff :acs _ cart

STATEf.1ENT OF AFFIRMATION : By filing this document the comr^,ittoe affirms tno following :

' . ., a 'oT'r 3D,a-,; t:BA en . ; 5r,5 an ."re ; :'nor >. 

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