FOR INSTRUCTIONS, SEE BACK OF FO

CHECK ONE . 7FAR II~ STATE=M E -

N(
This is an Initial'
Statement of Organization DR-1 OF
This is an amended Statement of Organizatlon (Rev . 0112006) ORGANIZATION

'An Initial Statement of Organization must be Nled win 10 days of the committee's eoninbutilons,
mekinq oxpondrtures. or incumng indobtednoss exceeding $750 Amendments must be fd, in 30 days of Car" . *
a change Ponaldes may be imposed for late-Nled Solbrrtonf.4 of Organization . A cendidols *stir an goan Indexed
committee that exceeds $750 in activity for another office snail 11110 within 10 days edlresra newor arnendad Audited
DR-1 disclosing information coriclarning the campaign for f now office wWht,
Computer ,

COMMITTEE NAME 1 1 (A canddate's committee must include the candidple's last name in ate narne of ft committee .)

11111011PORTANT : !nciW type cornmrwrro you cars rsporsno roc: I r I

(1 )8tatowiden-egisletive/Judge Standing for Retention Candidate 2 )Statewtde PAC (3 )Slats Party ( a )County Central Commttme
( 5 )Courtly Candidate ( 6 )City Candidate ( 7 )School Board or Otter Polllfal Subdivision Car Wato ( 8 )County PAC (8 )City PAC
( 10 )School Bound or Other Political Subdivision PAC ( 11 ) Local "tat Fsaue(Including comatno Involved In multiple city/county ballot Issues)

COMtArTTEE TREASURER (mandatory for all cortmlthrss)

Name T i.

Mailing Address - ill

1L 1
City , State :- 1 -Code 1. i. .

Phorw
V)9 ) 9

0-mall _--
INDICATE PURPOSEOF COMMITTEE - peck One ox Advocate forlagainst candidatd(s) Advocate for ballot issue(s)
Comment or description : [] Advowte a ainat ballot Mue(s)
All Candidates Enter
:[,,,,, ourny oca'l Candidaalnsand L al diIlot Commtltous Irnto~=
Office Sought ! nr/ n
County : ZdLs _L ' 'I L7)
Political Party (K applicable) (If Active in Multiple ballot MOW elections, attach hst of aourrias

DislriCt : ~~ Date of Elechom -:2UD~

A4iZet2z
Year Suin dmg for El6ct T -
Bgnk A"ount Namo - I--i- or SILL an

.&4"w
A& L'
Name of Ira al I uteon
LOW k
of Account
s
10 s
rn
-1
l
^ i~rn er
12 , 1d
ara,~4L 61S
Malllng Address W .,

City L State L J. Zip

STATEMENT OF AFFIRMATION : By (1Yng this document the committee rtfllrma the foilowhg :

1 Trx committee and all persons connected vntti the committee undwntand that they are subject to the laws in Iowa Code chapters 68A and 608 and the adminixtratNt!
rules in Chapter 351 of"Iowa Administratlve Code

2 Thur Iowa Code section 68A 402 and rule 351-4 9 require tie filing of disclosue reports and that the failure to Ak theAJe reports on or twfore the required due datrsi
subject', tt+o canddato or cnairpwson (in the case of 00mm'Qeet other Tan a dndIdatt's committee) to the sutornstc 0560OGnlerit of a avtl penalty and Me P0-_L3-b41
impostbon of other alm+nal and civil sanction%.
3 That Iowa Codo u)Cion 68A405 and Miles 351 --4 38 through 4.43 require the placement of the words `pad Vby" end the name of vie committee on all polmcal
matenals except for those items exempted try statute or rule . A oommtace thatwbJxis to register a Wmmoee memo for purposes of using the sf+ortr,+'pmd for by- and
does not intend to cross it* 2750 filing ttueshoid shell the M1e Form DR-SFA brm.
4 Than Icwo Code section 68A 503 and rules 351--4 44 through 4 52 prohibitthe rtrosipt of corpora" oontrlbolones by aM oornrnitteeo except for statewide arO IOC3rI ballot
issue PACs

5 A c3ndidote and a candidate's committoe may only oxperxt campaign funds as permitted by Iowa code sectio%t GaA 301 thrriogh 6ak303 and nde 351---t 2i!7,

6 That !he GOMMImae vnll continue to file disclosure reports until ail w1mity has oectsdd . committee funds gent, debts reacted. and o final report and a stmenxint of
dirsolution (OR-3) her, been filed .

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