FORIT

DR€FA Statementof
(Rev.0412009) Organizafion
'Paid For

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FOR INSTRUCNONSSEE BACK OF FORM
ThlsFom to bs filedfor each:

flt amfilingthlsbrmio usetheshoiler'paid

foroy attibution.
fie commiteE b6crossrns
wirtngt mustbe
liled prforto the dlstribulionorpostng of the politicalmaterial. ""**Qh,*n$m
ElAmendeOform updalingany previouslyfiled informationinc$.rding Dateof ElEctionand Year Standingfor Elec{ion.
'lt thecommlftee
crossesfhethreshold,a DR-i Statementof Organhatonmudbe frledwtfninI 0 daysol thecommlttee's
awptlng antrlbutlons,
making
expnditures,
orinaning lndebtadness exceeding $7tu.ln addltion,
he ammitteewillbe rqulredto frlewnpaigndidoare reprts.

{ { (A canAHate's@mmitteemustIncludetre canddate'elast nameln tre nameof the commitee).

commltbo tlou am reglstedng fon I

p 9tand[rg lor RefienuonCandldste PAC(3lstabPqrty (4
( I )Cry Candldate ( 7 )Scfrool Board or Otrer Politlcal Subdlvlslon Candtdd ( 8
bdlvlslon Candtdab

COMMITTEEGHflR (mandstory for all commltk except a CANDIDATE(rundalory qcept lor a non.candldste commltleol

l{ame

Malllng MalllngAddres { {

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INDICATEPURPOSEOF COMMITTEE Alvocab br/agalnstcanOOate(s)E Advocatelor ballotlsue(e)
Commentor description: E] Advocateagalnstbalst bsude)

Goungy'Lcal Gandld&s and All Ofter Gornmttbss Enten

(lf acfiveIn nultple ballotbsue electons,attachllet of countleeor enter

'ehtewlde)

Ilate of Eler$onl

STATEMENTOF AFFIRMAflON: By flhrg thls dcument the conrmtlbe ffinns tfie fotlqrhg:

1. The comtrttbe and all personeconneded with the comndfieeunderstandthatthey arc subJecttothe lanr in lona Code chapters@A and 688 Endthe adminffiive
rul€s in ChaptEr351 of the lowa AdmlnFfawe Code.
2 Thd lo'na Code sec'fion6EAz[]5 and rules 351-0.38 through 4.43 requlrethe phcenrent otthe worde "pald ior bf and the namootthe oommfft€eon all polltcal
materialsexceptfor those ltems exemded by stduta or rule.
3. Thst lora Code seston 6ld5ff1 and rules 351-4.44 though 4.52 prohlbitthe recelptof corporatecontibutons by all conunttees exoeptfor dovide and local bellot
bgue PACg.
4. That if$e cormlt@ exceade$750 ln campaignacffvity,a DR-1 Statem€ntof OrganEadonrnu$ be filed rdthln 10 days and tre commltteels requlredto flle aampatgn
dledosure reporb.
5. Thstthls form ls ffled prlorto the dlstribufon or podng of politcal rnaterlalroqulrlngthe'peld for bf attlbuton.
6. A new fom or amendd brm ls requlredb be filed for each subsequentelEctlonthat I am Involved.