FORM DR-1: Statement of Organization Form Statement of

ID 6160 DR-1 Organization

Type Iowa PAC Web Reporting System Rev. 09/2003
Status Amended For Office Use Only
Name Iowa Independent Bankers Political Action Comm. # 6160
Committee Indexed
Filed/Amended 7/30/2007 Audited
Date Computer

Committee Treasurer Committee Chair

Name Donald E. Hole Name Jon C. Simplot
Address Suite 102 Address PO Box 1010
1603 22nd Street
West Des Moines, IA 50266-1410 Fairfield, IA 52556
Primary Ph. (515) 453-1495 Primary Ph. (641) 472-3161
Secondary Ph. Secondary Ph. (nul) lnu-null
e-Mail iib@iibonline.org e-Mail jsimplot@isbff.com
Purpose
Endorsing candidates for the state legislature and candidates for state offices who are supportive of the
goals and philosophy of IIB.

Office Sought: District:

Party: Year Standing for Election:
County: NA Date of Election:
Primary Bank Account PAC Parent Entity, Affiliate or Sponsor
Name West Des Moines State Bank Name Iowa Independent Bankers
Address PO Box 65020 Address Suite 102
1603 22nd Street
West Des Moines, IA 50266
Account Type Checking Primary Ph. (515) 453-1495
Account Name Iowa Independent Bankers Political Action Committe
e-Mail iib@iibonline.org

Statement of Affirmation By Treasurer and Candidate; or Political Committees, By Chairperson

STATEMENT OF AFFIRMATION: By filing this document the committee affirms the following:

1. The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68B
and the administrative rules in Chapter 351 of the Iowa Administrative Code.
2. That Iowa Code section 68A.6 and rule 351-4.9 require the filing of disclosure reports and that the failure to file these reports on or before the
required due dates subjects the candidate or chairperson (in the case of committees other than a candidate’s committee) to the automatic
assessment of a civil penalty and the possible imposition of other criminal and civil sanctions.
3. That Iowa Code section 68A.14 and rules 351-4.38 through 4.43 require the placement of the words “paid for by” and the name of the committee
on all political materials except for those items exempted by statute or rule.
4. That Iowa Code section 68A.15 and rules 351-4.44 through 4.52 prohibit the receipt of corporate contributions by all committees except for
statewide and local ballot issue PACs.
5. A candidate and a candidate’s committee may only expend campaign funds as permitted by Iowa code sections 68A.40 through 68A.42 and rule
351-4.25.
6. That the committee will continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report
and a statement of dissolution (DR-3) has been filed.

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Chair Person: Treasurer:
(signature and date) (signature and date)

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028
 Filed/Amended
Committee Accounts 7/30/2007
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Default
Checking Iowa Independent Bankers Political Action Committe
1 West Des Moines State Bank
Default Account PO Box 65020

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 Filed/Amended
Committee Officers 7/30/2007

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Role Name and Address

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 Filed/Amended
DR-1 Auditors Notes 7/30/2007

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