IOWA ETHICS AND %.

AMPAIGN DISCLOSURE BOARD Form

VERIFIED STATEMENT
514 EAST LOCUST, SUITE 104 REGISTRATION
DES MOINES, IOWA 50309-1912 (Out-of-State Committees)
(Rev . 5/99)

VERIFIED STATEMENT REGISTRATION For office use only

(Out-of-State Committee)
rV IIkiexed'=.
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
SEND ORIGINAL COPY TO THE BOARD AND Audited r
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMIVTEE . S F cke4
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF Ft RMp  Ljr_
1
Comput4
COMMITTEE NAME

Official Name of Out-of-State Committee (Do not abbreviate committee na

F ;rP ;cEh rs Tn _r t d in Registration and Education Pol .
Mailing Address
1750 New York Avenue, NW
City, State, Zi Code '~ °de 7 37 g No .
Washingto n, DC 2006 T ' e

TREASURER OTHER OFFICERS (Attach second page ff needed)

Harold A . 9cT1DaT~hTrger
Name otTreasurer
Vincent J . Boilon
1 75 Q New Yor'"'AAdvreemnue,
n ue, NW 1750 New YoWhnkISTMe, NW
City . State, Zip Code Telephone City, State, Zip Code Telephone
Washington DC 20006 (202)737-848 Washington . DC 20006 X021 37 7-841 4
IOWA RESIDENT ENT
PARENT ENTITY, AFFILIATE , SPONSO R OF COMMITTEE
i9 ature I Resident Agent (Use separate page if needed to list more than one entity)

Typed Name ofIowa Resident

Ja k Reed International AsMT . of Fire Fighter
427 C estview alTnuems 1750 New York ", NW
C 'tS C°~iA 52501 Telephone
( ~?? -0139
C'~y , State, Zi Code
Washin ton, DC 2000
FI'REPAC is a political committee which supports
PURPOSE OF COMMITTEE :
candidates for office which have been endorsed by state or local
affiliates of the International Association of Fire Fighters .
a
IOWA COMMITTEE RECEIVING CONTRIBUTION
STATE OR FEDERAL JURISDICTION WHERE COMMITTEE
IS REGISTERED OR OPERATES Name of Committee
Comm Ltt-p-2 F1 ert i0e1anig antes
Name of Jurisdiction P .O . Box 601, lt "Irl'"Bluffs, IA 5150 12
Mailing Address Date q1 16S i If In Kind Contribution, Describe
999 Fyg Strppt f NW
Amount
City, State, Zip Code Telephone
Washington, DC 20006 _L202)219-3419250 .00
VERIFIED STATEMENT OF COMMITTEE :
1 Vincent J . Bo l lo n , swear that Me contribution reported above is accurate. I further swear that the information about this out-of-
state committee is correct and accurate to the best of my lohowledge. I attest that the reports filed in the named jurisdiction comply with requirements which are
substantially similar to Iowa Code section 56.6, including the disclosure of aN contributions received and all expenditures made. 1 further attest that the
conbibution ad above was made from an account which does not accept contributions from corporations or other prohibited contributors under Iowa Code
section 56.1 1 understand that Iowa mittees are prohibited from accepting contributions from out-0f-state committees unless a signed original of this form
ha;.beer,Flll t3+elata Ethic~,c an ampieigp Disclosure Board, or the out-of--state committee is registered and filing full disclosure reports in Iowa.

Treasurer / OS
Signature of TreI
ajrer or Chairperson) (Tale) (Vale)
Subscribed and sworn before me this /~~ day of f ir4- , A-mat LL&" fhL~-n7X1 , DG

My notary commission expires --vy10