02 :28- 05 )ION 10 :32 FAT 515 955 3215 FD CHA'IIBER OF CO)IERCE C?

(J01

FOR INSTRUCTIONS, SEE BACK OF FORM'

CHECK ONE: FORM STATEMENT

XX This is an initial* Statement of Organization DR-1 of

0 This is an amended' Statement of Organization FES 2 8 (REV. 0712004) ORGANIZATION
2005
ForOffice Use Only
An Initial Statement of Organization must be filed wiC7in 10 Gays of the-committee's.accepting cantrJb*ns, Comm . #
making expenditures, or incurring indebtedness exceeding S75a Amendments must be filed within 30 flays of Indexed
o chongo. Penalties maybe imposed for late4ad Statements of Organization. _.. ` . Audited
Computer

COMMITTEE NAME J. ~
Vote Yes March 8th

IMPORTANT : Indicate type of committee you are reporting for.

(1 )StatewidelLegislative/Judge Standing for Retention Candidate (2 )Statewide PAC (3 )State Party (4 )County Centra(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 Pol itical Subdivision PAC ( 11 ) Local Ballot Issue
COMMITTEE TREASURER (mandatory for all committees) _ COMMITTEE CHAIR (mandatory except for a candidate's committee
Name 1 1 Name 1 1
Doug Sanders Dan Pavne
Mailing Address y y Mailing Address d J.
1127 North 40' Street 1406 Central Ave.
City, State d. ~. Zip Code 1 J . City, State ~ d Zjp Code 1 1
Ft._O50501
ggge, Iowa 50501 Ft. Dodge, Iowa

Phone ( 515) 576}1750 Phone (515)3-x282

erMail pamsprintsitlcs&odgenaLco m I Mail dlpkayAfron6emetxe

INDICATE PURPOSE OF COMMITTEE - Check One Box a Advocate forlagainst candidate(s)XX Advocate for/against ballot issue(s)
Comment or description : Local Ballot Issue
All Candidates Enter.
Office Sought District

Political Party (if applicable) Year Standing for Elrxaion:

CountylLocal Candidates and Local BallotlFranchise Committees Enter.
Date of Election : March 8, 2005.
County. Webster

Bank Account Name d Candidate name Addrgvs or retlt.EntlhUPALs .

eN-
Vote Yes March d y
1

Name of Financial Institutionifype of Account Mailing Address .4 S (// 7_,-'W

Fast Federal Savln S Bank Checking

Mailing Address city I I

825 Central Ave-
City d J. State Zip 1 y
Phone ( )
Ft. Dodge. Iowa 50501
e-Mail

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 chapter- 68A and 6813 and the administrative
rules in Chapter 351 of the laws Administrative Code.
2 . That Iowa Code section 68A .402 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 On 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 cavil sanctions.
3 . That Iowa Code section 68A.405 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. A committee filing this statement for purposes of using the shorter'paid for by' and who have not crossed
the $750 shell notify the Board that the $750 threshold will not be crossed.
4 . That Iowa Code section 6BA-503 and rules 351-4 .44 through 4 .52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
icr.,ue PACs.
5 . A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 66A .301 through 68A .303 and rule 351-4 .25 .
e 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
(DR-3) ha§ been fit

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