INSTRUCTIONS, SEE B

g : EGK ONE: FORM STATEMENT

This is an ktifar Statement of Organization OF
© This is an amended` Statement of Organization (REV. 12/2005) ORGANIZAT40N
"An initial Statement of Organization must be filed within 10 days of the committee's accepting contributions, For Office Use Onto
making expenditures, or incurring indebtedness exceeding $750. Amendments must be filed within 30 days of , ~
Comm. #
a change. Penalties may be imposed for late-filed Statements of Organization . yl candidate with an open indexed
committee that exceeds ,$730 in activity for another office shall file within 10 days either a new or amended Audited
DR- 1 disclosing information concerning the campaign for the new office sought.
Computer

COMAtTTEE NAME ,k

l.. ('C(1 CA A nd,e rs cSYi ~ -S LA- p~r 0 '% S 10 v,

IMPORTANT : indicate type of committee )Fort are repoMt 1w : .

ae/Judge standing for Retention Candidate { 2 ),statewiae PAC ( 3 )State Party (4 )county central committee
6 )City Candidate ( 7 )School Board or. Other Political Subdivision Candidate ( 8 )County PAC ( 6 )City PAC
Other-PoliticalSuladivision :RAC ( 11 .)Local Ballot Jssue
COMMITTEE TREASURER (mandatoryfor af-co~jttees)
Name ~- 1
e-,,t S ~^
Mailing Add I

City, State ;1.. , Zip Code ;l

fy\ P.sf

Phone ( 7t 2) S''~S - ~2 (4 9 3
e-mail . .ra 14 p a h Pp
I awa - lvtt I e-mail
tNDFCATE -PUR"SE OF CONIIr11TTEf Check One BOX 13 Advocate forlagainst sandidate(s) Advocate foriagainst ballot issue(s)
Comment or description :
AD Candidates --Enter :
Office Sought: CI O 5 u d e,.f 1) l S I OY
t
Political Party (if applicable)' Year Standing for Election : 02_0 O b
County/Local Candidates and Loca SallotlFranchise Commtttees Enter.
County: ~'la tv-. o "A-V, Date of Election:

Bank Account Name Candidate name -& Address or Patent Entity (PACs. if applicable)
G-v-
Ailiate, or Sponsor

('-rt:~ .~: ~~b.dur.nrs ~~-" (~.m-Pr7W ih cLe=1^ S ~4-

Name of Financi I Institutionttype of Account

i- "ay%6k J&_Ck~
Mailing Address 1. I State ~. 1 Zip
)00 6r>e 4~3 v 11 1e.v-ri t\ S to3~
city . State 1

41 /A ars e-mail Cr y < rr 1 `.~

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

1 _ The committee and all persons connected with .the committee understandthatthey are subjectto the taws in Iowa Code chapters 68A and 66B andthe administrative
rules in Chapter 351 of the loam Administrative Code.
2 . That Iowa Code section 68x .402 and rule 351=-4.9 require the filing of disclosure reports . The failure to fife 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 possfble imposition of
other criminal and civil sanctions pursuant to lowa Code section 688, 32x(7).
3. That Iowa Code section 68x.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 shall notify the Board that the $750 threshold will not be crossed.
4. That lowa Code section 68x.503 and .rufes 351-?1.44 through 4.52prohibit the receipt of corporate contributions by at! committees except for statevAde and
issue PACs. local ballot

5 . A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68x.301 through 68x.303 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
i.- - has been-filed .
dissolutionK3)

for all other cornrnitteas,Chairperson