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FORM DR-1: Statement of Organization Form Statement of

ID 6078 DR-1 Organization


Type Iowa PAC Web Reporting System Rev. 09/2003
Status Amended For Office Use Only
Name Iowa Physical Therapy PAC Comm. # 6078
Indexed
Filed/Amended 7/20/2007 Audited
Date Computer

Committee Treasurer Committee Chair


Name Michael C. Mandel Name David L. Scott
Address 1228 8th St Suite 106 Address 5355 Eastern Ave

West Des Moines, IA 50265-2624 Davenport, IA 52807-


Primary Ph. (515) 222-9838 Primary Ph. (319) 332-5493
Secondary Ph. Secondary Ph. (319) 355-3867
e-Mail mail@iowaapta.org e-Mail davescott@qcptc.com
Purpose
Political contributions

Office Sought: District:


Party: Year Standing for Election:
County: NA Date of Election:
Primary Bank Account PAC Parent Entity, Affiliate or Sponsor
Name FirstBank Name Iowa Physical Therapy Association
Address 1630 22nd St Address 8355 University Blvd Ste K

West Des Moines, IA


Account Type Checking Primary Ph. (515) 222-9838
Account Name Iowa Physical Therapy PAC e-Mail mail@iowaapta.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 7/20/2007
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Default
Checking Iowa Physical Therapy PAC
1 FirstBank
Default Account 1630 22nd St

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Filed/Amended
Committee Officers 7/20/2007

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Role Name and Address

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Filed/Amended
DR-1 Auditors Notes 7/20/2007

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