FOR INSTRUCTIONS, SEE BACK OF FORM CHECK ONE: Tenfom J [FORM ‘STATEMENT CI Thi isan nitiat* Statement of Organization DR+ OF CI This is an amended Statement of Organzation (Rev. 0172006) | ORGANIZATION “An inal Statement of Organization must be fied within 10 days of the commitoe'saccoptng conirbutons, | For Office Use Only making expenditures, or incuring indebtedness exceedhng $750. Amendments must be Med with 30 days of | Coren. 2 change. Penalties may be Imposed for lat ied Stalorents of Organizatan. A canddate wih an open’ | indexed Eerie tat exceeds 8750 nactvly fv another offes shal Me within 0 days other arew or amended | fsyeg De ascasng inermaton concerning the campaign forthe new ofice sought a COMMITTEE NAME 1 1 (A candidates conmlioe mist include th candi’ ant ramo i th name ofthe commen) Butler Coun WRegelolieanr Ceutral Commer TT hdiaio type of commie you ar reporting Tor (4 )StatowidelLogisiativeudge Standing for Retntion Candidta”(Z )Satowide PAG (3)State Party (4 \County Cental Commitee {5 county Candidate (8 Cty Candidate (7 )School Board or Other Poltieal Subdivision Candidate (8 JCounty PAC (9 chy PAC {10}Sehoo! Board or Other Polkical Subdivision PAC (11) Local Balt lasuo(including commie Involved in mull clyicounty ballot issues) COMMITTEE TREASURER (mandatory forall commites) COMMITEE CHAI mando eco cndnt's commis) Name_]-T Navel Reea Myers sVésen_S, Sohuson ing Adie tn iaing Aeress TL 7 wena oD St, noi! Sanset Detve iy, Stato 1 12 Gi Sate + 1 Zp coco tT Mison 24 Seco % Meeeeslawee ed Sblede 5 Prone ( 3/9)_ 94 7-2IO Phone (3/7) S44 - 7%. eat Lagan 4 Bea g oni Butler cepcheiv @ Hotwre, [Cory INDICATE. fhe Bm He lem Oates a Saab es ol ‘Commentor description Avoca againat blot sal TIT Candidates Enter: CounigiLScal Candidates and Local Salo Committees Eni Ofc Sure Coury: _ wz — Potcal Paty appicable (ace inate at a Slacons, Sach ToT ears District: — — Date of Election: ‘Year Standing for econ: Bank Accountname ‘Sansa par & Adaosa Parent Ey PACS anak, TT? ‘Afflate, or Snonser Butta Co, Repulaliean Cesitval Hee Name ot Financial nststoniype of Account tt ‘amas dass TT Seeuvity State Rawk Haig Adress | TT wy TT Sai Tae TT Loy W) Crevey St, wy tt Wate 1 Tap TT Shel Roew Ta $0476 STATEMENT OF AFFIRMATION: By fing this document the commie affims the folowhng 1, Ths commites and al parsons connected wih the Commitee understand that hey ae subject othe laws in towa Code chapters GBA and G86 and the admis ‘een Chapter 381 ofthe twa Adminevabve Code 2. Thatlowa Code section 68A 402 andre 3514.9 aque the fg of closure repos ed that he fare to le hese reports ono Delore the eed doe dates Eisecs te candidate orenaperson (nthe cate of commtaes other than scandals commas tthe automate assessment tail petay andthe possible imposton of oer sna and hl sano. 3. Thatowa Code secon 8.405 and ues 351—4.38 trough 4.4 require the placer ofthe words “paid for by” and the nameof te commit onal pc! Imatoalsorcont for thase tems exompied by satua ors. A commits tat wines roger a commes name le pupeces Of sing the shore “pi ory” and ‘oes ot intend to ron he $780 fg tresbeld sha e he Form DR-SFA Sm 4, Tat owa Code secton 6.503 and ules 3514.44 tvough 452 probithe recap ot cerporatecontbutons by al commie iteve PAs. op for statewide antes baat 5. Acandidate and a candidate's commitee may only exper campsion funds as permite by lowa code sectons GA.201 trough 68A 303 and nse 351425, 6. Thatthe commie wil continue o le disclosure reports unt all activ has cased, commie funds spent debi esohved, and a al epost ae a statement of ‘issouton (OR) nas bgen aa. mated Wyo