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SEE BACK OF FOi|lfi,f

FORINSTRUCTIONS, 0tstlSSLIRE
FII
,Q
,AE'J,*
CHECKONE:
I This is an Inltlal' Statementof Organization
fnis is
i: an amended'Statement
amended' Slatementof Organization
Organize
2oogAPR-7
Affi,tr lG
fi!
E.Il,^".
'An inmal
'An in,lialStatement
Statementof Organization
of Organization mustbe
mustbe filed
filedwithin
within10
10days
daysof
of the
the@mmittee's
mmmittee'sa@pting
a@pting @ntibutions,
@ntibutions, Comm.#
makinqexpenditures,
making expenditures.or incuning
or indebtedness
incuninsindebtedness ex@edins$750.
ex@eding Amendments
5750.Amendments mustbe
must be frled
frledwithin
within30
30 days
davsof lndexed
a change. Penaltiesmay be impo*d for [ate-filed Statementsof Organization.A andidate with an open Audited
ommittee that exceeds$7il in adiviU for another offi@ sllall frle within 10 days either a new or amended
DR-1 disdosing information@n@ming the @mpaign forthe new offie sought.
J J (A candidate'scommltteemust includethe candldate'slast nameIn the nameof the commfttee.)

lndlcate typs of commlttee you aro r€portlng for:

PAC(3)StateParty( 4 )County GentralCommlttse
( 6 )Clty Candldate ( 7 )School Board or Other ( 8 )County PAC ( I )Clty PAC

COMMITTEE
*" *tt"
" 4i-ou" [\,*Irolo ft."^ s^,'A
wtalino_|a$rerss "^-1;;'"b- ilrnro* tJitl ts1,'0
MalllnqAddress J J
bb z^l_l S+.
' 'D[ea<*t*
Pl.n.-,* tJiil . t A laSZT tL"tl tA 6d337
Phone(Jl5 t JAl-15q1 Phone(ltj t J/^1-84s-z
e-MailtLTS S*et, @ Oa L ca^n *vial Danea QniA @6pI ,car^
INDICATEPURPOSEOF COMMITTEE- CheckOne Box lJ Advocate
for/against
ca-ndidate(s)
K[ Advocateforballotlssue(s)
Commentor descriotion: E Advocateaqainstballotissue(s)
All Candldates Enten CountyAocal Candldatggand Local Ballot Commlttoes Entor:
OfnceSought:
County:
PoliticalParty(if applicable) (lf aclivein multple ballotissueelec{ions,
Disfict: DateofEtedion, J'5 -Ofl
Year Standinqfor Elec{ion:
Bank Account Name (musl malch commffieename) Gandldatename & Address or @
tt
J J Afflllate. or Soonsor
tlus Fon Do-, 6,+-r.
Nameof Financial
lnstitutioffi Mailing
Address J J
Vatleo
&^k. / &A*k;*
ciry J 0 stareJ J zip J J
& to llF D,l^rroe" A,te
cny J J stareJ J ap J.f Phone ( )
AoKouy lA fieo"zt'A7l e-Mall

OF AFFIRMATION:By flllng thls documenttho commltteoafilrms the followlng:

STATEMENT

1. Thecommitteo andall personsconnected wilhthecommltteo understiandthattheyars eubjectto the lawsIn lolvaCodechapters68Aand688 andthe admlnistrative
rulesin Chapter351ot the lowaAdminigtralive Code.
2. ThatlowaCodesecton68A.402and rulo351-4.9 requlrethefillngof disclosure reportsandthal thefallureto filethosereporbon or beforetherequiredduedates
eubjectsthe candidateor chalrporson(ln the caseot committeesotherthan a candldate'scomminee)to the automatcassessmenlot a clMlpenaltyandthe possible
impositionof othorcriminaland cMl sanctions.
3. ThatlowaCodesection68A.405and rute8351-4.38 through4.43requirathe placement ot thewords'paidfor by' andtho nameof thecommineeon all political
matErialsexceptfor thoseitEmsexemptedby statuteor rule. A commtteothatwishesto regi$tera'commlttee namefor purposes of usingthe shorter'paidfor by' and
doesnotinlendto crossthe$750filingthresholdshallfilethe FormDR€FA formln lieuof lillngthls form.
4. ThatlowaCodesection68A.503and rules351-*4.44through4.52prohlblttherecolptot corporatecontributions
by all committees and localballot
exceptbr stiatewlde
issuePACs.
commneemayonlyexpendcampalgnfundsas permittedby lowacodeseclions6EA.301
S. A candidateanda candidals's through68A.303andrule351-4.25.
wlltcontinueto file dlsclosurereportguntl all actvttyhagcEased,commfilestundsspent,debtsresolved,and a nnd reportand a statementof
6. Thatthe committee

z/-&,. a g
Date Slgned

q la/a
t / Date Signsd