FOR INSTRUCTIONS, SEE BACK OF FORM FORM STATEMENT

CHECK ONE: . DR-1 OF

41003
® This is an initial' Statement of Organization SE(' (Rev . 07;00) ORGANIZATION
This is an amended' Statement of Organization
For Office Use Only
'An initial Statement of Organization should be filled within 10 days of the committee's accepting contributions,
Comet . I
making expenditures or incurring indebtedness exceeding 3500. Amendments should be filed within 30 days of a
Indexed
change . Penalties may be imposed for late-filed Statements of Organization .
Audited
Computer
9 -.03 .
COMMITTEE NAME (Required by law) 7

4 :~F "v; ~ot~Nt"1l Co/ ~

IMPORTANT : Indicate type of committee you are reporting for :

( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC (3 )State Party (4 )County/Local Candidate ( 5 )County PAC ( 6 )Ballot
Issue/Franchise
Committee ( 7 )County/City Central Committee ( 8 )Support slate of candidates (list candidates under purpose o f committee)
COMMITTEE TREASURER This address used for all reminders and COMMITTEE CHAIR (List additional officers on separate page)
(Required by law) correspondence)

Name
,M ,1re
7h%' T J /`~ hti/ rJ ~t~tJE L5tYl~ - - C~,4 i.2~-tfbJ
Mailing Address Mailing Address

City, state Zip Code City, State Zip Code

Phone(3/~ 266___5_0621 Phone

e-mail 0 0 ,Tud B lot AUL .L0~t. e-mail

INDICATE PURPOSE COMMITTEE - Check One BOX Advocate for/against candidate(s) Advocate for/against ballot issue(s)
Comment or description :
All Candidates Enter :
Office Sought, ~~ ^~~>rit(Q6LCr L District : C~ l . k3 SU(.t
Political Party (if applicable) Year Standing for Election:
County/Local G@ndidates and Local Ballot/Franchise Committees Enter :
County: 1.51 AC(~ uakwkl- Date of Election : /V,i, l/r=)vl &~f 2Gb3
Bank Account Name y 1 Candidate name 8~ Address or Parent Entity (PACs . if applicable) .
1 11, Affiliate . or Sponsor
_PnIZL,4F f2~it ~LfN~iL Cowl,u ;~t~E ~L~4i :tl~ >4. ~,9- !f
Name of Financial Institutionitype of Account 1 1 Mailing Address 1 1 L,
~,eSf l~l 'Yiy~llA-L ~>~N ~ - j0 1t
Mailing Address :. J. City 1 1 State 1 1 Zip .1 . 1

City ~. 1 State 1 1 Zip 1 1 Phone (3 f ct ) 17 7

Cf SZ* 13 e-mail CFA L Z CFU . ~lI E
DLSPOStfION OF BALANCE OF FL'N0
.S UPON DISSOLUTION 'statement orment
t required by law or all committees, except state parties and central
Indicate disposition of funds by marking appropriate number in pox: C1 committees and committees using only personal funds .)
1 NA+- + COUNTY CENTRAL COMMITTEE o + i N
(2) DONAT'EED TO LOCAUSTATEINAT'L POLITICAL PARTY (wdedne or*) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE

(3) DONATED ~TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)

(specify) 4"LG m/wic Soci e'fV (8) RETURN TO PARENT ENTITY GENERAL FUND (PACs ONLY)
(4) CIMYICOUM'IYISCHOOL+STATE OF IOWA GENERAL FUND (undeAne one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC

(5) PARTISAN CONGRESSIONAL DISTRICT FUND

STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE, OR POLITICAL COMMITTEES, BY CHAIRPERSON

I am aware that I am required to file disclosure reports if the committee receives contributions, makes expenditures, or incurs indebtedness in excess of
5500.00 in a calendar year to expressly advocate for any candidate or ballot issue . 1 understand that although the treasurer normally prepares and files
reports, the candidate or chairperson (PACs) is responsible under the law for accurate and timely disclosure reports and that late-filed reports are subject
to civil penalties. In
and possible other legal action . i understand that by filing this form, I am subject to the laws found in Iowa Code chapter 56, chapter 686
and administra rules found in ter 1 . I affirm that all committee officers have been informed of their appointment and obligadons .

+ Lure or iWeasurer Oats Signed

V
tardn5, 3
Signature C n te. OR, ,f PAC . Central Committee or Local Ballot Issue, Chairperson Date Signed
 FOR INSTRUCTIONS, SEE BACK OF FORM FORM STATEMENT
CHECK ONE: . DR-1 OF
This is an initial* Statement of Organization SEP 4 ?003 (Rev . 07/00) ORGANIZATION
This is an amended* Statement of Organization
For Office Use Onl y
'An initial Statement of Organization should be filled within 10 days of the committee's accepting contributions,
Comm . T _
making expenditures or incurring indebtedness exceeding 3500 . Amendments should be filed within 30 days of a
Indexed
change . Penalties may be imposed for late-riled Statements of Organization .
Audited
Computer

r
COMMITTEE NAME (Required by law)

LZT2A F Ffln ComM/ tfL E

IMPORTANT : Indicate type of committee you are reporting for :
( 1 )Statewide/Legislative Candidate (2 )Statewide PAC (3 )State Party (4 )County/Local Candidate ( 5 )County PAC ( 6 )Ballot Issue/Franchise
Committee ( 7 )County/City Central Committee ( 8 )Support slate of candidates (list candidates under purpose of committee)
COMMI7TEE TREASURER This address used for all reminders and COMMITTEE CHAIR (List additional officers on separate page)
(Required by law) correspondence)
-
Name (Name

ouy L_,4u
Mailing Address Mailing A(oj-Jress

Zip Code
7 Cr-7v 4 ., / L-A) /i'1 L ltt
City, State City, State Zip Code

Phone ( ) Phone (3/j) 77- 7 -7-70

e-Mail e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate for/against candidate(s) I Advocate for/against ballot issue(s)
Comment or description :
All Candidates Enter :
Office Sought: District:

Political Party (if applicable) Year Standing for Election :

County/Local Candidates and Local Ballot/Franchise Committees Enter :
County : Date of Election :
Bank Account Name 1 1 Candidate name $. Address or Parent Entity (PACs . if applicable) .
1 Affiliate, or Sponsor

Name of Financial Insbtutionitype of Account 1 1 Mailing Address ! ,.

Mailing Address ~. City 1 ~. State 1 1 Zip 1 1

City 1 1 State 1 1 Zip 1 1 Phone ( )

e-Mail
nlctx-tcmnnl r and AnrP nc P Imnc i IDnAJ DISSOLUTI ON y law dr ai1 commutees, except state p _
Indicate disposition of funds by marking ap propriate number in box : committees and committees using only personal funds .)
NA

(2) DONATED TO LOCAUSTATEJNAT'L POLITICAL PARTY (vxw6»one) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE

(3) DONATED TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)

(specify) (8) RETURN TO PARENT ENTITY GENERAL FUND (PACs ONLY)

(4) CITYICOUNTYISCHOOUSTATE OF IOWA GENERAL FUND (underline one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC
(5) PARTISAN CONGRESSIONAL DISTRICT FUND

STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE : OR POLITICAL COMMITTEES, BY CHAIRPERSON

I am aware that I am required to file disclosure reports if the committee receives contributions, makes expenditures, or incurs indebtedness in excess of
$500.00 in a calendar year to expressly advocate for any candidate or ballot issue . I understand that although the treasurer normally prepares and files
reports, the candidate or chairperson (PACs) is responsible under the law for accurate and timely disclosure reports and that late-flied reports are subject
to civil penalties and possible other legal action . I understand that by filing this form, I am subject to the laws found in Iowa Code chapter 56, chapter 68B
and administrative rules found in chapter 351 . I affirm that all committee officers have been informed of their appointment and obligations .

Signature of Treasurer Date Signed

Signature of Candidate, OR, if PAC, Central Committee or Local Ballot Issue, Chairperson Date Signed
FOR INSTRUCTIONS, SEE BACK OF FORM FORM STATEMENT
CHECK'ONE :
DR-1 OF
(2f This is an initial * Statement of Organization (Rev . 06/97) ORGANIZATION
This is an amended* Statement of Organization For Office Use O nly
An initial Statement of Organization should be filed within 10 days of the committee's acceptin6,== ~,
Comm . #
contributions. making expenditures or incurring indebtedness exceeding $500 . Amendments sho~El be file
)40exed
within 30 days of a change. Penalties may be imposed for late-filed Statements of Organization.
`Audited _
Computer

COMMITTEE NAME (Required by law)

6''-Lz91-;,4 F ~2 Cou,vc ~ C no ~ -
IMPORTANT: Indicate type of committee you are reporting for :
( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )County/Local Candidate ( 5 )County PAC (6 )Ballot IssuelFranchise
Committee (7 )County/City Central Committee (8 )Support slate of candidates (list candidates under purpose of committee)

COMMITTEE TREASURER (This address used for all reminders COMMITTEE CHAIR (List additional officers on separate page)
(Required b law and correspondence)
Name Name

Jr4tle_7-.S .04
Mailing Address Mailing Address

31o / 6,"7!r
City, State Zip Code City, State Zip Code

C~~~~,~

Home Phone ( ) Home Phone (3/,~? )

Day Phone Day Phone
INDICATE PURPOSE OF COMMITTEE -Check One Box X To support or oppose candidate(s) To support or oppose ballot issue(s)
Comment or description :
All Candidates Enter :
Office Sought : District :
Political Party (if applicable) Year Standing for Election :
County/Local Candidates and Local Ballot/Franchise Committees Enter:
County : Date of Election :

Bank Account Name I 1 Candidate Name & Address or Parent Entity (PACs . if applicable) .
1 1 Affiliate, or Sponsor

Name of Financial Institution/Type of Account 1 1 Mailing Address 1 1

Mailing Address I 1 City 1 I State 1 1 Zip 1 1

City 1 .L State 1 1 Zip I 1 Home Phone ( )

Day Phone( )
DISPOSITION OF BALANCE OF FUNDS UPON DISSOLUTION (Statement of intent required by law for all committees, except state parties
and central committees.)
Indicate disposition of funds by marking appropriate number in box : 11
1)
) DONATED TO COUNTY CENTRAL COMMITTEE (6) PRORATED REFUND TO CONTRIBUTORS
(2) DONATED TO LOCAL/STATE/NAT'L POLITICAL PARTY(uncerline one) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE
(3) DONATED TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)
(specify) (8) RETURN TO PARENT ENTITY GENERAL FUND (PACs ONLY)
14) CITY/COUNTY/SCHOOUSTATE OF IOWA GENERAL FUND (underline one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC
(5) PARTISAN CONGRESSIONAL DISTRICT FUND
STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE ; OR POLITICAL COMMITTEES, BY CHAIRPERSON
I am aware that I am required to file disclosure reports if the committee receives contributions . makes expenditures . or incurs indebtedness in excess of five hundred dollars in
a calendar year for the purpose of supporting or opposing any candidate for public office or ballot issue. 1 am also aware that late-filed reports are subject to civil penalties
fines) under the disclosure law. I also understand that although the treasurer normally prepares and files reports . the candidate or chairperson (PACs) is responsible under the
law for accurate and timely disclosure reports . Finally. 1 affirm that all committee officers have been informed of their appointment and obligations.

Signature of Treasurer Date Signed

Signature of Candidate or Chairperson (if a PAC) Date Signed