" v" vw

CHECK ONE : DR-1 OF

Q initial" statement of orpant;adotl
This is sill (Ray . 007) ORQANIUTM
This is an arrtindad" Stet~ a *ganizadon For O111111 u. . edr

" An ir*al Statement a Orgwldsadon shoua be Rod wlhin to ai ys of Me oaamf:s ecc@Pftng Corms. i
contnbudws. erakirg axpanafwoa of incWnbg (ndeblsdheas exosedng SSM Amwrdnsnts atlowld be Algid
within 30 days of a charge . Penalties may be +ntpossd br la*AW Sfetentents of OrpanisaftorkW /- 3
Indexed 64?~
Audited
Compuw gu n,

COMMITTEE NAME (Required by law)

I
n A
IMPORTANT: Indicate type of eomrnitt" you an reporWq for ., `' , l(,~av , /,- u,~-A c -~
roe
(t )StatewldefL"islad" Candidete (2 )afateWde PAC (_Pea% Party ( ~ountylLoeal Candidate ($ )County PAC ($ )Ballot IsswIFmnbhise
Committee (7 )County/City Central Canwnlltee ( s ~uppoR slate of eandidatea (cast andldala under purpose of eanMetes) G

COMMITTEE TREASURER (This addroas used br aI ternindisrs COMMITTEE CHAIR (List additional ofi)icsrs on sepwate page)
(Required law) and correspondence)
Name Nwnq

La kLA- e-
Mailing Address
-77
Mailing Address

3D
City, State Zip Code
o ' A 0 e-
City. State Zip Code

-
Home Phone (6 w) l{ - fo Home Phone (~ b ~n r{S' ~-

Day Phone Phone( )

INDICATE PURPOSE OF COMMITTEE - Chedt One Boot Q To support a oppose andillaee(s) QTo support a oppose belot Issue(s)
Comment or desai",.@n :
All Candidates Enter:
Office Sought District

Political Party (It applicable) Year Statbig for Elecdon:

CountyA .ocM Candidaoes and Local BaMofiFmndthe Commllbsss Enter :
County: Date of Election :
Account CantUde Norms A Address a
Bank Nam 11
11 Affflials. or

,
Narne of FinancialInstitudoruType of Account
S . (h
1 1
ba h
Mailing Address 1 1

er I a. Ire 'n
Mailing Address 11 City 1 1 State 1 1 Zip 1 1

City 1 1 State 1 1 Z)P i 1 Home Phone ( )

0+t U~ M t v --<- '--r-6-0 D I Day Phone (

(Statement of
)
intent revuirea by Ire far 2e nW Mln" -,~e 0210
DISPOSITION OF BALANCE-01 - FUNDS UPON DISSOLUTION
WA central carrrn)aees.)
Indicate difoosition of kinds by martcino aDDfoortete mnnbsf in boo[ n
(t) DONATED TO COUNTY CENTRAL COMMITTEE (e) PRORATED REFUND TO CONTRIBUTORS
(2) DONATED TO LOCAUSTATENATIL POLITICAL PARTY(urdoerr am) (n TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE
(3) DONATED TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)
(speaty) (e) RETURN TO PARENT ENTITY GENERAL FUND (PACs ONLY)
(a) CITYICOUNTYISCHOOUSTATE OF IOWA GENERAL FUND tv+ewear) (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 Mat I am nqured to file disclosure t9p&U d M e canm11W nc&s eonb+8udmt mslres erpendwes . or incurs oWeOMdness in excess of &e hundred dollars in
a calendar year for Me purpose of supporrinp or opposog any caedd& . &public oftice a baabt IssM. I am also swan mat 1ara+Wd reports are sub0a to aid P"a"s
(lines) under rM disdawre law. 1 sho wrderafand dNf aA~orpfr lA9 treatlaar namely DnPaAS and fifes nPoItA Mle CandIdaM or chailpraon (PACs) is nsporrsfDre under tM
law ibr accwate 4W obney dredature reports. Firoafj: l aAhn tAat tee oonrniMee oafears have been illbrmed dl their appo(nbrrent and ob8ga6bns.

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