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FOR INSTRUCTIONS, SEE BACK OF OWI§PLOSURE BOARD
STATEMENT
Ri',For 0F; M
7F_
J1,1L I P 2005
CHECK ONE :
This is an initial- Statement of Organization DR-1 OF
0 This is an amended' Statement of Organization 101/2006) ORGANIZATION

'An inii
CfateiTOnf of organization must be Fled within t~ yso~~~nr o c '>+~~ r M~Iributions, For t 1 e Usf Only
making expenditures, or ihcurring indebtedness exceeding $750. Amendments must be tired within JO days of Cemnt #
a change Fenalties may be imposed for late-filed Statements of Organization A candidate with an open Indexed
committee that ekcoeds 5750 in activity for another office shall file within 10 days either a new cr amended Audretd ,-
CR_ 1 disrioslny information concerning !he campaign for the neweffioe sought CemG user

COMMITTEE NAME L !. (A candid e the candidate's last raring in the name of the corritittee " )

IMPORT .' Indimtte type of committee you are reporting tor:

( 1 )StatewidelLegislative/Judge Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )State Party ( 4 )Court N Central Committee
( 5 )County Candidate ( 6 )City Candidate ( 7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC
16 )School Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issue(including commlttae Involved it multiple 0)rlcounty ballot lssueis)

TREASURER (mandatory for all co mm ittees) COMMITTEE CHAIR (mandatory exeeptfor ; t ca ndidate's committee

wrrcL
1,4allinq Address y Mailing Address
tin o~1 S
Cllr t~ Zi e L City, State L Zip rode '
C' Q,S ` ; yT 5ofo I to ' + 0 ~ri 0~} SD .P I (J

;ZZ '" Z`Z-7~1 + ~ Phone 1~~~1 ~-

e-rdu _ e-Mail ' rnaV ~~ 5 ~C I

INDICATE PURPO MMITTEE -Check One xo Advocate for/against candidate(s) Advocate for ballot issues)
Comment or descriptcn : 0 Advorat a-129alnsttallctissua(s)
A~tl andidatos titer: ountylt-otal Candidates and Local Ballot :;ommitteas Enter.
O''isse Sought :
County-
Fairly (if 3Ctive m multiple ballot issue elu-Aiony ai list cf counties
Political iii applizable)
Owli ;_t U3te of Election,
Year St :t ndlng for Election _- _ no tv
Bank Account Name Candidate name all Acldr
dial ). or Soon tor

Nanp of Financial Instiluionltype ofAccdunl Mailing Address 1 ,

6 6Q1 ~_~
- stflt. ,-77T Zip T

Phone (to I ) 7 7

e-f"nnu

STATEMENT OF AFFIRMATION: By filing this document the committee affirms the following .

1 The -orrmttee and all persons cCltneded with line commltlee understand that they are subject to the 13ws Ir Iowa Code Ch " 1pters CaA +end 1386 and the aomlni^lr11111c
r~_ :IC ; r~ Ch3pler ?5 - of the Iowa Adminiltrall'.,e Code

,: Thai Iowa COdP iFCton 66A 40< 3r1d rule 3~ 1--11 9 require 1,nc f I,ng of d,YGIO .Sure report.% and that the 110 file these reports on or Defore the required due i1,alAS
;iiclec"i5 Ine :ahdld3te o, ~,rairper50r nn the -,It,? .If comRlr,te?S other fhnn A candidatQ " 5 Commitlee) to the aitoma' c asSess rent of a chit partalty and the ooss ;Dle
imi si Outer criminal and chit SBrclion ;
°. That io ..a Coda se^GOn GSA 405 and 'ies d 351 -4 33 th,ojgn s 43 require the plBcement of the words paid for by dnd tn, name of the committee on 31V p~ ;iii cal
ma!Briali ifor !hose items exempted by i1alute or rule A corlmlllf-e (hat wishes to reglsler a Comm .nee name for pure cses e' us,nu the shorter pa d for of f 3rG
Cot', not intend to cross the S7°c riling tnreshcld Shall file the Form DR-SFA form
a Th31 Iowa Code s"ection 68A 503 and ruies ?51-a 44 thirlugh a 52 proNellthe receipt of corporate ceninbunons by all icrimittess eti apt for statewide and Iccal b3l'e!
7sua PAC-

e and i ~:andidete "; committoo may only expend c*Ampalpn funds a; permitted by Iowa :oae sections 68A .301 Ii .rough 68A,303 and rule ?S1--a 2
nhnue to file 'liscic3ure reoen=_ until aq acajity has ceased Commihee hinds spent. dert3 resolve d, and a fin?il report and a Statement 01

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