Please Complete ALL Blanks

FORM I
STATE"
Check One : ORGANIZATION
O
CANDIDATE
o This is an Initial' Statement of Organization
For office use gall
This is an Amended' Statement of Organization
'A new Statement of Organization should be filed within 10 days of l c rp i s tributions, Comm. # 17304
making expenditures or incurring indebtedness exceeding $500 i a calendar year. Amendments should Indexed

be filed within 30 days of a change . Audited

Checked
STORY COU - I - AUDITOR
Computer

CANDIDATE COMMITTEE NAME

Official Name of Candidate Comrgitt-e (Identify acronyms. Last name of candidate shoWd be part of official name.)

T-F-tit-gcT HALL16UtToN CGMM1'TT6E

Mailing Address of committee if a separate headquarters is established.

II& P-665EYecr
City State Zip Code Area Code Telephone

A+M E 5 ~4 .54010 -5"97 4 515- -

COMMITTEE TREASURER (Must bean Iowa resident of ma)odly age.) COMMITTEE CHAIR (Ustotherofficers asnquired bylaw ff-)
Name
NFk'ANKL11V J . FEII MEYEk,
Maili Address (T^
his address used for all reminders and correspondence) Mailing Address
1 t 9 Gie-Aryb AvE-
p Code Area
Telephone City . State- Zip Code Area Telephone
AMES 50010 Code
t
FINANCIAL INSTITUTION IN WHICH FUNDS ARE DEPOSITED (MUST BE LOCATED IN IOWA)

Candidate Committees are required by law to deposit all funds and pay all bills from a separate account, and to disclose the name of the financial Institution
where funds are deposited. Use back of form if more than one. Exception: If all campaign expenses will be paid from personal funds and no donations
will be accepted, separate account not required.
Name of Financial Institution (Bank, Savings & Loan. Credit Union, etc)

FIRST ///47-/OA//9,4- q-K4

Mailing Address Name of account as shown on checks and bank statement
I ;~
y FF
lJ2 ~clETT T F'' EC . EcT ~f}LL r~U,eT6K ~G/~fM! TTEF
City Zip Code Type of Account (checking, swings, certificate of deposit, etc.)

AME5 .J'Q-
-J-'Q ~QO/0 CNECK11 l
CANDIDATE SUPPORTED
Name of Candidate ~~ /~
5
Office Sought county

JA N F. E. t1 ALL 1,6 01.To lJ t- 0unl-T Y U GE4 V 1501Z , 5TO/

Address (Home)~ Political Party (Democrat Republican, Independent, etc. Year Standing for Election

X. 00 5 ~--= VEL7- --J)EAJ 0 C C R7 - l 9 9~

City State Zip Code Arm Code Telephone

At~s --rn . 5o6l0 515 - l

DISPOSITION OF BALANCE OF FUNDS UPON DISSOLUTION

All candidates are required to make a statement of intent of how leftover funds would be expended at the close of the campaign when
the committee is dissolved. This statement may be amended at a later date if the candidate chooses. The statement must be made,
even if the candidate anticipates there will be no leftover funds . The choices listed below are the ONLY legal options in accordance
with Iowa Code 56 .42 .

CHECK ONE AND ENTER SPECIFIC NAME :

13 Return Prorata to Contributors
0 Donate to Local Political Party
13 Transfer to State of Iowa General Fund
V Donate to 57'OO2 i County Central Committee
E3 Transfer to Charitable Organization -
13 Donate to State Political Party
0 Donate to National Political Party (Specify Charitable Organization)
0 Transfer to another committe of this same candidate

STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE

I am aware that disclosure reports are required if the committee and/or candidate 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.
1 am also aware that late filed reports are subject to civil penalties (fines) under the disclosure law. I also understand that although the
res and files reports, the candidate is responsible under the law for accurate and timely disclosure reports.

nature of Treasurer Date Signed

I

/99
Signature
of Candidate Date Signed
ttPK-02051140-0063(N)/(Rev . 199C;)