ENTERPRISE P .

02
h1AR-30-2005 08 - 07 AM B .B . 712 262 1577

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE :
0 This is an initial' Statement of Organization i4/VU
r7,7347
' FORM
DR-1
TATEMENT
OF
t~This is an amended' Statement of Organization 92005 (REV . 07/2004) ORGANIZATION
For Office Use Qnly
"Ar Initial Statement of Organization must be filed within 10 days of the committee's accepting contriuflons, Comm ~!
malting expendllures, or incurring indebtedness exceeding 5750. Amendments must be filed within 30 days of Indexed
a change Per) aiGes maybe imposed for late-filed Statements of Orgenlzatlon Audited
Computer Y~

I COMMITTEE NAME 1 1

CC
IMPORTANT: Indicate typo of committee you are reporting for: I,
( 1 )StatawldelLeglelalive/Judge Standing for Retention Candidate ( 2 )Slatewldv PAC ( 3 )Slate Party (4 )County Central Committee
( S )County Candidate ( 6 )City Candidate ( 7 )School Board or Other Political Subdivision Candidate ( e )County PAC ( 8 )City PAC
L1 0 )Sch o ol Board or Other Political Subdivision PAC ( ii ) Local Ballot Is sue
COMMITTEE TREASUREAmandato ry fo r all commltte es]i COMMITTEE CHAIR (mandatory except for a candidate's _committee)
Name d ./ -- e I I
Nam -
L- M cc.::~g /9
0 w
I

Mailing Address Moiling Address I 1

C-0 AU lz- _

City, state 1 .'. City, state 4 ~ Zip Code I b

Phone (71 ~lrl1 o` " 4e: , 3 S-~ Phone ( )

e-Mall e-Mall _
INDICATE PURPOSE OF COMMITTEE -Check One Box Advocate for/egalnat carsdldote(a) TAdvocate for/against ballot issue(s)
Comment or description'
rAll Candidates Enter:
i Office Sought
District :

Political Party (if applicable) Year Standing for Election :

County/Local Candidates and Local Ballot/Fronchlss Committees Enter:
Date of Election :
County

Bank Account ama L ~,andldel117^name 9. Addraea or Parent Cntlly fPACx. if applicttblaL

AffIllatt, or Sponsor

Name of Financial Inatltution/type of Account d 1 Melllng Address 1

Melling Address 1 1 City --y .1 state l y zip y 1

City ~ state .. 1 zip y Z

Phone ( )

e-mail

STATEMENT OF AFFIRMATION: By riling this document the committee affirms the following :

1 The committee end all persons connected with the committee understand that they ere subject to the laws In Iowa Code chapters 68A end 688 end the admlnlmrstive
rules n Chapter 351 of the Iowa Admlnislretlve Cods
2. That Iowa Code section 66A,402 and rule 351-4,8 require the filing of disclosure reports and that the failure to Ale these reports on or before the required due dates
ii the candidate or chairperson (In the case of committees other than e cand)dsts'e committee) to the automatic assessment of a civil penalty end the possible
imposlllon of other criminal and chill sanctions.
3 That Iowa Code section 68A .405 and rules 351-4.3a through 4.43 require the placement of the words 'paid for by' end trio name of the commltloa on all political
materials sxcepf for those Items exempted by statute or rule . A COmml009 1111110 11118 statement for purposes of using She ehoder'pald for by and who have not crossed
the 8750 anell notify the Board that the $750 threshold will not be crossed,
4 Thal Iowa Code section 68A.503 and rules 351-4 44 through 4 .52 prohibit the receipt of corporate contributions by all committees except for olotewldo and local ballot
issue PACs,
5 A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A,301 through 66A,303 end rule 351-x.25
6 That tire commillee w 11 contlnus to file disclosure reports until sit activity has caused . committee funds spent, debts resolved, and a Anal roporl and a statement of
diosolulion (DR-3) has been riled,

Signolure reasurer Date Sign*;

grawre of Candidate . OR . for all other comm flees Chnlrparoon ate 11-9-4