P_ 13

JAN-07-05 09 :37 AM QUALITY ACCT AND TA?: SER 5639336416

FOR INSTRUCTIONS, SEE BACK OF FORM FORM ATATEMENT

CHECK ONE : D R-1 OF
/'his is an Initial' Statement of Organization (Rev, ORGANIZATION
V l his is an amended` Statement of Organization
000031
For Q(11;e Uip4_IIlY
'Ar rrdiel Statamonr of Orpsnizatlon must be R1ed wlthln 10 days of the committee's accsptlng contr/buttons, making
Com(ri .0 X02
expenditures, or rhcurrfng indebtedness sxeoadlng $730. Amendments must be 171sC within 30 days of a change . Indexed
Penalties may be imposed for lato-filed Statements of Organization . Audited -
Computer ~-~- I

' COMMITTEE NAME 1 1

I
Ct +t Zer15 -~or E n h an C .P m t° r OF ~Arawkerr4 Po i nt

IMPORTANT ; Indicate type of committee you are reporting for :

( 1 )Slatewldefl aglcletiva Candidate (7 )Stalewlde PAC ( 3 )State Party ( 4 )County/Local Candidate (S )County PAC ( 8 )Ballot Issue/Franchlso
Committee (7)County/City Central Committee
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name 1 1 Name b 1

_ lrt,~ Yric4J1___________
M3111np Add( ss 1 Mailing Aclros

4_ -1..2_ PS 1r1-ai_Aye--__________________-
Clry_ State 1 b Zip Code 1 1 cry, Stele Zip code l 1
r

Phone (,5(t 3)___1-3-3 ___'___- ____...___r.__________ Phone ------- ,

e-l"1011
t- afs i
o«te icfevm . rte e-Mail f---------
ININDICATE PURPOSE OF COMMITTEE - Checks Advocate for/8901n t Candidates) Advoc to forlagalnat ballot issue(s)
Commen t or descrl ttion : L t~'t Z e r1 i ' V 4°C C ; C. ve C
n
.i aeitil~T
All Candidates Enter : ' t e re
v t.'LLL)war v o t`'V 4.) + .
Office Sought : --------------------------- _----_----------- ------- DlBtriC ;

Political early (if applicable) _ ------------------------ Year Standing for Election : ______________
CountylL7 I Candf atos and Local Ballot/Fronchiso Committees Enter ;
County : Oats of Election : _

1 i or parent rnllly IPACa- If appllCdb I et .

Bank A=1111 Name
Affiliate . or Sponsor
f
-'lLti 1'>`i C ~L ~~r c' S ~JLl/1 k _~ 1 r e
Na f Flnanc!sl Ins111ulIOn/t pe of ccount 11 Mailing Address
I
_PC 80 __I3_ o - _____zip_ .._-___ __ __
cityw 1 1 ---___ slue
Mailing Addreee 1 1

1 1. State '1. 4. - Zip 1 l~ Phone ( )_ _--

Clty
*-Moll-____

STATEMENT OF AFFIRMATION : By tiling this document the committee afflfme the following :

the laws In Iowa Code chapters GSA and 8813 and the
i Tne committee and all persons connected with the Committee understand in al they are sub)ect to
admirisi rules In Chapter 351 of ttte Iowa Admlnistrative Cede .
on or before trio required due
2, That lows Coda saehon 88A .402 and rule 351-4 9 require the filing of disclosure reports and that the failure to file these reports
the case of committees other than a candidate's committee) to the automatic assessment of a civil pen611y and the
dates suelecis line candidate or chairperson (In
Doss b.e Imposilor, of other criminal end civil sanctions .
for by' and the name of the committee on all 00111)cal
3 That lows Code section 88A.405 and rules 351-4 .38 Through 4 .43 require the placement of the words 'paid
mater'ols except !or hose Items exempted by statute or rule
by all commilteee except for slalew+de and local
4 Tnat lows Code section 88A,503 and ruse 351-1 44 Through 4 52 prohibit the receipt of corporate eontrlb0lons
Cal ot ,txl.a PACA
.301 through 88A,303 and rule 351-4 25
5 A candidate and A Candidate's committee may only expend campaign funds as permitted by Iowa code sections 88A
a final report find A statement of
8 Ins committee will continue to Ole disclosure reports until all activity has ceased, committee funds spent, debts resolved, and _Trial
d,saotu g(+ (OR-3) Mom been gled . ~ y
-- , (,.j. l ug ~~ t-Lj-- 4-, aCL(2
Signed
v/ b.
Slgnsl(A of Tre

Sle u . of Cendtd.U, OR, !w eX oth milieu, Chelrpeno^