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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD Form

510 EAST 12th, SUITE 1A VERIFIED STATEMENT
REGISTRATION
DES MOINES , IA 50319 (Out-of-State Committees)
www .iowa.gov/ethics (Rev . 07/03)
- EIIIE® STATEMENT REGISTRATION For office use only
(Out-of-State Committee) Comm, #
Indexed
COMMITTEES NOT ORGANIZED IN IOWA TO COMPLETE IN DUPLICATE .
SEND A COPY TO THE BOARD WITHIN 15 DAYS OF THE CONTRIBUTION DATE AND Audited
ONE COPY WITH EACH CONTRIBUTION TO THE IOWA COMMITTEE WITH THE CONTRIBUTION . Checked
PLEASE REFER TO DETAILED INSTRUCTIONS ON BACK OF FORM .
THIS F ORM MUST BE FILED FOR EA CH CONTRIBUTION IN EXCESS OF $50 Computer

COMMITTEE NAME #8137

Official N ame of Out-o f-State Committee (Do not abbreviate committee name. Written explanation must be provided for Acronym) .
IRONWORKERS LOCAL #21 LEGISLATIVE FUND
Mailing Address
1451 5 Industrial Rd
StateW4ode Area Code Te ephone No .
Omaha, CN ( 402 )333-027e

STATE OR FEDERAL JURISDICTION WHERE COMMITTEE PARENT ENTITY, AFFILIATE, SPONSOR OF COMMITTEE
IS REGISTERED OR OPERATES (Use separate page if needed to list more than one entity)

Name of Jurisdiction International Association of Bridge, Structural

Ne bI^ Si
Ornamental and Reinforcing Iron Workers
M rd res
C/17n F~ t-~t e C ~a L Local Union #21
C" y, Stat , Zi Teleph e 14515 Industrial Road
111C6 ki lo$SOf b2 4*71-2522 Otnaha, NE 68144

PURPOSE OF COMMITTEE

To assist with the election of suitable candidates for office

and attem?tq~vr*mW%-&-nwy;=Vjassage of fair and reasonable legislation

IOWA RESIDENT AGENT IOWA COMMITTEE RECEIVING CONTRIBUTION

Typed Name of Iowa Resident Name of Committee

William L . Biede tli Zu~S 40 e l-e-4 J1yYZri 11~~'eJ

Mailing Address Mailing Address
2109 Avenue A D. - ~o/ a~,,L 2~'AA 61
City, State, Zip Code Telephone Da e Contribution . Describ
Council Bluffs, IA 51501 ( 712 ) 322-0156 gJiq124,0-
Check # ,r Committee . ID #
13 `5

VERIFIED STATEMENT OF COMMITTEE :

I W + LL I A M r.7" I P- , attest that the contribution reported above is accurate and that the information about this out-of-state
committee is correct an ccurate to the best of my knowledge. I also attest that the reports filed in the named jurisdiction comply with requirements that are
substantially similar to Iowa Code section 58A .6, including the disclosure of all contributions received and all expenditures made. I further attest that the
contribution reported above was made from an account that does not accept contributions from corporations or other prohibited contributors under Iowa Code
section 68A .15, unless the Iowa recipient committee is a ballot issue committee . I understand that potential civil and criminal penalties may apply unless a copy of
this form has been filed with the lowa .Ethics and Campaign Disclosure Board within 15 days of the date of the contribution .

(0lj~-R M I r=te -T C~ -i9 -o-->r,-

(Person submit ing form) (Title) (Date)