LATTA HARRIS PAGE 02/02

°x/09/2005 14 :04 3196536801

FOR INSTRUCTIONS SEE BACK OF FORM

FORM STATEMENT
CHECK ONE :
[~] This is an Initial' Statement of Organization DR-1 OF
U This is an amended' Statement of Organization (REV . 0512005) ORGANIZATION
An initial Statement of Orgenitolion must be filed v*hln 10 days of the committee's accepting contributions, For Office Use OhlX (~
making expenditures, or incurring indebtedness exceeding $750 Amendments must be filed within 30 days of Comm, #
a change. Penalties may be imposed for t 61 .1 tpffle&j of Ofman)2adon. A candidate with an open Indexed
Committee that exceeds $7501n activity fo ~t._T I t~1tMt7 1'0 r new or amended Audited
OR-1 dJsGoslng TnformatiOn concerning th r r~ipex ,ot~4ce~ttCu Com uler _ iii
' NO r N ?7-0 -L/V i

COMMITTEE NAME 1 L

SEP ' 9 M ,
Vision 52353
IMPORTANT: Indicate type of commltt `yoii
(1 )StatewidelLeglslatlveiJudge Standl g for Retention Candidate (2 )Statew(de RAC ( 3 )State Party (o )County Contral Committee
(6 )County Candidate (6 )City Candlds (7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC (9 )City PAC
(10 )School Board or Other Political Su )division coca M5110!
COMMITTEE TREASURER (mandatory for all committees COMMITTEE CHAIR (mandatory except for a candidate's committee
Name Name 11
Mike Van Osdol Eric Turner
nq 0$d s J. 1
114 dodI alrlQ Ct "'91~t1Oth
C~l~ty,State 1 1 2i Code 1 1 City, State y 1 Zip Code 1 1
Washington, IA 5353 Washin ton IA 52353

Phone ( 31g ) 653-9117 Phone ( 319 ) 653-1051

e-mail
mvenosdol(gyahoo.com e-Mall e ' turner mchs i . com
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate forlagalnst candidate(s) U Advocate forlagalnst ballot issue(s)
Comment or cescri tion :
All Candidates Enter,
Office Sought: District:

Political Party (if applicable) Year Standing for Election :

County/Local Candidates and Local BellotfFrenchise Committees Enter:
Date of Election :
County : Washington

Bank Account Name 1 Candidate name It Addmss or Parent Entity IPACs. If aoDIU,ablel.
1 y Affiliate, or Soonaor
Vision 52353 Vision 52353
Name of Financial Institution/type of Account L 1 Mailing Address 1 1
West Cheste r Saving s Bank 906 S. 10th
Mailing Address 1 1 City 1 1 State y Zip 1 1
10130 W. Monroe Washington, IA 52'53
City 1 1 State 1 1 zip 1 1
Phone (319 )
6ss-1051

Washington, IA 52353
e-Mall

STATEMENT OF AFFIRMATION : By filling this document the committee affirms the following:
1. The committee and all pensons connected with the committee understand that they are subject to the laws In Iowa Code chapters 6aA and 68B and the admlnisirallve
rules In Chapter 351 of the love Administrative Code .
2 . That Iowa Code Section SaA,ao2 and rule 351-4, 8 require the filing of disclosure reports and that the failure to file these reports on or before the required due dates
subjects the candidate or chairperson (In the ease of committees other then a candidate's committee) to the automatic easesement of a civil penalty and the possible
Imposition of other criminal and dull senctloru.
3 That Iowa Code section 68A,405 and rules 351--4 .38 through e,A3 require the plocemert of the words 'paid for by' and the name of the committee on all political
materials excepi farthose Items exempted by statute or rule . A committee tlllng this statement for purposes of using the shorter "paid for by' and who have not crossed
the $750 shall notify the Board that the 5750 threshold will not be crossed.
4, That Iowa Code section 68A,Sa3 and rules 351-4 .44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statewideand local ballot
Issue PACs.
5. A Candidate and a candidate's commhtee may only expend campaign funds as permitted by Iowa code sections 68A.301 through 80A,303 and rule 351-6.25.
6. That the commttlea will continue to file disclosure reports until all acthAty has ceased, committee funds spent, debts resolved, and a anal report and a statement of
dissolution QR-3) has been fi
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9 2_~5
Signature 01 TraSsuref Dale 910nea
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(-C~ -0~
Signature of Conciliate, OR, forall outer oomhttees, Cholrparmn Date signed