10/27:2005 07 :13 NC .

107 D02

FOR INSTRUCTIONS, SEE BACK OF FORM"""' flt1:;~-

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CHECK ONE: FORM "STATEMENT

This is an Initial' Statement of Organization OCT 19 2005 OF
DR-1
LI This is an amended' Statement of Organization b
(REV, 0512005) ORGANIZATION
'An 114G51 Statement of Organlzadon mrlst bB h7ad within 70tt?aysfp416 committee"s accepting c tdbWons, For Office Viso Oaty
melting expenditures, or incunting indobtodness axceedlng . ,.Q,:fltt? aa BrA tltir3ia". n30 days of Comm .
a change . Pariallies mayhe Imposed for late-filed Sletemenfsrof'OYganrzation . A candidate wth an open Indexed
committee That exceeds 3750 rh octivr7y forenolltgr office shall Rte wifnin 10 days either e new or amended Audited
OR-1 disclosing Information concerning the campaign for the new once sought. Computer __

CO TTEE NAME 1 d

M1619?/rl e ~.- eZ- f , 'l1 4/l Ut. -7 2 % LUJJ

IMPORTANT: Indicate type of committee you are reporting for, b
(1 )StatowldolLoglslativelJudge Standing for Retention Candidate ( 2 )Statewide PAC (3 )State Party (4 )County Central Committee
( 6 )County Candidate (t? )City Candidate (7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC ( 9 )City PAC
(10 )School Board or Other Political Subdivision PAC (1" Local Ballot Issue _
COMMITTEE TREASURER mandate for all committees COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name 11/ ~yA . dQ Nam
Q. r4e f-
Malpng Address J.
tv- Mailing Address

city, tatey- -- .-r

e -
My, Stele L b - Zip Codc J-4
i
Phone Phone

e-mail e-mail
INDICATE PURPOSE OF COMMITTEE- Check One Box Advocate fortagalnst candldate(A) [] Advocate (oriagainst ballot issue(s)
Comment or description:
Sou vs Ente rer  . ,L. q
Candidates
Off
Office gh : JUGL~TD
District:

Political Party (It applicable) Year Standing for Election : Gl1

County/Local Candidates and Local BalloVPranchtae Committees Enter:
Date of Election : / i-e-65

3" AGcoUtlt Namo_ e or Parent EntityfPACS . If applicable).

J. Affiliate, or Sooneor

6)7)m i deer ~u C lee- f JrJ ~l &/~) Jan ~w/)-)

Name of Financial Insikulion/typ of Account y 1 Malllng Address J.

6 au-
J- S.14,1=h 4ve . 1~)
~1 ec.&
, rr n q
Mailing Address 1 City 1, stole J. .1 zip b S.

a1 ~ 4), o?A-4
City y 1 State J, S Zip L I
Phone ((d//)
1yeWfwr) .7a- jD.Z 6
I e-mail

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

t . The committee and all persons connected with the committee understand that they are su4ed to the laws In Iowa Code charners e8A and 68B and the adminisirallva
rules In Chapter 351 of the tows Admlnlstratlve Code_
2. That Iowa Code section 6a,4,402 end rule 351-4, 8 require the filing of disclosure reporls and that the failure to file these reports on or before the required due dates
sublacts the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
Imposition of othercriminal and civil senelione.
3, That Iowa Code section 68A.405 and rules 3S 1-1.38 through 4.43 require the placement of the words 'pall for by' And the name of the committee on all political
materials except forineae Items exempted by statute or rule. A committeefiling this statement for purposes of using the shorter - paid for by' and who have not crossed
the 9750 shall notify the Board that the 5750 threshold will not be crossed .
4. That Iowa Code section 68A.503 and rula6 951--444 through 4 92 prohibit the receipt of corporate contrtbutlons by all rammltees exceot for s(a1&wide and local ballot
issue PACs
6. A candidate bnd A candidate's committee may only expend campaign funds as permitted by Iowa code sections SeA.301 through 68A 303 and rule 351-4 .25.

e Tnat the g6/firniltee will continue tgflle discosure re-00A3 until all actfAly hoe ceased, Committee funds spent, debts resolved, and a final report and a statement M
dlssotuuorl" 3) has beelrtlled,

Onto Signod

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