FOR INSTRUCTIONS,

SEE BACK OF FORM

CHECKONE:
E fnis is an initiat*Statement
of Organization
^ E rnis is anamended*Stratement
-'sfaternenf oi6rs;iza&n
musfbfrrdwit in fiaaysof aniffia@pring@ntibutiong m*ingexpndihneg
incuninsdebsexeedinq$79). An;ndn',nlo-;rd or Comm.#
Eftaive January1, 2016,attsatemJnranJili"G ry. ryofnti {d r;;; ; ; A",ry,r. Indexed
nro by newommiitee tursrareoffce
andeftciive January1,2012,iiiiaie-em 6nalep"rtsfil"d by -.rin"o must
electronig?lfy befired
tur stateoffiae
Audited
mustbefiledelecfronically. "il
PAG,sand
I $ (A canOiOate's
committeemusilincludEthe candidate,sf""t
put old namein ( ),

Co,tP.r. Fot,a-$re"*.rrso.{
IMPORTANT:Indlc# type of commltbe you are reportngLlor:
( { lstuflidcrtqlsldvefJudge f
Standtng fbr Rebnflon GanOlda6 ,!e PAG( 3 )Sh Party ( 4lGounty Cent|at Comr
( 5 fGounty Candklab ( 6lGtty Candtdab ( Z lschoot Bqrd or(lthir S-ubdivislon_-Ga4id+ t e lCormty pAC ( 9 lGiry

TREASURER(randatory tur alf COIttrlTIEE CHAIR (mandaforv ercant far a .orrnE o ,5

Name {
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Phoneff Phone (
e-ruair
IusAtfHT@ !Atl.r- . Co!^^\ a-.ilall
INDICATE PURPOSE OF COMM|TTEE - Chd( One Box
,Comment or descriotion: zu@
\
tr Advocatefor ballotissue(s)
tr Advoc& aoalrct ballotbsue(s)
sounlyrLrocatcandtdab and Ballot lsUa Gommitk Enter:
Oftce Sought
Count!,:
PoliticalPady (if applicable) (lf aciivein eleciions, counlies
Distuict
tlateofEteciion:
^ b-%' lt)
YearStandins
forEledion: AOr O

AUL{ bhnnCrp't 6't-LVYCrEurE5 FA tr:

Nameof FinancialInstitutonftypeof A@um

MailingAddr€ss J J City + + SbteJ L ap J J

city t J sldel { ry + J
Phone ( )
e{rlail

STATEIIENT OF AFFIRIAT|OI{: By finng $ls docutrrent tto commlleo affrms the ltollorlng:

1.. The commitbe and a[ peraons@nneded with the comnritbo mrtersbnd thd t|ey arc subject !o the law8 tr| loTraCode chapbr8 6EA ald 6g8 ard O|eadmfrist.alive
ruls h ChapGr 351 of the lof,a Admlnbfraliw Code.
2. That lowa Gode sedon 60A402 and rule 351.-1-S require the ftlhg of dlsdclnre reporb ard that the failure to file ttrese reports on or bebre the requireddue dates
:ubJecb tf€-cadldate or dlaltperson Gnthe case of commitles other than a candiddd's commlt@) to the automaic assesinfieniof a aytf-periaftyano the pcsible
imposlton of other crirninaland civil samffons.
3. Thd lormCodesecdon8ArO5 andru163514.38 tuough4.r[3requhetheplaoerneril of thewords'paidfur bfr anOthenameof the@mmn1ge
on a[ polldcal
materblsercpl for thce iterns_
exemptedby statrileor rule. A commreeUrawistm to regLsmr a commiieename-Orpunnseqof qsingO1gBhorbrbaE dr bf antl
doesnothtetd to crws the$750nbtgfresftolrl shal fle the FormDR-SFAfrrm h fieuof ffitg Udsfum.
4. Thd lolm Code setdon 084503 and rul€s 351-f..[4 ftrough 4.52 prohibntlrc recetptof corporateconfihfiong by all comnb €N6pt br balot bsue pACs.
5- A candidateand a candllaie's commltiee may only €Dpsndcampalgnfirntts as permittertby lea codo €€dior|s @A"301 through 6ga303 and rule 3Ii1-..425.

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