FOR INSTRUCTIONS, SEE BACK OF FORM Z'6- '-~

CHECK ONE: FORM STATEMENT

0 This is an initial* Statement of Organization DR-1 OF
0 This is an amended* Statement of Organization (REV. D7rz004) ORGANIZATION
For Office Use Only
*An initial Statement of Organization must be lied wfin 10 days of (Ire committee's accepting conbibufons, Comm. s % 9
malting expenditures, or intoning indebtedness exceedng $750. Amendments mist be tied wi(tan 30 days of Indexed
a change. Penalties may be imposed fortate4ied Statements of Organization . Audited
Computer

COMMITTEE NAME 1 1

Crab hr she.6a
:
IMPORTANT Ih care type of committee y you are reporting for
(1 Statewide/Legislativdjudge Standing for Retention Candidate T
Atatcwide PAC (S)State Party (4)County Central Committee
(5 )County Candidate (8 )City Candidate (7 )School Board or Other political Subdivision Candidate (9 )County PAC (9)City PAC
(10 LSchool Board or Other political Subdivision PAC (11)_Local Ballot Issue
all

Pa4twi op,
COMMITTEE TREASURER (mandatory for corrrniltees) COMMITTEE CHAIR (mandatory exert for a candidate's connn itee)
Name 1 Name 1 1

Mailing Address1 1
. Mailing Address 1 1
0CI1.1In Cud ,°
State 1 1 zip Code 1` -1i, City, State 1 1 Zip Code 1 1

Phone ( 0 1)QCL 35~. Phone (

e-Mail e-Mail
INDICATE PU OSE OF OMMITTEE - Check One Box Advocate forlagainst candidate(s) [] Advocate forMgainst ballot issue(s)
Comment or description :
All Candidates E~ ° c i ~
Office Sough : N(`~ ~ .(1,~~,_1,~ C
W (~
District : fl,Ila
e-
11 \11
Political Party (if applicable) Year Standing for Election :
CountyALocal Candidates and Local BalloWranchise Committees Enter :
County: Nag -h)(- e-n Date of Election : UN)2 m r7e (' aatOA

BankAccount_Name 1 1 Candidate name & Address or Pent EntRv (PACs . if WpIceble) .

1 1 AfMilat-orloonsor

fWa 61~ :`W.n ~-~

Name of ' ncial Institutionltype of Account 1 1 Mailing Address

,1the IS-{6
Lommun6A r~- 1y0zb "?A
Mailing Address 1 city 1 1 state 1 1 zip 1 1

:11(-1 1YT are-e-111- I fl~ ~~l ~'~L11

city 1 1 State 1 1 zip 1 1
Phone (n , ) 'f' 1r - ~- I o11f3 P`~

@J e-MM i0,4e d i ou~ e iQ t~ , ale -

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

1 . The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 688 and the administrative
rules in Chapter 351 of the Iowa Administrative Code .
2 . That Iowa Code section 68A .402 and rule 351-4.9 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 case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
imposition of other criminal and civil sanctions .
3. That Iowa Code section 68A .405 and rules 351--4.38 through 4 .43 require the placement of the words 'paid for by" and the name of the committee on all political
materials except for those items exempted by statute or rule. A committee filing this statement for purposes of using the shorter 'paid for W and who have not crossed
the $750 shall notify the Board that the $750 threshold will not be crossed .
4 . That Iowa Code section 68A.503 and rules 351--4.44 throw 4 .52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
issue PACs.
5. A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections SBA-301 through 68A.303 and rule 361-d.26 .
6. That the committee will continue to filer disclosure reports until all activity has ceased. committee funds spent . debts resolved, and a final report and a statement of
dissolution (DR-3) has been filed .

Signature of Oat Signed