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01,,25,,05 04 :43 FAX 563 933 6175 David E . Could

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FOR INSTRUCTIONS, SEE BACK Of
GHYE-CK ONE: FORM STATEMENT
[~'Th is is an initial
in Statertle t of Organization '. of
DR-1
0 This is an amended' Statement of Organizatio6, (REV . 071`2004) , ORGANIZATION
For office Use Only
'An initial Statement olOrganizatim must Do filed within f0.' Comm. s
malting expenoauraA or incurrfng indeArednss^, exaeedrng Indexed
a change. Penames may the imposed forwe-Red Staifemen Audited
Computer

COMMITTEE NAME 1 1

Citizens for a Fiscally Responsible Strawberry Point

IMPORTANT. Indicate type o1 commutes you are reporting for. I ' ' 1
(1 ).4tater.idotlogislatfvxlJudge Standing for Retention Candidate (2 )Statewide PAC ( 3 )State Patty ( " )County Central Commttewe
( 5 )County Candidate ( ti )CK7 Candidate (7 )School Board or Oftler Polldcal Subdivision Candidate ( 8 )Courrty PAC ( 9)Cky PAC
(10 ISchool Board or Outer Political Subdivision PAC (11 ) Local Ballot issue
COMMITTEE TREASURER (mandatory for all commiRees COYIMITTEE ChtAtR Imandatory except for a candidatrii'o committee]

Nl`~em k Could David E . Could

M~~IInn,~od ' d Mailing_Address 1 y
204'Elkar 204 Elkadei" S<
City, State l l zip code 1 1 City, Stale 1 1 2Jp Code ~. L
Strawberry Point, Iowa 52076 Strawberry Point Iowa 52076

Phone ( SW ) 9 33-617 5 Phone ( 593 ) 933-6 175

9-M31 dtgould@iowateleoom,rtet dtg°uld @ l°vratelecom .net

e-mail
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate forlagalnsl candidate(s) J] Advocate forlagairtd hello! issue(s)
Comment or dion..,i7ip(ion:
All Cand(datrs ErtMr.
Office Sought
District

Political Party (if applicable) Year Standing for Election

.
County/local Candidates and Local Ballot/Franchise Committees Enter.
Date of Election : February 1, 2005
County. Clayton County

Rortf-Account Name y 1 Candidate 4, Addrvax or Parent Erttity (PACs, if a Irrdt><e

Affilltde, orSporesur
WA

Name of Financial lngHutionltype of Account L y MallingAddre.c 1 1

Mailing Address ~ 1 City 1 1 State 1 1 Zip .i- 1

City . l Slate l l Zip 1 1

Phone ( )

Mail

STATEMENT OF AFFIRMATION: By IIBnp this document the eanmttow affirms the following:

all persons Connetied with the committee understand that they are sublect m the laws in Iowa Code chapters 60A and 6BB and Vie admini5U3tv6
t
The ormmitlm and
rules in Cnapmr 361 of Me 10-2 AdMiniStratwe Code .
2. That lows Code section 6BA.a02 and rule 355-4 9 require the filing of disclosure reports
.and that the Failureto file these report on or before the required aue dates
sul>le2s the mnAodate a ct+airperson (in the case of Committees Otfler than a candidate's mmmRNe) to the automatic assessment O< a evil penalty and the prxcibie
impw`ition dorx3 cnmtnal and avil sanWons.
3. That Iowa Code seaon 68A 405 and rules 351 30 through 4 .43 require the placement of me woNS'paid forby"and the name or l11d committee on all political
m©tenals except for those items exempted by statute or rule A oommirlee filing Inns Statement for purposes of using the snorter'paw for by and who have not Uoesed
that
the 8750 shall notify the Board the $750 tMCSho{d will not be crossed.
a Thai Iwa Code seniors 58A.503 and rules 351-a.aa ttsrpugh a 52 prohibit the receipt of corporale COntnbuuorLC by all committees excegt for stateMde and local ballot
issue PACs .

5 A candidate and a canOrdatB'S Committee may only expen0 campaign funds as permitted by lours Coda sections 68A.301 through 68A.303 and rue 351Jt 25 .
6. That the committee well contnue to Rte disclosure reports un01 all activity has waned, committee funds spent, debt- resolved, and a final report and a xlatemncl of
dissolution (OR-3) has been rated

Date Signed

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