FOR INSTRUCTIONS, SEE BACK OF FORM

STAT Ivt ?J`f

CHECK Uhf : FORM
car
g This is on initial" Statement, of Organization DR-1
t¬i V . 07J'20 04j
[f. I his is anOR GANIZATION
atnemded' Statement of OrgartizaWn . k
~ For Officet usy Oafw
BAR ~~
/2 16
'An net ; al Sinfament of Prganiardian must bo Ned Mthirk ?0 ddyar' of the cominit.PWA arrtrpting orintribuflanS, Count . ...
rai;rki,"sy e,xFte±'~cd?ttrrea. or i?iorming rrdtrfaferJriess exceoding 3150. AfrAruimgnts mast he fried wfn 30 days of Ifidt xLd J

,:-j rh rrwk R?nrftie .s may the imposodfiler late-f&W &afementa of drvanizathxn, Aud^fed
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IMPORTANT, Indicate type of committee you are reporting For.... te( .... ..... ...
j I )Statewlde?LegnsIative/Jodge Standing for Retention Candidate ( 2 )statewide PAC (3 )State Party t 4 )County Central Committee
I S )Courtly Candidats ( 6 )City Candidate ( 7 ]Sr hoal ward or Other Pal itical Subdivit:Ion Candddats (& )County PAC (fi )City PAC
1U 5ehoof Board_ or Ctthet fofiflcaf Subdl>rision PAC (14 )Local 9aflot issue
COMMITTEE TREA9itJRf~R ('tnanr3;;tor r for aA avmrn t#etsJ..,._ .-~ ,._.... , COMMITTEE Cnd CHAIR m N atory except, tar a candidate's committee
N 1
Nierrl Johnson McConnell
t~.!~trlt tq i.r?rc ti, t+.L3~i, n Ad6resr, ! 4
3U,~ ~ end
1 L'ity ,,ate j
Zip.Crida . 1 C:rr state. . i a Zip Code 'w1
iinaton e,1A 52353 'W 101M 1 53
..

rr^~,e r, ~l'~ ) ~a53"53 Pte :.~e ( 31~ ; G.r,3-2058

r"-ra k t t#' ' }s4n fedr milonbank,,aom sr rNtc McP sh rlatldbut-sC9.net:

i ta, ` a:.risl carididata(s) fldanr te. lei?*4gti nSt hailot femur(~;)
r INI}iCAtT PURPOSE (3! CO i41MITf' E - Cttecat One fiche: Advocate
` " ~ advrkcslmg~chatty in sit t>rt s~f the local school
- V!Ic~. arr
Contmr:rsi or flr:Srriptfan. .. ,boarda there currenll
is ._._
__ .__._. ... ... . Ync)
. hat)ot issue,
All Candidates Enter.:
f:3rf ce 5augri' : Uitltrict,

PraitiCW party (if egfrifaNe; `rear Standing for C ection:

CounlyiLocal Candidates and Local Salfotlt=rinchise Committe Enter:

f i'.e)urity ; Washington

d . ._ . .e''&~Addr-ass or PIraftt ERity PAl I.il,tal, flit^tt ' i

f"`
1 Afti~c. ar Saonsar

Citizens for Quolity School s

'tu'tu FittarcW : tnafrtiKlan:Y~ entA"orrnt klla&eig Address

Federation Bank
ui aPea
^
A':a7 rg Addrfm
102 E : Main
stale 1 Xp 1 l
htiorte ( )
ilVcStlin:~ att (A 5235:
e- Ma;l

By filimi this document the ccmmiffe4 affirms the following,.

STATEMENT OF AFFIRMATION :
fkRk and fiwv}f and the attawersk°?ti~a¬+
1 . "he Mrttruttett and All Frfr"iOns cormex:twt vr tt,, the carrmih" undewntarid Ilnd ttmy are subject fa the 4n-s in lota,a Cafe ctapram
wrtis in 01wo4r 35i of the to+ova Administrative ode,

$ . That Iowa .rxia . cation 6ivA~ .407 and tWu 3551 ---4~t re-,pure then filing of dircief ie ro" ' - its and Ihat trie Witire to ir73 thMe (PM.rta Or. or Were ttw rex; uired titre dotes
the KASible
uL,, ::ds tire candidars or chairpemor. (in the ease of ct:rmtitlaes rAtw titan a %andrdauft mmr-Aitoe) tit tire uuloeruttlo a; r~snitu'i! of a civil penalty and
ivp.,i~iti?n ni oil= otiei»rlaf and eivii ears=tins+5,:
cr- all rntillca!,
,- That fuwa Code seutiors 33A.40 and nil es 151-1 .38 tlumo A A's iw,ar the fidx^psnent of itn wants 'patir lot tiy` and the name of the wmnittaa
rnaaYrinGn rlzo3p. fir ih7?... ,~.ert;l "axr rr"utc~,: 4y simtut!x cr ni,e. A wmm"tee Tianr, ttus -YVemrtnt
a for fto+-rrsur
u of using the shorc r "paid fix W acid whu naves riot t re3sed
the 575{0 afsail ralify tfte riaaW deaf V-u S7all throohnd odd nr: br rse=vd:
: excapt far statewide and IO;ai tasltrr
4 . TI tat laew (.c>::c ~;'t i:m 58k 50 and r,lee 351-4 :4d firr ah r . 52 prchlbil y:e %ocefpt of cerpornte rm!rib Roes by :elf cwtntrllv"
,>s-,u PAC's,
.-.r .25,
5, A eandida:e and a cardMaWr rzin,mince may nisty ()Xfr*Ntd camp ign f,~n(ts %,a PrWrrfttiai tri kit+oa mode seclons. F&A307 `,Frotigh FAA ;43 rend rata 3161-

B. Tkin. the rxtrur'ei: dis'fosure report; until all aetieaty haw rslserri, ocrnrtilthe !sods spent, calf rer +er and a finaai moot and a s aterne^t of
~fis~~it,Afnr (C7f~;~h

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