FOR, INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM STATEMENT

is is an Initial* Statement of Organization DR4 OF
U This is an amended* Statement of Organization (REV.05/2005) ORGANIZATION
An initialStatementof Organization must be filed within 10 days of the committee's accepting contributions,
making expenditures, or incurring indebtedness exceeding $750. Amendments must be riled within 30 days of
a change_ Penalties may be imposed for late-rded Statements of Organization. A candidate with an ope
committee that exceeds 5750 in activity for anotheroffice shad file within 10 days either a new or am
DR-1 disclosing information concerning the campaign for the new office sought

COMMITTEE NAME 1 1

~i E~IOS OF ~2i r_`

IMPORTANT: Indicate type of committee you are reporting for. 1 r 8. 1
(1 )Statewide/Legislative/Judge Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )State
( 5 )CountyCandidate ( 6 )City Candidate ( 7 )School Board or Other Political Subdivision Candidate
(10 )School Board or Other Political Subdivision PAC (11 ) Local Ballot Issue
COMMITTEE TREASURER (mandatory forall committees) COMMITTEE CHAIR (mandato except for a candidate's committee)
Name 1 I ' ,~,/ Name 1 1
lie
I CN Ar~ l "I U,fC,~Jg
Maaing Address 1 1 Mailing Address 1 1
1 LO ~St0 5 7 I'll
ity, Stated 1 Zip Codp I 1 City, State 1 1 Zip Code 1 1
SA Szsc(-
--r aye~rlN-~-
Phone (,'`3 ) 3 ~s6 - 5 -i 6 3 Phone ( )

e-Mail I; e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate for/against candidate(s) Advocate for/against ballot issue(s)
Comment or description: C- .,, .&4 1 f,,_f-
All Candidates Enter:
Office Sought: C ll c rw%, a n
District : S }~ w, o_ r I
Political Party (f applicable) Year Standing for Election : C 6)
County/Local Candidates and Local Ballot/Franchise Committees Enter.
Date of Election : 6 y i= ,K & r ,z 2 ~
County : S C c-

Bank Account Na Candidate name &Address or Parent Entity (PACs, if applicable),

1 1 Affiliate, or Sponsor
-.
~9 1 1 L rt .~ c (i L n
Name of Financial Instihrtionfype of Account 1 Mailing Address T-1-1
C,`++
TR F NAt-r, (,tJ4 L- 13~,~K 113-5- V~a11-ti
Mailing Address 1 1 City 1 1 State 1 1 Zip 1 1

P 0, ,~ 1030
City 1 1 State 1 1 Zip 1 1
Phone (S&3)
z. A .- ate.- -~ -T\A S,z 7JL
e-Mail ~ :It( Co Fr3~LLLynn .LcM

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

1. The committee and all persons connectedwith the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68B and theadministrative
rules a Chapter 351 of the Iowa Administrative Code .

2. That Iowa Code section 68A.40i2 and rule 351-4.9 require the filing of disclosure reports and that thefailure to file these reports on or before the required dire dates
subjects the candidate or chairperson (n the case of committees otherthan a candidate's committee) to the automatic assessment of a civil penalty and the possible
imposition of othercriminal andcivil sanctions.
3. That Iowa (ode section 613A.405 and rules 351--4.38through 4.43 require the placement othe words "paid for by" and the name of thecommittee on all political
materials except forthose keens exempted by statute or rule . A committee filing this statement for purposes of using the shorter "paid forloll' and who have notcrossed
the $750 shall ratify the Board that the $750 threshold will not be crossed.

4. That Iowa Code sedan 68A.503 and rules 351-4.44through 4.52 prohibit the receo of corporate contributions by all committees except forstatewide and local ballot
issue PACs_

5. A candidate and a candidate's committee-may only expend campaign funds as permitted by Iowa code sections 68A .301 through 68A .303 and rule 351-x.25.