@

[ ,,

i8l0JUf,l-lAl.l
FOR INSTRUCTIONS
SEE BACK OF FORIYI
Thls Formto be ffledfur eadr:

,{f filing this form to use the shorter"paidfor bf attibuton. The committeewill not be cresing the $750threshold,' This form must be
filed"r
priorto the distibution or postng of the politicalmaterial.

E RmenOeO form updatirg any previously fited inbrmation induding Dateof Eledion and Yer Standirg for Eldion.
'lf theoimmitfoesossesfis thrc$old,a DR-lS:tatemerrtof OrganEatonmu$be frledwtttin10 daysof tlremmmtt|pie's
a@pting@ntibntions,
makirg
expnditures,orlncuningildebtedness exc€€dlng $78):ln ddi6on, the@mmltteewill@ rqui@dto fileanpalgn disr,06,ure
relp/b

J J (A candidab'scommitb mu$ lnctudethe candldate'sId n€rlE In the namEof the commib).

4fj 6r €ulerW,sar
Indl@ type of conmlGeyou are teglsbdrqg fon
(f lstaterulddloglslatvefJudgeStandlngforRetenfionGandldfr (2|StabrldePAC(3lS@Pafty (4fGomtyGentalGommttb
(5)GountyGsndld# {8}CltyCandldato (TlschoolBoardorOthrPotl0calSubdhdslon@ndl@ (ElCormtyPAC (S}CltyPAC
Bord or CltherPolldcal SubdMelon PAG { ll I Local Bdlot

COMIf,ITIEECHAIR (mandatoty forall commlttoe excepta CANDIDATE(manddory ercept frora non.candldate commltbe)

Pnone
tJ?

- CheckOneBox
INDICATEPURPOSEOF COMMITTEE Advde for/againstcandid@s) E Advocab tur ballotbsue(e)
Gommenlor description: B AdvMe agaln$ ballot'rssue{s)

All GandirtaF Enbn .a -. - CountyrLocalGandldat6 and All Othercommltbss EntEn

offcesousht >Ubef Visof
ebtfions, attacfi lFilof courds or

2^J torc

STATEMENTOF AFFIRilAflON: Ey f,llng thls documentthe connnlfieo aflnns ttre follorlng:

1.- The commitbe and all personsconneded wlth the cotnmltb urderstand thet they are subjecl to O|elatE ln loyracode chapter€68A and @B and Oroadmlntstatr€
ru1€6h Chapbr 361 of the lorE AdmlnFfathre Code.
2. Thd louraCode secdon@A405 and rules 351--4.38 through 4.43 rqulre the placsment qf the rrords Taid fur bf and the name of the commlttEoon alt politcal
matedalsexcept br thoee fiems exemptd by stafute or rule.
rj 1
3. That lorra Coda secffonSA"503 and ruls 351-4.44 through 4.52 prohhlt the reaaht of corporareconblbutons by a[ commltbec except for Etahrrtda and local hlld
lssue PACS.
4. That if the committeeerce€ds $750 In campalgnacfiW, a DR-1 Stabment of Organlzaton must b fi]ed withln 10 dsF and the commltee l8 rqulred to frle campslgn
dlscl@ulo reporb.
5. Thd this turm b filed pdor to the dlsfflbuton or p6thg of potldcalmabrlal reql.lfi'|g the ?aE fur byr affbution
6. A new fotm or amendd brm b rqulred to bo ffed hr esdr Eu@uent elecfronthal I am bnrohd.

/)

e2 -ea/r/ sltzln