FORM DR-1: Statement of Organization [Form Statement of ID 13744 DR-1 Organization] ‘Type Municipal Candidate lWeb Reporting System Rev. 09/2003 Status Amended |For Office Use Only Name Sires for City Council IComm. # 13744 Indexed bdiAmended Date 10/1/2007 JAudited [Computer ‘Committee Treasurer Committee Chair Name Terri J. Sullivan Name Dennis Mills ‘Address 1222 Franklin St Address 3515 Union Road Cedar Falls, 1A 50613 Cedar Falls, 1A 50613 Primary Ph. (319) 266-0908 Primary Ph. (819) 266-8964 Secondary Ph. (nul) Inu-nutl Secondary Ph. (nul) Inu-null e-Mail tisully@cfu.net e-Mail generalmills@intergate.com Purpose To fill vacancy in Ward Four-Cedar Falls 1A Office Sought: Ward Four Gity Council Representative District: 0 Party: Not Available ‘Year Standing for Election: 2007 County: Black Hawk. Date of Election: 11/6/2007 Primary Bank Account Candidate name & address Name US BANK Name David L. Sires. ‘Address 3228 CEDAR HEIGHTS DR Address 4107 Horseshoe Drive Cedar Falls, 1A 50613 ‘Account Type Checking Primary Ph. (319) 404-8255 Account Name SIRES FOR CITY COUNCIL e-Mail dave@siresforcouncil.com Statement of Affirmation By Treasurer and Candidate; or Political Committees, By Chairperson “STATEMENT OF AFFIRMATION: By ling this document the commits aims the flowing 4. The commitee and al persons connected wth the commits understand that they are subjact tothe laws in lowa Code chaptorsG2A and 688 ‘nd the administrative rules in Chapter 351 ofthe Jowa Administrative Coco. 2° Thattowa Code section GBA and rule 357-8 9 requ the ling of dscosurerepets and that he flue to fe thse rapt on or bore tho Fequted ue dates subjects the candle or chapareon (es tho cave of comitioosothor than a candidate's commitlee) othe automatic ‘assessment of ac penalty and the possible mpostion of other ciminal and cil sanctions 3 Ynat iowa Code eocton O84 14 and rules 351-8 38 hvough 443 roque the placement ofthe words paid or by" an the name ofthe committee ‘on all poliial mateias except fr those tams exempted by statute or ule 11" Tat lowa Code section 68A.19 ane los 351-468 rough 4.52 prot the receipt of corporate contibutons by al commits ‘atowide and loal ballot sue PACS SrAccanddate and candidate's comilloe may only expend campaign funds as permite’ by lowa code Sections GBA 40 through 68A.42 and rule Soias 6 That the committe will continue o fe disclosure reports una activity has ceased, commie funds spent, debts resolved, and ara epor ‘and slalement of cisschuton(DF3) has boon lod excopt for Candidate: Treasurer: {signature and date) (signature and date) IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12h, SUITE 14 |DES MOINES, 1A 50319 | (515) 281-4028