ETHICS AnD, TATEMENT oF ORGANIZATION FOR INSTRUCTIONS, SEE BACK OF FO! CHECK ONE: ‘This isan intial” Statement of Organization OO this is anamended" Statement of Organization 0°70i° -2 fit) “Anita! StatomontefOpanizaon muatbo fd win 10 ab tb caifeo acs Ponrnatore. _making expenditures, orincurng indebtedness exceeding $720. Amendments must be fled win SO days of ‘ change. Penalties may bo imposed er ltetled Statements of Orgarizaton. A candeate wih an open ‘Commie tat exceeds $750 n actly for another ofice shal fo wihin 10 days ether a new or amondod 108-1 ceclosng inomaton conceming the campaign forthe new ofce sought. COMMITTEE NAME 1 1 (A candidate's commie most incude the candidat’ lastname in the name ofthe comet.) Committee to Elect Hickey “TNPORTANT= inlcata type of commitioa you are reporting Tor jf. ogialativa/Judge Standing COMMITTEE TREASURER (mandatory forall commits) (1)Statowid Yor Retention Candas (2)Sttewlde PAC (2)Stte Party (4)Coumty Cental Commie (5)County Candidate (8 )City Candidate ('7 }School Board or Other Political (10) School Board oF Other Political Subdivision PAC (11) Local Ballot lesue(including committee involved in multiple cty/county ballot lestes) ‘Subdivision Candidate ( 8 )County PAC (9 City PAC COMMITTEE CHAIR (mandatory except for a condidate's committee) ‘Sharon Hickey ‘Barbara Campbell 504 2nd St. NW S03 and St. NW ‘Fort Dodge, 1A 50501 Fort Dodge, 1A 50501 Prone (515-) 976-6393 Phone (615 ) 573-2886 ena Shickey@mohsi.com Check One Box a re “Tevoato for batt sve) Comment or desergton Advocate against bait sets) eta | ton and Local Ballot Ofice Saunt City Council Poltical Paty ( appicable) Distrct:_Ward 4 ouny: Webster (acive mule Bais oes, ach tT Sta Date of Election: 10-9.07 Year Standing for Election Bank AccountName 1 Affliate. or Sponsor ‘All campaign expenses paid for by personal funds ‘Sharon Hickey ‘Name of Financial insttulonfype of Account| 1 Maling Adaress 1 304 2nd St. NW aling Address) wat See yt a tt Fort Dodge, a 0501 w Sate Te Phone (15 ) 576-6393 emai Shickey@mchsi.com STATEMENT OF AFFIRMATION: By fing thie document the committee stfirme the following: 1. The commitas anda persons connected with the commitee understand that they ao subject the laws in lowa Code chapters 6A and 688 and he administrative ‘les in Chaptor 351 of te iowa Admanistatve Code. 2. That lowa Code section 6A 402 and ule 351—4 9 require the fing of ceclosure reports and thatthe fare to le these report on or bere the required due tes ‘subjects te cancate or chatperson (nthe cae of commtlees other than a candidate's comma) tote automate assessment of cl penaly and he poss Impostion of cher criminal and ck sanctions {3 That lowa Code section 684 406 and rules 35138 through 443 requie the placement ofthe words “pad or by" and the name of the committee onal polticl ‘aterals except for Bose ters exempted by staid o ule. A commie that wishes to ogi comes name fr purposes of using te shorter “pad fr by” end oes not ntnd to cross the $750 fling threshold shal Me the Form OR-SFA form 4. That wa Code section 68A.503 and rules 361 —4 4 through 4 62 prohibithe receipt of corporate contrbutons by all commitees except fr satewide and loca bate ‘Ssue PACS 5, Acandidate anda candidate's committee may only expend campaign funds as permited by owe code sections 68A 301 through 68A 909 andre 2514.25. 6. That the commitce wil cortinue to fle disclosure reports unt all activity has ceased, commie funds spent, debi resolved, and a final report and a statement of ssoluion (OF) hes been Red _hhar wre Nes M9-1- 07 id