Sep 23 04 08 :20a Oakland 712-482-3424

FOR INSTRUCTIONS, SEE BACK O FORM STATEMENT

CHECK ONE: DR-1 OF
(Rev. ORGANIZATION
) This is an initial* Statement of Organization
0712003)
This is an amended* Statement of Organizatio
For Office Use Only

'An initial Statement of Organization must be filed within 10 mittee's accepting contributions, making
expenditures . or incurring indebtedness exceeding $750. Am dments must be bred within 30 days of a change. Indexed
Penalties may be imposed for late-filed Statements of Organization . Audited
Computer

COMMITTEE NAME .l- 1

" Cl yl r\,1 r ~ t

IMPORTANT: Indicate type of committee you are reporting for,

( 1 )Statewide/Legislative Candidate ( 2 )Statewide PAC ( 3 )State Party (4 )County/Local Candidate ( 5 )County PAC (6 )Ballot Issue/Franchise
Committee (7 )CcuntylCtty Central Committee
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name 1 1 Name 1 1

11
V %Wg
Mailing Ad ress Mailing Address 1 .l
3yti sx \_ ., : t~A LA
gqttB"
City, State 1 1 Zip Code 1 1 City, State 1 1 Zip ode 1
C!C,V~~ ~, ct , 1,^'t
SiS~'L'- Gr~"000 34 Jis3S
Phone 331 1 Phone (7/a) -184 - a 3 43
e-Mail e-mail
INDICATE PURPOSE OF COMM[7~EE - Check One Box Advocate fortagainst candidate(&) [X Advocate for/against ballot issue(s)
Comment or description : EuS~ fo~lc~twca4ti"f- L, ,k 6 c ~e~Pr n
All Candidates Enter:
Office Sought : District :

Political Party (if applicable) Year Standing for Election:

County/Local Candidates and Local Ballot/Franchise Committees Enter:
County : Date of Election :
Bank Account Name 1 1 Candidate name & Address or Parent Entity (PACs, if applicable).
~(q¢hy APpIe Qic clod
t ~ 1 1 Affiliate, or Sponsor

E" Qo-I~~'~2rt° r~,t r~ ~-o rvt m ~'ftiK '~

Name of Financial Institution/type of Account 1 1 Mailing Address 1 1

CA , Z.f a~, Y~Ye fl~trA / c,~ed<-, n5

Mailing Address 1 J. City 1 1 State 1 1 Zip 1 1

0C F111,
City 1 State 1 1 Zip Phone ( )

kG ~~ :\:- 4 - t~ 4 C e-Mail

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

1 . The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68B and the
administrative rules in Chapter 351 of the Iowa Administrative Code .
2. That Iowa Code section 68A.402 and rule 351-4.9 require the'61ing of disclosure reports and that the failure to file these reports on or before the required due
dates subjects the candidate or chairperson (in the case of committees otherthan a candidate's committee) to the automatic assessment of a civil penalty and the
possible imposition of other criminal and civil sanctions .
3. That Iowa Code section 68A.405 and rules 351-A.38 through 4.43 require the placement of the words 'paid for by' and the name of the committee on all political
materials except for those items exempted by statute or rule .
4. That Iowa Code section 68A.503 and rules 351-4.44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statewide and local
ballot issue PACs .
5. A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 6BA.301 through 68A.303 and rule 351-4.25.
will continue to file disclos e reports until all activity has ceased, committeefunds spent, debts resolved, and a final report and a statement of
been filed . n f

-1 A. F-l 9r--~)J-
of Candidate, OR, 'or al other oommittoes, Chavpers n Date Signed