IOWA-HEBPASKA STATE SANK 712 423 1062 P .

02
OCT-12-04 12 :06 PM

FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM STATEMENT -7
[r] This Is an initial' Statement of Organization OF
DR-1
This is on amended' Statement of Organization (REV, 0712044) ORGANIZATION
For Ofice Uw4 Only ~~~~~
An WOW Statement of Organlzadtgrt must oe filed *Rhln 10 days of the commilfse's accepting contributions, Comm, #
rnaklrig expenditures, or incurring Indebtedness exceeding $7517. Amendments must be filed wfthln 30 days of Indexed
a change . Penelffes maybe Imposed forlate-flied Statements of Organization . AudIted
Computer _

COMMITTEE NAME 4 d

Committee to Elect Jeffrey R . Pratt Sheriff

r IMPORTANT: Indicate type of Commas" you are reporting for; O
(1 )Stnit-WO/LegislatlveiJudge Standing for Retention Candidate (2 )Statewide PAC( 3 )State Party (4 )County Central Committee
(5 )County Candidate (e )City Candidate (7 )School Board or Other Political Subdivision Candidate (8 )County PAC (t7 )City PAC
-10)8choot Board or Other Political Subdlylston PA C 11 Local Ballot Issue _ _
COMMITTEE TREASURE . R (Mandatory for all committees) COMMITTEE CHAIR man( datory except for acandidate's commM?),___
y~me Name d
em Prett i -

W
1X1 1 ith 5;s
a l Mailing Address 1

City. State a ZIP Code y ~. City, State Zip Code d

0nawa L IA 51040 ,.- . . . .-_. .. .-- .
1
Phone ( 712 ) 433,3728 Phone ( )
,me tipratt0willinel not
&-Mail
INDICATE PURPOSE OF COMMITTEE-Check One Box 2 Advocate for/against canddat~a) -T-Advocate for/against ballot issue(s)
Comment or description :
All Candidates Enter:
Oftce Sought : _ Sheriff
District :
Oe moaat 2004
Political Party (If applicable) Year Standl-,g for Election :
County/Local Candidates and Local Ballot/Franchise Commttte" Enter:
11102/04
County. Monona Date of Election :

Sank Account Name d 1. ndl Press or Parent Entity (PACs if eppligableL

y Afflilato. or Soonaor
Jeffrey R. Pratt - Campaign Fund Jeffrey R. Pratt

l Name of Financial InatnutioNtype of Account y b Mailing Address .d

Iowa-Nabra&ka State Bank/ Checking 511 4th St. Zip
Malling Address 1 1 City ,. L state 1 J.
PO Box 59 Onawa, IA 51040
City i. J. State ~. 1 ZIP y d 433-3726
Phone (712 )
Onawa, to 51040
mocosciQlorgllnes .c om
e-mail -

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

1. The committee and all persona connected with the oornminee understand that they are subject to the ]ewe in Iowa Code chapters WA and e8B and the administrative
rules in Chapter 351 of the Iowa Administralive Code .

2. That Iowa Code section 68A,402 and rule 351-4,9 require the filing of disclosure reports and that the failure to file those reports on or before the required due dates
&ubiecth the candldals or Chairperson (In the case of committees other than 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--4 .38 through 4.43 require the placement of the words 'paid for by"and the name of the committee on as political
matene s except for Incise items exempted by stelule or rule . A committee filing this statement for purposes of using the shoner'paid for by' and who have not crossed
the 8750 shell notify the Board that the 8760 threshold will not be crossed .
4, That Iowa Code section 6aA.503 and rules 351-4.44 through 4.52 prohibit the receipt of Corporate contributions by all committees except for statewide and laical ballot
issue PACs .

5. A candidalo and a candidate's committee may only expand campaign funds as permitted by Iowa code sections 68A.301 through 68A,303 and rule 351-4.25.

6. Thal the COmmi1t00 will continue to Me disclosure reports until ail activity has ceased, committee funds spent, debts revolved, and a Anal report and a statement of
dissduilon (OR-3) h4a been tied .

A -/ -a
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