JLL-26-2005 14 :20 IA ETHICS CAMPAIGN DISCLO 15152813701

CH CK ONE FORM,- -I STATEMENT

his is an initial' Statement of Organization
C1 This is an amended" Statement of Organization . REV, 4712004) OROANIZATION
AUG L ~.
ERE Oftle Y111, 20
'An iniNai Ststimenf dOrgar ation must bo filed within 10 days of Ow commit"s accaptinyr aonmulions, GGrSirrl .e
making expenditures. or incwrinp indoWedneas excesdkV $750. Amsndmerf Must be Ned wrthfn 30 days of Indexed
a ohanga, Penafas may be Imposed for deta4&dStatements of tanlratio& - _ . _ - . - ;. Audited
Computer

COMMMEE NAME 1 d

rm ec.~
IMPORTANT : Indicate type of committee you are reporting for
(1 )3tatewidelLsofalativeiJudgeStanding for Retention Cand1iati ($)6tiltewdde PAC (3 )Seats Patty (4 )County Central Committee
( 5 )County Candidate ( 6 01 Candidate ( 7 )School Board or Other Political Subdivision Candidate (e )County PAC ( 9 .)CIty PAC
(10 Ar hppl Board or t)!hgr Political Subdivision PAC (11 ) Lout Ballot Issue
comagum Oh1MITTEE CHAIR(mudalcry sxraiptfor a candidrtt'" aammltaet
Name Z 1L';
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Na rr~y ,;
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INDICATE PURPOSE MM - Check One Box U Advocate for/against candidates) Advocate for/against ballot isetue(s)
Core or d tion!
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Office Sought District

Political Party (if applicable) Year Standing for Election,

CountyAacal Candidates and Local SalloWnrmehlss Cons .tlttses tee.
:b= L/gtdA~
: Date of Election,
County:
A
rt mill It ddress or Parent Entity (PACs
.If walictbld).
Af011ata. or 8mnaor

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,~area of Financial Institution/type of Account y y Mailing Address J.

commu,n ~ I :'-I)u .S Cred f Un ior1

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pity J. y State 1 1 zip,l
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STATEMENT Of AFFIRMATION: Illy riling this document the committee aftlrms the following:

1, The committee and all persons connectedwith the committee understand that they are subject to the" in rows Code ohapims 68A and 611E and the admirlslralNe
rulesin Cnapter 359 of the Iowa Administrative Coda
2. That Iowa Coda, socaon 56A.40 and rule 351--4.4 raquiYS the tiling of disclosure reports and that thefailure to file these reports on or before the required duo dates
"ecxs the candidate or chairperson ton the case of commlloss other than a candideW'a conin III*$) to the sutonralio assessment of a civil penally and the possible
impoaibon of aM8r crlmlnei and oM ianclions.
3. That Iowa Code $00110188AA06 and rules $51--4,36 through 4,43 require the placementof the words 'paid for by' and the name of the oornnlittse on ellpdilical
materials except forthose items exempted by slatula Or rule, A COMMON Tiling INS statement for purposes of using the shorter 'paid for by' end who he" not aamed
the $750 shall notify the Board that the $750 threshold will not be crossed .
4 . That Iowa Code ssdton 8814503 end rules 351-4.44 through 4.52 prohibit the receipt of corporals contributions by al comrnktass except for statewide and local ballot
Issue PACs .
5. A oandidoH aril a candidate's Committee may only expend campaign funds as permitted by Iowa code sections ESA.301 through 85A.303 and rule 351--4 .25.

6. That the aommitise will continue to fit diseiraslrs rapef unfit all eetivily has osased, committee funds spent. debts resolved, and a Inat napeit and a stetsawnt of
dissolution (DR-3) hasbeen d.
11.11 . n nA ii -7

TOTAL P .O1