NO . 5174 P.

2
JUG 27,2005 1 :34PM 3146548764

FOR INSTRUCTIONS, SEE BACK OF FORM

STATEMENT
CHECK ONE: FORM
XThis is an initial" Statement of Organization DR-1 OF
L This is an amended` Statement of Organization (REV. OSI2005) ORGANIZATION
An Initlal Statement of Organization must be filed within 10 days of the committee's accepting contributions, For Office Use Only
making expenditures, or incurring indebtedness exceeding 8750 . Amendments must be filed Whin 30 days of Comm. #
a change. Penalties maybe imposed farlate-filed Statements of Organization . A candidate with an open Indexed
committee that exceeds 5750 in activity tbr another office shall file within 10. days either anew or emended Audited
DR-1 disclosing Information concerning the campaign for the new office 6ught. Computer

COMMITTEE NAME J. 1
,,wt.. N 7 ZOLI`,

D ;-
f
IMPORTANT : Indicate type of committee you are reporting for: [fi-(1
' )Statewido/Loglslative/JudgeStanding for Retention Candidate { 2 j8%tswlde PAC (3 )State Party (s )County Central Committee
~ ( 5 )County Candidate ( G )City Candidate ( 7 )School Board or Othiir Political 3ubdIvIsIon Candidate (e )County PAC (9 )Cllr PAC
j (10 )School Boa rd or Ot her P olftlcal Subdivision PAC (11) Local Ballot Issue
COMMITTEE TREASURER mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name b Nam~ -
~ - ~
f04. ~bUmmi-wvd '9iU, QUIAJB~f
Mailing Address b y Bo Mailing Address .4 y 7 -p
?0 p

l k. =
city, tale J. I Zip Co~e City, state 01 4 Code
I C-TSkf2 TLa"IP 4 -C-0410(a -XA Oft

Phone i3q) e~

e-Mall e-mail
INDICATE PURPOSE OF COMMITTEE-Check One Box X Advocate forla~iAetaerldidete(s) forlagainstballot issue(s)
Comment or description : (1( *,K- 11At~/(tlrt17-fe

Mg.
14
All Candidates Enter. ~. A
Office Sought District

Political Party (if applicable) Year Standing for Electio

County/Local Candidates and Local
Date of Elecdon : I
County: GIAW
Brink Account Na me Candidate na e &Address or Parent Entity (PACs, if applicable) .
Afflllate or s oneor

IIiiWQ/j 132 "a0-

Name otfFinancial Institution/type of Account J. M ailing Address J

(A-1 "G re&r- -DR,v6-

Mailing Address I y City y y State y y zip

-IOD t5
l kip Sod
City I Z stale y J. Zip .1 1
Phone
O.aka WcOS 5~Lq0 -,L-
e-Mail ~~ ~ Scy~`t ~Saal~

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

1 . The committee and all persona connected with the cornmlttee understand that they are subject to the laws In Iowa Code chapters 6BA and eeB and the admlnlstrative
rules in Chapter 351 of the Iowa Administrative Code,
2 . Thai Iowa Code section 68A .a02 and rule 351-f.9 require the filing of disclosure reports and that the failure to file lhe6e 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 cMI penalty and the possible
Imposition or other criminal and civil sanctions .
3 . That Iowa Code section 69A .405 and rules 351--4 .38 through 4 .43 require the plammert 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 . A committee flung this statement for purposes of us)ng the shorter 'paid for by' and who have not crossed
the $750 shall notify the Board that the $750 threshold will not be crossed.
4. That Iowa Code section B8A,503 and rules 351-4 .44 through 4 .52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
laeue PACs .
5 . A candidate and a candidate's committee may only expend campaign funds as parmilted by lava code sections 09A.301 through eeA.303 end rule 351-4 .25.
a . That the mrnIfe&,riftL"fRlmqo fd losurs reports until all ac" has ceased, committee funds spant, gebts resoivpd, and a final report and a statement of
disaalLoefl y/t3) has be