FIRST WHITNEY HF1NK 7122433198 P .

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FOR INSTRUCTIONS, SEE BACK OF FORM FORM

A DR-SFA Statementof
Mtbe
I am filing this form to use the shorter "paid for by' attribution . The commiit~e will (Rev . 01/20D6) Organization
crossing the $750 threshold `Paid For By"

'If the committee crosses the threshold, an inifiet DI4-1 Statement of Orgenaabon our/~t be1)Md wllhln 10 days
of" oommlttse's accepting contributions, making expendihires, or incurring ind=ness exceeding $750, M Co #
addition, the committee w01 be required to Me campaign disclosure reports . '
i Inde.iid
Audited
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COMMITTEE NAME m *ft name of the ;Commifles .)
z x (A candidate's committee must include the candidate'ss-138tviiia-

IMPORTANT : Indicatetype of committee youare registerirtg

(1 )StatewidelLegislatimMudge Standing for Retention Candidate (2 )Statewide PAC (3 )State Patty ( 4 )County Central Committee
(5 )County Candidate (t3)City Candidate ( 7 )School Board or Other Political Subdivision Candidate ( R )County PAC ( 9 )City PAC
(10 )School Board or Other Political Subdivision PAC (11 ) Local Ballot Issue(Includlng committee involved in multiple cityfcounty ballot issues)

COMMITTEE TREASURER (mandatory for all tcntrnittses) CAhDDATIE COMMITTEE CHAIR (mandatory except for a candidate's
committee
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INDICATE PURPOSE OF COMMITTEE -Check One Box M Advocate forlagainstcandidate(s) C3 Advocate for ballot issue(s)
Comment or description : 1] Advocate against ballot issue(s)

All Candidates F tar: CountoLocal Candidates and Local Ballot Committees Enter :
Office Sought : CaA.ss
County: t~2 ¢ SS
Po'ltical Party (f applicable) -:;6P--PUA L/(' A (If active in rtuult~lp`Te ballot issue elections, attach list of counties

District Date of Election . CP

Year Standing for Election : VrorsX!
:

STATEMENT OF AFFIRMATION: By filing this document 1he committee afflrims the tollowing:

1 The com rnittee 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 lows Administrative Code .
2 That Iowa Code section 6aA.405 and rubs 351-4 .38 through 4.43 require the placement of the words "paid for by" and the name of the committee on all political
materials excep(for those Hems exempted by statute or rule
3 . That Iowa Code section 68A.503 and rules 351-4.44 through 4.52 prohibitthe receipt of corporate contributions by all committees except for statewide and local ballot
issue PACs
4. That if the committee exceeds $750 in campaign activity, a DR-1 Statement of Organization must be filed within 10 days and the committee is required to file campaign
disclclosuro reports.

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