11'211 16 : 1 1-583-387-41383 DITOR

IA ETHICS " ; C
FOR INSTRUCTIONS, SEE BACK OF FO WIsctt>Slt^F FOARD
CHECK ONE: FORM STATEMENT
Q This is JUN, - i Nor, DR-1 07
7
an initial' Statement of Organization
This is an amended' Statement of Organization (Rev 01/2006) ORGANIZATION

'An initial Statement of Organization must be filed within 10 ony trihutions, For Office Use Only
malting expondifurgs, or incurring indebtedness exceeding $750 Amendments must be flied within 30 days of Comm, 0
g change Pen»flips may be imposed for fate-Red Statements of Organization . A candidate with an open Indexed
committee that exceeds $750 in activity for another office shall file within 10 days either a new oramended Audited
OR-1 dlscloslng information conceming the campaign for the new office sought. Computer

11 COMMITTEE NAME .. ~. (A candidate's committee must include the candidate's last name In the name of the committee,)

~.q Vo h )~ ~ - lir er u YY1

IMPORTANT: Indicate type of committee you are reporting for:
( 1 )Statewide/Legislative/Judgo Standing for Retention Candidate ( 2 )Statewide PAC ( 3 )State Party (4 )County Central Committee
( 5 )County Candidate ( 6 )City Candidate (7 )School Board or Other Political Subdivision Candidate (8 )County PAC ( 9 )City PAC
_( 10 )School Board or Other Political Subdivision PAC 11 Local Ballot Issue (including committee involved in multiple ctlcounty ballot issues)

COMMITTEE TREASUR ER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name .l- ! t
I-e lel C) J1 (t_ - -" /
Ritailing Address "% l. Mailing Address. .4
l~s a Nf
City, State .:- .: Zip Code J. .; City, State y y zip Code
6,ri a 77 4j, C~C'Cra c~'I!

Phone ' )- Phone ( )

e-Mail 1 I e-M2il
INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate forlagalnst candidate(s) 0 Advocate for ballot issue(s)

AllComment or description : Advocate against ballot Issue)

Candidates Enter: County/Local Candldates and Local Ballot Committees Enter
Office Sought
County,
Political Party (if applicable) (lf active in rnuttipic ballot Innsue elections, all list of counties

District. II of Election :

I
Year Standing for Election
Ban k Accou n0gm-v y J PADdi a e~rtafnP&Addres or PaMntEntltV (PACs If appl icable_),,
. J. Affiliate, or SpORsor

Name of Flnanclal Institutionitype of Account Mailing Address J.

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

City . d. state J. d
Phone ( )

e"Mail

STATEMENT OF AFFIRMATION : By filling thle document the committee affirms the following:

1 . The committee and all persons connected with the commlttco understand that they are subject to the laws in Iowa Code chapters GSA arid 6819 and the adminiirative
nuies In Chapter 351 of the Iowa Administrative Code .
2. That town Code ~eclion 68A402 and rule 351-1.9 require the filing of disclosure reports and that the failure to rile these reports on or before the required clue chins
sub)eots Ire candidate or chairperson fin the case of committees ether than a candidate's commttr:e) to thr: automatic assessment of a civil penalty and the poi^ i ble
Imposition of other crlmlnal and civil sanctions.

3 That Iowa Code cocoon 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 all political
materials except for those Items exempted by statute or rule A committee that wishes to register a committee name for purposes of using the shorter "paid for by" and
does not intend to cross the 57'0 fling threshold shall fle the Form DR-SPA form .
4 . That Iowa Code section 68A.503 and rules 351-4,44 through 4 .52 prohibit the receipt o~ corporate contributions by all committees except for statewide and local ballot
Issue PACs
5 A candidate and a candidate's committee may only expend carnpalgn funds as permitted by Iowa code sections 88A.301 [nrou,gn 68A. .303 and rule 351-4,25 .

G, That the committee wilt continue to file disclosure reports until all activity has ceased, committee funds spent. debts resolved, and a final report and a statement of
dhsotution (DR-31 has been filed .

Data Signed

Date Signed