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FOR INSTRUCTIONS,
SEE BACK OF FORM FORM STATEMENT
CHECKONE: DR.{ OF
El fnis is an lnlUal* Statementof Organization l:l {Rev 1Ol2OOgl ORGANIZATION
E rnis is an amended'Statement oiOrganization
's:Fitementmusibefildwlthin llReset Form I EgEZM9.!,:Wry,
loctaysofommlfteeawpting@ntib,ttions,naklngexry@ Comm.#
incurrlngclebtsexep,dJnss7il. Amendments mustbe frledwithin30 daysof a change.
EfiediveJanuary1,2010,all statementsandreportsfiled by newcommirtees Indexed
for etateoffce mustbe flled Audlted
electronlcally
andefiectlveJanuary1,2012,all stalementsandreportsfiled by all commlttees for stateofrce
mustbe filedelecfonlcally.
and
coMMlTTEENAMEJJ6cancioate,scomm|teemustlncludethecandldate'slastnameinthenameofth"-'.molffi
tSdHgftISgN
lon supenvson
IUPORTANT:lndlcatetype of commftteoyou arc repordngfon | 5 |
( f Ftatewld-dleglslatlvelJudge_Standlng
for RotondonCandldate( 2 )Shtewldo PAC( 3 )stato party ( 4lcounty CentralCommltto
( !)9_ou_ntv-candldate_(e )cp-$n{!a!e ( 7 )sclgl Boardor othor PoilflcatSubdtvtitoncancroat6i a icounti pAc ( I tctty iac
( l0lSchool Boardor OtherPollllcalSuUlvlslon PAC ( tl I Battotlesue(lncludlnocommltteelnvotved tn mutttntecttu/dorinrs-rgnar
tslaal
COMMITTEE all
[ame J. J
-uaveJones Name
MallingAddress J J

Q2ffie+t
tfr[s?Et?n8,in City,State J .1, Zp Code I J

pnone(563)-26ffi Phone ( )
-rou Davejones@muscatinefoods.com
INDICATEPURPOSEOF COMMITTEE- Check One Box
Commentor descriptiolr:
n eovocatetorla@otissF
l-l Advocate aoainsl ballol lssue(s)
All Candldat€ Enten . Countyr|.ocalCandldatssand Ballot lssue Commttto€aEnton
OfficesoughtUounryboardof supervisors
County Muscatine
Political Party (tf appllcable) Republican (lf actve ln multipleballollssueetedions,attachllsi of counties
Dlsfid: 5
Dateof Eteclon| 11f2f2010
Year Slandinofor Election: 2010
EanK ACC'OUnIilamo (mUStmatch commftte€ name) Candldatp Fame & Addrug or Parent Entttv PACs. lf aoollcable).
J+ J J Affiilate. orSooneor
SORENSENFOR SUPERVISOR Jeff Sorensen
Nameof FlnancialInsttrdon/typeof Account J J Mailing Address .t J
CentralStateBanUOhecking 620WierSt.
MallingAddress + J ciry J J srde0 { zp J J
301lowaAve Muscatine,lA 52761
City J J StateJ t ap J J
Muscatine Phone(563) 264-3188
lA 52761
*Mair askjeffsorensen@gmail.com

STATEIUENTOF AFFIRJUATION:By flllng thls document the commlttee affirms the followlng:

1' The committeeand all psr€onsconnec'td with the committeeunderstandthat they are subjec{to the tawsin lona Codechapters6EAand 6EBand ths administative
ru16 ln Chapter351 of the loira AdministEtiveCode.
2. That lowa Code sdion 684402 and rule 351-4.9 requio the filingof disclosurereportsand that the taitureto file these reportson or bebre the requireddue ddes
subjeclsthe candidateor chairperson(in the case of committeesotherthan a candidate'scommittee)to the automaticassessr;entof a civil penalg and the possible
imposition of olhercriminalandcivilsanc{ion8.
3. That lowa Code sedion 684405 and rules351-4.38 thrcugh4.43 requirethe placementof the words'paid for bt' and the nameof the committeeon atl potiticat
-fur
materialseept frr tho€eitemsexemptedby staMe or rule. A commitee that wishs to registera committeoname purposesof usingthe shorter'paid fdr bf and
does not intendto crossthe $750filing thresholdshallfile the Fonn DR-SFAtorm in lieu of filingthis torm.
4. That lowa Codesection68A503 and rules 351-4.4 through4.52 prohibitthe receiptof corpoEts confibutions by all committeeserept br ballotis8uepACs.
5. A candidateanda candidale'scommitteemayonlyerp€ndcampaigntundsas permnedby lowacodesections6EA3ol through6EA3O3and rule3Sl*4.2S.
6. Thatihe committe€will conlinueto file disclosurereporb until all activityhas ceased,commitee funds spent,debts r6otved, and a final reportand a statementof
dbsolution(DR-3)hg*@en filed.

7-t(^3nru
Dateslsned
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