You are on page 1of 1

Tim & Ruth 712-475-2588

FOR INSTRUCTIONS, SEE BACK OF FORM FORM r /9TATEMENT


DR-1 OF
ChfECK ONE :
(Rev . ORGANIZATION
Thi . i s an Initial' Statement of Organization
07t2003)
This is an amended" Statement of Organization For Office Use OntV
~-B~ 5 2005
r~ r
An initial Statement of Organization must be ftod within 10 deys;of the cdmMlffee s ecoeprtng contributions, making Comm f/,M'
expenditures, or Incurring indebtedness exceeding 3750 Amendments must be filed within 00 days of aChange . Indexed
Pcralties rney be imposed for lets-tiled Statements of Organization Audited
Computer

COMMITTEE NAME 1

z,~ fc -(~ l

IMPORTANT : Indicate type of committee you are reporting for 1--sr--~


( t )StatowldelLoglslatlve Candidate 1 2 )Statewide PAC (3 )State Party ( d )CountylLocal Candidato ( 6 )County PAC ( 6 )Ballot Issue/Franchise
I Committee (7 )C o untylCity Ce ntral Committee

COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)

Name  1 Name 1

T1 h^ Kr li P C 1110
T ull
f s
l sit
Ma .l'mg Address 1 1 Mailing Address $ 1

~110 al/l 44 IN asp sf r

City . State 1, 1 Zip Code 1 1 City, State 1 1 Zip Code y L

(x,-! ark ,
-T
-~
j4 S a3 ~,
f
P,
,
s a3 7

` Lf
Phana il -W ) ' q 7S- a SA Phone (71L ) 4 7S -

e-M311 a-M311
INDICATE PURPOSE OF COMMITTEE - Check One Box I/ Advocate forl3g3inst ballet issue(s) I
Comment or descri .tion*
All Candidates Enter :
Office Sought : _ District

Political Party (it Ipplicablo) 'fear Standing for Election .


County/Local~andld~tea and Local Ballot/Franchiso Committees Enter:
County : -~~ 'r! DaleofEIsciort: Maul^ 15.,..a
Bank Account Nome Candl4: n name & rt-l teas or Paro rt Entity (PAI;s if gn(Zlicable)

~~~rn~~ tr9 un ,~ d' -L-j"


hODI Affiliate, or Sponsor

Name o'rinanciall titubonnypeolAccount 1 Mailing Address I

0-I k7t .t'-', 15 6( 1, )


rdialling Address City "ale 1 Zip 1

City 1 1 Stale :. 1 Zip 1 .. Pho e (j


r
>1 - 1e I J Or1 !w ~120i e-Mall_ ,

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

1 The committee and all persons connected with the oommitteo understand that they are suo)oct h the laws in Iowa Coca chapters 6BA and 660 and the
aomimslranvr ru!cs in Chapter 351 of the Iowa Adminislrative Code

2 That Iowa Code section 88A 6 and rule 351-4 ° require" filing of disclosure reports and that the fatlurb to 1110 these reports on or beforo the required duo dales
sublecls the candld3le or chairperson (in the case of Committees Otner than a canoidate's committee) to the automatic alssessmenl of a civil ponalty and the p05SVO
im'vosillor of otnor criminal and civil sanctions.

3 That Iowa Code section OBA to end rules 35 t-4 38 through 4 .43 require the placement of the words 'paid for by' and the name of the committee on all political
mattvials oxdopl for those Items exempted by statute or rule.

4 That Iowa Code section 68A .15 and rules 351-4 44 through 4 .52 prohibit the receipt or corporate contributions by all committees except for staiewido and local
nellot issue DACr .

S A candidate and 3 candidate's committee may only expend campaign funds as permined by Iowa code sections 68A
.40 through 60A.e2 and ruld 351-4.25.

6 That the committee wit) continue to file disdosuro resents until all activity has ceased, ccrmmmee funds spent, debts resolvoo, and a final report and a statement or
dissolu4on (QE- :l) hss bob tiled .
_ _ .ss
.~.- , 7
`' ignaiure of ea1uror Oslo Signed

synew~a or Candldnte . On, nor Sri Dtlbr .JI1tTlneOn, Cnalroerson Date Sinned