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COMMITTEE NAME 1
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COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
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Ma .l'mg Address 1 1 Mailing Address $ 1
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INDICATE PURPOSE OF COMMITTEE - Check One Box I/ Advocate forl3g3inst ballet issue(s) I
Comment or descri .tion*
All Candidates Enter :
Office Sought : _ District
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 .
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`' ignaiure of ea1uror Oslo Signed
synew~a or Candldnte . On, nor Sri Dtlbr .JI1tTlneOn, Cnalroerson Date Sinned