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FOR INSTRUCTIONS, SEE BACK OF

CHECK ONE- FOR STATEMENh
(,a This is sn Inttfal' Statement of Organization DR-1 Ot=
C7 This is an amended' Statement of Organization (Rev . 01/2006) ORGANIZATION

An initial Statement of Orpenizotion must be filed wRMn 10 q loe cam ospaer"e ritributlons, or ce se my
making 9rpenditurrots, or incurrirrp Indebtedness exceeding 3 QlIOGiwer~'"~~ filed within 3o days of Conxn 4
o change, Penahias may be irnposad forlatrrflW Stahsnent_ 0rgsr&atlon. fl uvrrdtdete with art open Indexed
comrnftlee that exceeds 3750 in adivfty for another office shelf Re wtftin 10 days ~a new or emended Audited
DR-1 disclosing irrrormeAon colmernirtp file cornpeyn forthe new office so(Vtrk
Computer

COMMITTEE NAME ~ : (A candidate's committee mint include tlno candidate's last namo In the name of the committee.)
Creger For Supervisor
tid'6l?! type of commife you are repoRmg for
( 1 )StatewIdelLeglxiatlve1Judge Standing for Retention Candidate (2 )Statewide PAC (3 )State Party (4 )County Central Committee
(5 )County Candidate (6)City Candidate 17 )School Board or Other Political Subdivision Candidate (B )County PAC (9 )City PAC
( 10 )School Board or Ot her Political Subdivision PAC (11 )Local Ballot Issue(inciuding committee involved in multiple city/county ballot issues)

COMMITTEE TREAS URER (mandatory for all committees) COMMITTEE CHAIR (mandatoryvxcept for rr candidate'4 committee)
Name .I. 1- Name
Kevin Petznick Kenneth E. Johnson
MallIng Add_` ms
2206 485th St .
City . State L 1 Zip Code
I t Northwood, IA 50459

phone ( 641 j 324-2029

e-Mall n1a
7i Advocule for/against candidate(%) Advocate for ballot issue(s)
Comment or description : Advocate apairtst ballot esaue(%)
All C9ndIaTexTnter County l aa n~das`~E~~al~o{ rnm tttoesEnmr
Ouse Sought : County Supervisor
County_ Wo rth
Polibcal Party (,t appricable) Democrat (if active in multiple ballot IRque elections . attach list of cartel
Di,trlct : 3 Date of Elactlom 1117106
Year Standir* for Eledion: 2006
Ca- a narrw areesor p~ tEntltlffFAC4.VT9aDIKAD 1
1 1 gft~118~~fS~OOsor
Creger For Supervisor Jeffrey L. Creger
Name of Flrranclal Inaftutfonrtype of Aocount Mafllng Addr"s '.
Northwoods State Ban k/Checking 2220 490th St .
Mailgtg Addmsr. L I. i 1.
Clly 1 1 State Zip
900 Central Avenue Northwood,(A 50459
cry l State 1 1 ZJp 6
Phone (641 ) 324-1139
41

Northwood IA 50459
e-Mat
JScreger@myclearwave .net

STATEMENT OF AFFIRMATION: By sling this document the commkt" affirms the lbllowi g:

1 . The cornmht+w and all partonc connected with thecormrnitlen undMrtnnd that they are subject the laws in Iowa Cole
10 chopiom 68A end MB end the admlnle+ " ith.n
tvlan in Clmpler 351 of the Iowa Administrative Code,
2 That levr Code -,ocl,on 68A.402 and rule 351_._4 .9 require the fling of dit;closure reports end that the railum. t
o rile these reports on or before the requhud dun datwr
subiocls the candidate or chalrpel-on (n the case of committees otherIh:)n a candidate's committee) to the oulomallc
gscn`:manl of a civil penalty and the posalble
imposition of other crlmlnal end oivl sanctions .
3 That Iowa Code +rclion 68A,405 and rules 351-4.38 through 4,43 rnquim the placement o(lhe word% "paid for
fry' end the name of the committee on all polYlcal
materials except for those items eremplod by sm uve or nib . A eomrnbee that wishes to
asglfter a committee name for purpaaes of using the shnrter paid for by' end
does not intend to crtbr5 the $750 fling threshold shall file the Form DRSFA brim .
4 . That Iowa Code zaciIon BftA .503 and rules 351-4 .441hrotigh 4 .52 prohibathe receipt of eorporme
contributions by an comrritteec except for slafcrwidn end local ballot
kcun PACs,

5. A cordldale and a candidate's committee may only expend cempnign funds as permitted by Iowa cod@ seclionr 68A.301 through 38A
.303 and rule 351-4.25.
6. That the ccrrmlnw will continue to fife disclosure reports until all ac10ty has ceased, committee fund% spent,
debts resolved, and a final report and n cintemeni of
dl+rmlutb~p> .3 has been rl
A

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