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    2004 11 01 - DR1

    Uploaded by

    Zach Edwards
    This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    2004 11 01 - DR1

    Uploaded by

    Zach Edwards
    31 views1 page
    This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

    Original Title

    2004-11-01_DR1

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    © Attribution Non-Commercial (BY-NC)

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    This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    31 views1 page

    2004 11 01 - DR1

    Uploaded by

    Zach Edwards
    This document is part of the Iowa Ethics & Campaign Disclosure Board set, which was up to date as of 2/20/2011. The documents in this set consist of every pdf posted on the IEC website, but they should not be considered a replacement to searching the official website: http://www.iowa.gov/ethics/ ----- Disclaimer: I am not selling this data or making any money by posting this data. I'm merely trying to find a better way to search the information on the Iowa Ethics & Campaign Disclosure Board website.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    of 1

    FOR I 'RUCTIONS, SEE BACK OF FORM

    CH K ONE: FORM STATEMENT


    This is an initial* Statement of Organization DR-1 OF
    R This is an amended* Statement of Organization (REV . 07/2004) ORGANIZATION
    For Office Use Only
    *An initial Statement of Organization must be filed within 10 days of the Comm . #
    making expenditures, or incurring indebtedness exceeding $750. Amend Indexed
    a change . Penalties maybe imposed forlate-filed Statements of Organ1.7 1 Audited
    Computer

    COMMI EE NAME 1 ~.

    6 0 li~t 1 &0- A
    IMPORTANT: Indicate type of committee you are reporting for: =
    ( 1 )StatewidelLegislative/Judge 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 PACA 11 ) Local Ballot Issue
    COMMITTEE TREASURER mandato for all committees COMMITTEE CHAIR (mandatory except for a candidate's committee)
    Name 1 Name
    ,£l ve-
    Mailing Address 1 1- ? s Mailing Address

    City, e 1 1
    Zip 'ode City, a 1 1 Zip de l l
    S~471 5
    7 ~ o

    Phone Phone ,n'T O S -iL

    e-Mail e-Mail
    INDICATE PURPOSE OF COMMITTEE - Check One Box C Advocate for/against candidate(s) -] Advocate for/against ballot issue(s)
    Comment or description- -
    All Candidates Enter:
    Office Sought : ' v 11156-k-
    Political Party (if applicable) re/Ne est"L~tr Year Standing for Election : ;7,06 C/
    County/Local Candidates and LojEal Ballot/Franchise Committees Enter:
    Date of Election : It 4/
    Co u nty Ad/6 41

    Candida me & Address or Parent Entity (PACs, if applicable .


    ^Affiliate, or Sponsor

    ,51-1 Jq-r- "t4ce, e?"ele,


    Name of Financial Institution/type of Account 1 1

    1
    S
    Mailing Address City 1 1 State 1 1 Zip 1 1

    City 1 St 1 1 zip 1 1 Phone (f~" /~_)


    ,C2G 2`-Z Sr . e-Mail

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

    1 . The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68B and the administrative
    rules in Chapter 351 of the Iowa Administrative Code .
    2. That Iowa Code section 68A.402 and rule 351-4.9 require the filing of disclosure reports and that the failure to file these reports on or before the required due dates
    subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
    imposition of other criminal and civil sanctions .
    3 . That Iowa Code section 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 filing this statement for purposes of using the shorter "paid for by" and who have not crossed
    the $750 shall notify the Board that the $750 threshold will not be crossed.

    4. That Iowa Code section 68A.503 and rules 351-4.44 through 4.52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
    issue PACs .
    5. -A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A .301 through 68A.303 and rule 351-4.25.

    6. That the committe will continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of
    dissolution (D~ tO~gen filed .

    Si ature of Tyeasurer Date Signed

    a - zo
    of Candidate, OR, for all other committees, Chairperson Date

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