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    C.'R &N, RS A, R, ALG (K: - FXT Instructions, See Back of Form Check One: F

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    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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    C.'R &N, RS A, R, ALG (K: - FXT Instructions, See Back of Form Check One: F

    Uploaded by

    Zach Edwards
    19 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

    2005-11-08_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
    19 views1 page

    C.'R &N, RS A, R, ALG (K: - FXT Instructions, See Back of Form Check One: F

    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
    Download as pdf or txt
    of 1

    -FXt INSTRUCTIONS, SEE BACK OF FORM

    CHECK ONE : Reset Fotm FORM STATEMENT


    F-. llis is an initial* Statement of Organization DR-1 OF
    L_ This is an amended' Statement of Organization (REV. 05/2005) ORGANIZATION
    An initial Statement of Organization must be filed within 10 days of the committee's accepting contributions,
    making expenditures, or incurring indebtedness exceeding $750 . Amendments must be filed within 30 days of
    a change . Penalties maybe imposed forlate-filed Statements of Organization. A candidate with an open
    committee that exceeds $750 in activity foranother office shallfile within 10 days either a newor amended
    DR-1 disclosing information concerning the campaign for the new office sought.

    COMMITTEE NAME 1 1

    <fc- VV\l(A, -c-iZf- L c.'r &n,rS A, R,ALG(k


    IMPORTANT: Indicate type of committee you are reporting for.
    (1 )StatewidelLegislatlve/Judge Standing forRetention Candidate ( 2 )Statewide PAC (3 )State Party (4 )County C4NtratCorWittee
    (5 )County Candidate ( 6 )City Candidate (7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC (-!)CttyPAib
    (10 )School Board or OtherPolitical Subdivision PAC (11) Local Ballot Issue
    COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
    Name mil_ 61 Name 1 1
    ., >nrvtrS ~L
    Mailing Address II I ~~ Mailing Address 1 1
    ZZO NGS
    City, State 11 Zi- Code I I C,L ~ t City, State 1 1 Zip Code J. 1

    Phone ( Phone ( )

    e-Mail e-Mail
    INDICATE PURPOSE OF COMMITTEE - Check One Box 2-Advocate for/against candidate(s) Advocate forlagai Mot issues)
    Comment or description : ~(,q C-CLOU -T6 S t Uu4 Ct2'y , CLr\4 CatL)NC, L Cr O ,AW<S A 6q[G a
    All Candidates ESVer. ~
    Office Sought: 5L()1l1G Gl' ~tLN 1JUN(2.J 4-
    District:

    Political Party (ifapplicable) 0G P- (~- Year Standing for Election :


    CountylLocal Candidates and Local BallotlFranchise Committees Enter.
    of Election:
    County: CU )ry' 1 Q C3
    Ue::=id

    Bank Account Name 11 Candidate name & Address or Parent Entity (PACs, if aonlicab)e).
    1 1 Affillate. or Sponsor

    CGVy1.IMI,TZGc~ -CO CrL,0-;Z-T m,~, A . [4469- Jtd,lvtrs AL U4cG R


    Name of Financial Institutionitype of Account 11 Mailing Address 1 1

    A 1 ~-P, e1~ Sl. -~-


    16w Lu ZZ .xJ l,~( N GS aL G
    Mailing Address, 1 1 City 1 1 State 1 1 Zip 1 1

    ~2-U ~~i IU ~S t G ~W S'(UU y GlT'i 1(i-- jl L G


    City 1 1 State1J. Zip J. 1 Phone o ('L-I -3 - 6odcn o
    Sl UJ V GI'J
    Z=:~,
    ( (~- e-Mail eTJk4l. w e

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

    1 . The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 6aA and 68B and the administrative
    rules in Chapter 351 of the lows Administrative Code.

    2. That Iowa Code section 6aA.402 and rule 351-4.9 require thefiling of disclosure reports and that the failureto file these reports an or before the required duedates
    subjects the candidate or chairperson (in the case of committees otherthan a candidate's committee) to the automaticassessment of a civil penalty and the possible
    imposition of other criminal and civil sanctions.
    3. That Iowa Code section 68A405 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 forpurposes of using the shorter'paid forby' and who have not crossed
    the $750 shall notify the Boardthat 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 forstatewide 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 committee will continue to file disclosure reports until all activity has ceased, committee funds spell, debts resolved, and a final report anda statement of
    dissolution (DR-afIlias been filed .

    IL ~
    Date signed

    e Signed

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