2010 06 25 - DR 1

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FOR INSTRUCTIONS,SEE BACK OF FORM


CHECKONE:
El This is an Inl6al" StatementofOrganizalion lffi;ffit
tl Tntsb anamended'Statement
oi organlzaton
r Sfalemenfmus be fle.l withh 10tlays of crlmnlttec wpilng @ntibadiclns, lt$ffi[q.S-IRjll
n*try exffittnea','ffi
lry-wtitg ddbtsexceeqqS$750. Ametldme/,i.smuslbe filed wilhln 30 daysd a clrirye.'
Effec$veJanuary 1, 2010. all stalemenlsand rqoils fled by neu,coinrttt6€3 6r BtataoflfcemL€tbe fl€d
electronlca$yandeffEctve Jan ary 1,201?.a1lstatementBand feports0l€d by alt comrttt€€s forolsto oftoo
musf be filed eleclronlcatly.

COMMITTEENAME 0 $ (A canddate's cornnrllleemr.rsthd(rde ths cm.fldate's last nanrEh ttrg nameolthe cornmntee.)tt amendngmnrnttee name,
putoldnarrEln( ).

: Indlcato tlrTo of commlttso you are


( | Fratevrld,en
eglslatlvdJudgesndlng tor RoterdonCandldateT, PAC(3lstrleParty( 4 )CountyCanealCommtltoe mr-
| |
( Elcounty Candldala( C)CltyCandklate(.7)SchootBoardor Other 8 )Coung PAC ( g )clly PAc -!t
( tO lsohool Boardor OtfterPolltbalSubdlvblonPAC I tl I Be[orhr ,'--'l

all
ffinu'gb8arostey TBFnh*tr"' :]E
UallnoAdrtr€ss {, +
6E1SanduskyDr.
'f8Fiffiffi"{"{ct
C.it

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tg'if"-eilyi "EffClii,trffi;- -
Phon€(319 I 688-5859 Phone t31er999i99l
*"r,, [email protected] .-n,o [email protected]
INDIGATE FURFC,SE OF CC,dIISITTEE - GhECI( ONE EOX LJ AdvocatebrragBhd cendldde(s) f Advocrbforbalotlssuqs)
Cornmentor dEscrloton: n Adreale adalnrt ballot lMtcl
A[ CAnoloat€a E|tlon CormilyrLoEalCandldet6 a|rd Ba$otbgug Gornmltte@Enlot:
Off@Sowht:
county: Johnson
Pdltlcal Paty Cfapp[cable) (lt ett B hr mulilpleballotlssueelet{lons,attachtrglof coutieg
Dlstlct
-Ngvenlter.ZrZOtO
DstootEtecoon:
g3!!SSSSUS-EC@,(murrmarcncolrlnutree
JO
narE, **i$*orffi
21 Makes Sense
Narneof Finardal InsdMon/typeolAccounl J .l MalXrE
Addr€ss J .1,
MldweetOneBank/ Checking
MalfqgAddress 0 ,1, ClfV + + StateJ J Ap J 0
102 SouthClintonStreet
Cny .L J Stalal l. 4 {. +
Phone ( )
fowa Ci$ lA 5224/.

STATEMENT OF AFFIRMATION: By fillng thl6 documert tto oofnmlttee affrm the loflowlng:

L Tho comml0se ard a[ p€'3ons @nnecied s,Ur the cqnnlttee understard thal tl€y ar€ subJed to lhe lswt ln tofa Code chap{tro eAA afld 088 afld ths admlnlsmfve
rules ln Gh@ts 361 ot lhe lowa AdmlnidrAive Code.
2, Thst lov6 Code &n 64"4o2 ard rule 35't -4.9 rssrhe lfte glhg d dbdqro roporls snd &at lhe tBlturelo fla rhesa rapons on or beforo the raqstsBddue dats
$SFds ths @ndidate dcftalrpereon (h tftecaso ot@nmltbssolh€r thdra amddatEs commltbo) lo lh€ aubnaucasgos€nentola dvll ps|alty and lhE pcs[de
hpGilim of ohs ('tnlnal and clvil eandons.
3. Thel losra Code 8€cdon AaA.405 atd rules 351-4.38 thrcugh 4,43 rBq{rtsstho placsrnent ot the $6rdrE'pdd tor by'and tho narne ot the @rnmtttee otr an poillical
materlat8ercept lor lhooe llems €snpted by stalutg or rule. A @rnmltloo that wlsho to re$obr a 6mmlll@ namo (or nrposas ot uehrg$e Bhorta.'patd lbr hf a|d
does nol hterd lo crcs lhs $750 fihg tht€rfiold dra[ f ls lho Form DR€FAfom h lleu dfthg thls form.
4. T}rat losra Code sedht 644803 and rul€s 351-4.44 throwh 4.82 prohlblt ths rgcdpt d corpqale confih.dg|6 by a[ oomrtttaes elql for ballot lssue PACs.
6. A candfulateand a oandidate'ecommttteemay only oreend campdn fuids as permlted b loula @d8 ssc{ons 68A"301 fu{xrgh 68A"301ta.d rule 361*4.25.
3. Thattfteommltee wlll contho lo filodMosurc all acthdyhasosasod,confiritbo fundsspsr&d&ts r€sohrBd.
anda lhal roportanda dal€mail of

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