Klein, Jarad Amendment 1705

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FOR INSTRUCTIONS, SEE BACK OF FORM " ; FORM STATEMENT

CHECK ONE: frn 7 DR-1 OF


'M This i s an initial' Statement of Organization /11r'1 1 (Rev. 01/2006) ORGANIZATION
'This is an amended` Statement of Organization
iNtiM Statement of Organization must be filed within 10 dais of the oommdtee's accepa
making expeXhees, or g indebtedness exceeding $750. Amendments must be Ned within 3
a drarg&. PerlaBes may be imposed for late-idled Staternerrts of Orgawatiwr_ A candidate with an open
comnrlttee that exceeds $750 in activity for another ofe shag fide within 10 days either a new or amended
DR-1 disclosing information concerning ft campaign for the new roe sought.
COMMITTEE NAME 1 1 (A candidate's committee must include the candidate's last name in the name of the committee)
Klein for Statehouse
i s I type corwttittee you are reporting for. ff--l
(1 ' Judge Standing for Retention Candidate (2 ),Statewide PAC (3 )State Party (4 )County Central Committee
(5 )County Candidate (6 )City Candidate ( 7 )Sdwol Board or Otfisr Political Subdivision Candidate (a )County PAC (9)Clty PAC
(10 )Sdwoi Board or Other Political Subdivision PAC (11 ) Local Ballot tssue(including cornmittee involved in multiple city/county ballot issues)

COMMITTEE CHAIR (mandatory except for a candidate's committee)


Name 1 x ~ ctrl'
y ,lo-c-WA
Mailing Address 1 1 `'7
144 KeOkvk Wo,S ~L
City, State 1 1 Zip Code 1
KLh-Tl'tl~ . , =A S -zZy :p

Phone (Sr)') 6 3r( - OTs' 3

e-Mail
INDICATE PURPOSE-OF COMMITTEE - Check One Box Advocate for/against candidate(s) Advocate for ballot issue(s)
Comment or description : Advocate against ballot issue(s)
All Candidates Enter: ounty/Local tes and Local I of Comm Enter :
Office Sought: S'~ 0 V~0vse
County :
Political Party (if applicable) e- P ub I ; c-tX+1 . (If active in multiple ballot issue elections, attach list of counties
District: H 17 S9 ~-V
-. Z cD 0-8
Year Standing for Election : a oo '? Date of Election :

Name of Financial Institution/type of Account .I- 1

City 1 1 State 1 Zip 1 1

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

1 . The committee and all persona 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 680 .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 civd 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 dose items exempted by statute or rule. A committee that wishes to register a canmittee name for purposes of using the shorter'paid for try' and
does not intend to cross the $750 filing threshold shall file the Form DR-SFA torn.
4. That Iowa Code section 68A.503 and rules 351--4 .44 through 4.52 proh ibitthe receipt of corporate contributions by all oonmdtees except for statewide and local ballot
issue PACs.
5. A candidate and a candidate's convnittee may only expend campaign funds as permitted by Iowa code sections 68A.301 through 6aA.303 and rule 351-4.25 .
6. That the will continue to file disclosure reports until all activity has mod, committee funds spent, debts resolved, and a final report and a statement of
dissolution (DR3jxas been filed .

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