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    1998-05-11 DR1 Amended

    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

    1998-05-11 DR1 Amended

    Uploaded by

    Zach Edwards
    25 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.

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    1998-05-11_DR1_amended

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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
    25 views1 page

    1998-05-11 DR1 Amended

    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
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    FOR INSTRUCTIONS, SEE BACK OF FORM FORM STATEMENT

    CHECK ONE: DR-1 OF


    This is an initial" Statement of Organization (Rev . 05/02) ORGANIZATION
    g This is an amended" Statement of Organization
    For Office Use OnIV

    An initial Statement of Organization should be filled within 10 days of the committee's accepting contributions, Comm . #
    making expenditures or incurring indebtedness exceeding $750. Amendments should be filed within 30 days of a Indexed
    change. Penalties may be imposed for late-filed Statements of Organization . Audited
    Computer nQ

    COMMITTEE NAME (Required by law)

    IMPORTANT : Indicate type of committee you are reporting for :


    ( 1 )StatewidelLegislative Candidate ( 2 )Statewide PAC ( 3 )State Party C4)County/Local Candidate ( 5 )County PAC ( 6 )Ballot Issue/Franchise
    Committee ( 7 )County/City Central Committee ( 8 )Support slate of candidates (list candidates under purpose of comm ittee)

    COMMITTEE TREASURER This address used for all reminders and COMMITTEE CHAIR (List additional officers on separate page)
    (Required by law) correspondence)
    Name Name
    ~ A 1a
    P ~ lr"I 1 ~ Y t
    Mailing Address Mailing Address

    City, State Zip Code City, State Zip Code

    o IP.""-~~~Z
    Phone (Ila) L.~A __2LI Phone( )

    e-Mail 11'1'4 1-H i~ }7 Cp M n+e"+ e-Mail


    INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate for/against candidate(s) Advocate fo ' gainst tlallot issue(s)
    Comment or description : c
    All Candidates En^er " ~~ _
    Office Sought "~1:.~i~/3 " '(riW District: `-==
    C _ m
    Political Party (if applicable) 11Im o era-+- Year Standing for Election : 'a..
    00 c
    _ '-
    County/Local Candidates and Local Ballot/Franchise Committees Enter:
    County : S-I-c Y ~f Date of Election :
    , l~v,
    a~~ '"
    Bank Account Name I .( Candidate name & Address or Parent EntiiifPACS . if7m)Olicable)-
    Affiliate" or 5eonsor
    "-
    ~(~n'l 41!3) (rte o
    Name of Financial Institution/type of Account I 1 Mailing " ddress 1 I

    O~?r Y c,t-2J
    Mailing Address City .I- ~- State .I- ~- Zip 1 .I-

    co( oo 10
    City I 1 State 1 ~. Zip .I- ~. Phone 1 ) CJ

    6c)-o-01 e-Mail -d l~-hoC .~ a7 a.o ,. t^p M


    DISPOSITION OF BALANCE OF FUNDS UPON DISSOLUTION (Statement of intent required by law for all committees, except state parties and central
    Indicate disposition of funds by marking appropriate number in box: committees and committees using only personal funds.)
    (1) DONATED TO COUNTY CENTRAL COMMITTEE RORATED REFUND TO CONTRIBUTORS
    (2) DONATED TO LOCAUSTATE/NATL POLITICAL PARTY (underline one) (7) TRANSFER TO ANOTHER COMMITTEE OF THIS SAME CANDIDATE
    (3) DONATED TO CHARITABLE ORGANIZATION (CANDIDATES ONLY)
    (specify) (8) RETURN TO PARENT ENTITY GENERAL FUND (PACS ONLY)
    (4) CITY/COUNTY/SCHOOUSTATE OF IOWA GENERAL FUND (underline one) (9) OTHER (PACs ONLY), PLEASE BE SPECIFIC
    (5) PARTISAN CONGRESSIONAL DISTRICT FUND

    STATEMENT OF AFFIRMATION BY TREASURER AND CANDIDATE ; OR POLITICAL COMMITTEES, BY CHAIRPERSON


    I am aware that I am required to file disclosure reports if the committee receives contributions, makes expenditures, or incurs indebtedness in excess of
    $750 .00 in a calendar year to expressly advocate for any candidate or ballot issue. I understand that although the treasurer normally prepares and files
    reports, the candidate or chairperson (PACs) is responsible under the law for accurate and timely disclosure reports and that late-filed reports are subject
    to civil penalties and possible other legal acti I understand that by filing this form, I am subject to the laws found in Iowa Code chapter 56, chapter 68B
    and administratilrules found in chapter 351 I affirm that all 4nmittee officers have been informed of their gppointmerlt and obligations .

    ill 1~ la~~
    Date Sighed

    didate, OR, if PAC, Central Committee or Local Ballot Issue, Chairperson J Date Signed

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