_ : 11 5a1 ~15a~,8 raREEIIE FUELIi.

LIBR~;R

RM
FOR INSTRUCTIONS, SEE BACK OF FORM Statement of
DR-SFA
will nq( be (Rev . 0112006) Orqanizetion
am tiling this form to use the shorter "paid for by" attribution . The committee
'Paid For BV'
crossing tho $750 threshold.`

must be filed within 10 days For lc~ Usn my

-N the 0ornrrnirt4o crosses the throshold. an initial DR-1 Statement of Organization
incurring indebtedness excaecu'ng S750, to Comet. #
of the crirrrnlrl"'s accopliN contributions, making expenditures, to
addition, tho committee will be required to 1110 campaign disciosura reports . indexed
Audited
LComputer

COMMITTEE NAME 1. ~ (A candidrxo's con1mlttee must Inoude the csndidati last name to then name of the commilteo.j

wPOO : n gale type o committee you are registering for

Central Committee
( 1 )StatewidolLoglolatlvv/Judge Standing for Retention Candidate (2 )Statewide PAC ( 3 )Stato Party (4 )County
)City PAC
(5 )County Candidate (G )City Candidate ( 7 )School Board or Outer Political Subdivision Candidate (8 )County PAC (9
(10 )School Board or Other Political Subdlvlaion PAC ( 11 ) Local Ball ot Issue(Includins oommittee Involved in. mulGple cltylcounty ballot Issuex)

COMMITTEE TREASURER (mandatory for all committaea) CANDIDATEICOMMITTEE CHAIR (mandatory except for a candidate's
committee) ~ . ._
Name Name 1 Z
d r ~
1
Mailing Addre"FA Mailing AddrasI7

City, %ote~ Zlp Coda . City, Slate 1. Zip Code1 1

Phone to /I ) qa 11>7 Phone

-Mad 6D ~,e
INDICATE PURPOSE OF COMMITTEE - Check Ono Box Advocate for/against candidata(ts) [] Advocate for ballot issue(n)
Comment or description: AdvoCstP ,64fiirlst ballot i4.~.sue(s)

All Candidates Enter- County/Local Candidates and Local Ballot Committees Enter :
Office sought HI _i~ _P _
1L County :
Poetical Pony ( .f applicaolo) -C-4Qzdt (It active in mu pits ballot issue elections, attach Its! of counties

YPar Standing fpr Election : ,~-

Date of Election . QkWW
STATEMENT OF AFFIRMATION: By filing thle document the cornmitteo affirms the following :

1. Thd committee and all persons connected with the committee understand that they are subject to the tows in Iowa Coda chapters 68A and 685 and the adnllnislrtitire
rulae in Chapter 35 1, of the Iowa Administrative Code .
2 Tbat IoA" o Coda aac6on 68A.d05 and rules 351 -4 .38 througt, 4.43 raquira the placement of the words 'paid for by' and the name or Ine commltiee on all polltlc&I
rr~Mnaiz e~cMt for lhe3a item% exempted by 1411,311- or rule .

3, That lorta Code secnon 88A.503 and nlas 351 -4 .44 through 4 .52 prohibit the receipt of corporate contributions by all cornmittees arcopt for slatewi;ie an(J Ioc,+l fp311 ;,1
r :csue PACs
4. That Ir the. cornmitt9e oxeoads $750 .n campaign ucaviry, a OF-' Swoment of Organization muse be filed with n 10 days and the committee is required n file campaign
di~clonure rapomi .

RECEIVED
FAX

JUN 15 1UU6