FOLLETT INII PROPERTIES Fax :916-852-0115

Dec 2 2005 10 :55 P . 01

Revised 07/04

ICS AND CAMPAIGN DISCLOSURE BOARD Form DR-OTC

510 EAST 12T", SUITE 1A ONE-TIME CONTRIBUTION IN
7,t,F~
DES MOINtS, IA 50319 F7 ..Sa.yE^,~w
P

Sx ;~;J EXCESS OF $750 BY A

011511-1
,~

PERMANENT ORGANIZATION
t .

Fax: (516)281 " 3701

QEC
" 2 7005 www.iowa.govlethics For omce use only
Indexed
ONE-TI CONTRIBUTION IN EXCESS OF $750 Audited
PERMANENT ORGANIZATION Checked
Computer
Iowa Code section 66A .402(9) requires a permanent organization that contributes in excess of
$750 to register and file reports as a PAC. Thif form is intended to serve those purposes . lee
form mint be ed wit e Boar on or before the tenth day of th20ate the Merit was issued .

ORGANIZATION MAKING CONTRIBUTION :'

South View Investors, LLC

N2 X11 Gold Country Blvd ., #100, Gold River, CA 95670

Mailing Address City. State, ZIP Code
916.852 .0112
Emall Address (Optional) Area Code & Telephone No .

CONTACT PERSON FOR THE ORGANIZATION :

Casey K . Kelly

NIT21 l Gold Country Blvd ., #100, Gold River, CA 95670

Maillng Address City, State, ZIP
916 .852,011 2
Email Address (Optio nal) Area Code & Telephone Nu mber

CANDIDATE OR COMMITTEE RECEIVING THE CONTRIBUTION :

Iirn Nussle for Govenor

Name of Candidate or Committee
P. 0. Box 7701, Urbandale,1A
Mailing Address City, State, Zip Code 11103/05 s 2,500.00
515.282 .0606 Date of Contribution Amount

Email Address (if available) Area Code & Telephone Number

Date of Election County (if Applicable)

If contribution to candidate, disclose source of original funds used to make

such contribution (attach additional pages If necessary) . If In-Kind Contribution, Describe

Criteria to use this form:

One campaign contribution In excess of 8760 was made to a state or local candidate, party, political committee (PAC) for either a
candidate or a ballot issue, or any other organization that advocates the election or defeat of a candidate or ballot issue.
2. Must be a permanent organization not established for election purposes.
3. No person gave money to the orgartlzation for the purpose of the organization then using the money to make the contribution .
4. if the contribution was made to a candidate, no funds from a corporation or other prohibited contributor under Iowa Code section
6M503 were used to make the contribution (this does not apply to a contribution made to a ballot Issue committee) .
5. Only one contribution to any campaign committee except for a ballot issue committee was made In a calendar year. No more than one
contribution may be made to any one ballot issue committee during a ballot issue election, if more than one contribution and the total
amount of the conlrlbutions exceed $760, the organization must register with the Board as a political committee (PAC) within 10 days of
erosslna the $750 threshold.

Statement of Affiffnation :
I Casey K . Kelly affirm that the contribution reported above Is accurate. I further affirm that the information concerning the organization Is
correct and true to the best of my knowledge . I understand that by fling this form, I am subject to the laws found In Iowa Code chapter 88A and
administrative rules found in chapter 351 . 1 also understand that the failure to timely file this form leads to the Imposition of civil penalties end the
intentionobo&ue to Ale the form may lead to additional civil and criminal sanctions .

A In -5
Date

"Contribution" includes goods or services that are provided for free or otherwise leas than fair market value .