08 :11 3192341194 COMMUNITY NATL BANK PAGE 02/02

10/17/2e85

FOR INSTRUCTIONS, SEE BACK OF FORM

FORM I STATEMENT
CHECK ONE :
of
0 This is an initial' Statement of Organization DR-1
(REV, 05/2005) ORGANIZATION
Vd This is an amended' Statement of Organization
'An initial Statement of Organization must be filed within 'to days of the committee's accepting contributions
. For Office Use Only
making expenditures, or incurring indebtedness exceeding $7&). Am, BAt rfI within 30 days of Comm, #
a change Penalties maybe Imposed forlate-Bled Statements bf' 'iA t with an open Indexed
w or emended
committee that exceeds $750 in activity for another office afif f e Audited
DR-1 disclosing information concoming the campaign for the new 'd Computer

COMMITTEE NAME ~ J, ul.1 I C r_uu~

CITIZENS FOR HURLEY

IMPORTANT: Indicate type of committee you are rwxtl
( 1 )Statewide/Legislatly In for Ratentlon Candidate (2 )Statewide ( d )State Party ( 4 )County Central Committee
8 )County PAC ( 9 )City PAC
(6 )County Candidate 6 )City Candidate ( T )School Board or Other Political Subdivision Candidate (
10 School Board or O division PAC 11 Local Ballot Issue
COMMITTEE TREASURER mandato for all committees COMMITTEE CHAIR (mandatory except for a candidate's committee
Name 1 J. Name 1 1
JOHN SPEAS
Mailing Address 1
ROAD
City, State 1 1 Zip Code 1 1 City, State 1 1 Zip Code 1 ..
WATERLOO IA 701-5223

Phone ( 319 ) 235-2410 Phone ( )

JPSPEASI?)MCHSI .COM e-Mail

e-Mail
INDICATE PURPOSE OF COMMITTEE - Check One BOX J Advocate foriagainst candidate(s) Advocate forlagalnst ballot issue(s)
Comment or description:
All Candidates Enter:
Office Sought ; MAYOR- CITY OF WATERLOO
District:
2005
Political Party (If applicable) NA Year Standing for Election :
Countylt-ocal Candidates and Local Ballot/Franchlse Committees Enter
Date of Election ; 11/8/2005
cp,rnt , BLACK HAWK

Bank Account Name Candidate namo A Address or Parent ErttlW CPACs if applicable).
1 1 Affiliate, or 112onsor

CITIZENS FOR HURLEY TIM HURLEY

Name of Financial Instltutionltype of Account J. 1 Mailing Address 1 1

COMMUNITY NATIONA L BANK 1933 CRABAPPLE LANE

Malllng Address 1 1 City y y State J. I Zip 1
422 COMMERCIAL ST WATERLOO IA 30701

City J. 1 State y y Zip 1 1 23 2-1752

Phone (319 )
WATERLOO IA 50701
e-Mall

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

1. The committee and all persona connected with the committee understand that they are subject to the laws in lours Code chapters 68A and 68B and the administrative
rules In Chapter 361 of the loom Administrative Code,
reports
2. That Iowa Code section 68A,402 and rule 351--4.9 require the filing of dlsclowra end that the failure to file these reports on or before the required due dates
subjects the candidate or chairperson on thecase of commKtees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible
Imposition of other criminal end civil sanctions.

3, That Iowa Code section 68A.405 and miles 351--d,38 through 4 43 require the placement of the words 'paid for by' end the name of thecommittee on all political
materials except for those Items exempted by statute or rule, A committee filing this statement for purposes of using the shorter'pold for by' end who have not crossed
the $760 shall notify the Board that the $750 threshold will not be crossed,
4 That Iowa Code section a8A.503 and miles 351-4,44 through 4 52 prohibit the receipt of corporate contrlbutlons by all committees except for stataMde and lord ballot
issue PACs,
5 . A candidate end a candidate's committee may only expend campaign funds as permitted by Io+q code sections e8A .301 through 69A,303 sand rule 351-4,26.

6, That the committee vAI1 continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of
dissolution (Dg.2)~b!"d,

9/.~~q X~qa05 Dole Signed

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~12 ~ ZQOS
r Dole Signed