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FOR INSTRUCTIONS, SEE BACK OF FORM

CHECK ONE: FORM STATEMENT
I]This is an initial' Statement of Organization DR-1 OF
VThis is an amended" Statement of Organization
(Rev, 01/2006) ORGANIZATION
'An Initial Statement of Organization must bra filed within 10 days of the c For Office Use Only
m.9king eyponditures . or Incurring indebtedness exceeding 9L750. Amen of Comm . #
a change Penalties may be imposed for late-filed Statements of Organization. A cnndideto w Indexed
committee that exceeds 5750 In activity for another office shell file within 10 days either a new or Amended
Audited
DR-1 drsclosinp information concerning the campaign for the now oTce sought .
Computer

COMMITTEE NAME : (A candidate's committee must Include the candidate's last name In the name of the committee .)

LA Voy1y} e- 6 ;(- Y- q L,( -nn

rIMPORTANT : Indicate type of committee you are reporting for: _
( 1 )StatewidefLegfclative/Judge Standing for Retention Candidate ( 2 )Statewide PAC (3 )State Party ( 4 )County Central Committee
( 6 )County Candidate (8 )City Candidate ( 7 )School Board or Other Political Subdivision Candidate ( 8 )County PAC (9 )City PAC
`(10 )School Board or Other Political Subdivision PAC ( 11 ) Local Ballot Issue (Including committee Involved in multiple, city/county ballot Issues) I

COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (mandatory except for a candidate's committee)
Name e_ ~o ~~Ql
l?~o te
Mailing Address "l Melllng Address 1 1

City, State : y Zip Code City, State W Zip Code y y

12C'rs a r &%( a
t r
Phone uS y i2 ~ceNr Phone ( )

e Mail _ _ e-Mail
INDICATE PURPOSE OF COMMITTEE Check One Box 0 Advocate for/against candidate(s) Advocate for ballot issue(s)
Comment or descr iption : Advocate against ballot issu e
All Candidates Enter: County/Local Candidates and Local Ballot Committees Enter:
Office Sought :
County: . U
-'- 4VIrVlUE~1-11E K
I Political Party (If applicab'e) (If active In multiple ballot issue elections, attach list of counties

District : IL%n v\ P--C, Date of Election :

Year Stnnding_fCr Election : 00
Bank Account Na rnj L .I. Candidate name & Address or PUAt1tF ty (PACs. if applicable},
y :. Yf-il_(W. of Sponsor

LAVonlAlc bJERC(lrt LAVI 0-

Name of Financial Institutlonltype of Account Mailing Address

~~~K OF Ir-/E ~CSi --/7q,2-

Pria llng Address 1. .1 . City d. y State i .1. Zip ..

_ F1 `TC i sal®l

City y State +-

1)GeL (Z r-A1-I

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

1 . The committee and all pe^^ora connected wllh the committee understand that they are subject to the laws in Iowa Code chapters 68A and 688 and the administrative
rules in Chnpter 351 of the Iowa Administrative Code .

2 That Iowa Code section 68!', .402 and rule 351Jt,9 require the Illlng of dlsclot:ure reports and that the failure to file there reports on or before the roqulrcd duo dates
subjects the candidate or chairperson (In thin case of committee.q other than a condldale's committee) to the autom311c assessment of a civil penalty and the possible
mpor;ition of other rrlmlnrlt and civil sanctions.

Thai Iowa Code section 68A.405 and rule ; 35t--t 38 through 4,43 require the placement of the words "pald for by" and the name of the committee on all political
n Aerial ; except for Ilionsc items exempted by statute or rule A committee that wishes to register a committee name for purposes of using the shorter "pad for by` and
does not mend to cros^. the 7,750 filing threshold !
.half file the Form CP-SPA form .

4 . Teat lokvi Code section 884 .503 and rulrts 351--- t 44 throuqh 4 .52 prohibit the receipt of corporate contributions by all committees except for statevrlde and local ballot
issue PACs .
` . A candidate and a candidate's committee may only expend carrpnlgr fund : os permitted by lows cede sectlans 68A.301 through GBA.303 end rule 351-4.25 .

G That the committee viii[ continue to file disclosure reports until rill activity has cegsed, committee funds spent, debts revolved, and a fnal report and a statemert of
dirSOIUtian (DR-3) ha ; been filed .

Signature or Trcarurnr

I other Committee .- . Cnairccr.c n