2010 06 04 - DR 1

Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

FOR INSTRUCTIONS,SEE BACK OF FORM

GHECKONE:
EI fni,s is an tni0aFStabmEntof Organizdion
E fnis is an arnended"SiatEmentoTOrgJnbaton Reset Form
t-_--.
:-Wy_!-yy_Wglo^!aus.or@;;_@E,catuturtuts,^m,goffi
inanins debsex nc Vil. Azr,ohdneng
;"s b:iiA-,ffi;trd#& "
Eftdive January I ' mt0, aI silebmenb ard reports neO oy lw
[ffi];*'*'"
@mnitbes br stab ofi@ must bo filed
oloctuordcaly
andefrcfveJanuary
1,m12,anmementEino teporrsffi oiibffinnpomstub
muS be flEd elettrordcalty. ofice

J J 6 carffimt cfiurree mrsnnrOrf"m""rUOm


p|liloftlnameh( ).
F,i, ]>
e
erS
. t>*
tfFORfAilT:,lndlcab typo ot
( t [rwddelLabHwiJ:9ge-stattddE-tolgun[oncaruco-]lsamrreeplc(3xsr6p8nt rft
-{
t4lcoudrcermrconnrrueoT
!:jffi,,ffi;|:l*gfj3Jfgg*seoorooiriorucai-surcnirir#--canriGd (epn,pAc{
iiid"u,,ryeec =

r-,,Ev_
!F ==
l*hnhgAftlress
J l,lozoo -ngrdAvenue (!lffi
cny,sreJ{ zpcodeJffi Cfiy,S@ ZpCde

Phone1319) 462-3619

Adwcab forfagahsil caldidale(s)

courds Jones
PolilicalPartyGfappn"a661Democratic --
(l' actrugm mumle balot lssue 6lecfrm8, aliadt Estd@urffi

l,lanpofFhsndallnsffn.donfiypaotA@mt + J
CiBzens
Bank-clrcking account
ItlaflingAddress + J ;ity + + tuJ { ap +.1,
215EastMainStseet Anamosa lA S?2Os
ciry + J snae0 ! ap 0 t
Anamosa tA S22Os t319) 462-3619
Prrone

srArEuENT oF AFFIRilAnoN: ry oilng thb documsnt ore commft@ affrms fte fottfltng:

1-.The dnmftFe_and-al personscotltEctedu,ih tfiecommltee rmdelstandthalthey ale sut ecitoth€ laws ln lowacorb cfiapErs 6sA and
688 andtfte admlnhfatile
rul@ in Cfiapter351 of the lowaAr[mlnlsffiire Code.
2' Thatlowa code secdon684402 a,lg ge 35rJ.9 rcqulrothe flr€.d dlsdcur€ reportsand that ths lbflureto fitettE€g repqb on or
strbJe.btF candldatEor cfiatuperson berlbrethe reqlilreddue ddes
(h the @e d cornriri&€sdrcr-than a canool*Jt commineetto tre-alrd;ii; Gssnnett ot a clvitpaa1y anrl tre p*lbl€
Unpcltlon d oOErcrilnhet and dvil sardons.
3. That lou/aCqle [email protected] rute8351-4.3s through4.rt3.^requheare plremant d fre rrcnls "paldtbr blf and t1g nameot the @mmll€e on a[ poltcal
mffils excepttbr thcs ltsms@nt@ by stsfiJtgor rute. Acommite6 ura wbires to regffi a qnmn6i -_ - namJfur purpces of ugng te ehotbr 'patd for blf ard
- - '- --
do€snot inbnd to crossthe 97grofffingthregholdstEll fle the FormDRSFA form ln lleu ot fi]lmgthls tbtfm.
4' That l@ Cqte sedon 68A503 and rutes351-4.44 tluotrgh4.52 prohlblttle reeipt ot corporateconfibutlonsby alt commril€
exceptfor hltot issuepACs.
5' A cardldaleatd a catrddattb crynmflce nny onlyepend camplgn frmds6 pernlted by lolp de s€c66666aAg11 thrcugh
@A,g1trtard rule gst-1.2s.
disd6ure rwtts ufttl all advity 1t6 (d, oommneEtundsspe!|t,deb rcsolved,ard a linal rwn anrl a sffiernenrof

6; - g *'/P
t alesl.gnerf - r

b- s- toro

You might also like