FOR INSTRUCTIONS, SEE BACK OF FORM FORM ‘STATEMENT ‘CHECK ONE: DR-4 oF Cy Thiele an initia Statement of Organization sn ETHICS ANU (ev o77200,_| ORGANIZATION This is an amended Statement of Organization For Office Use Only Comm. # ‘An okie! Statement of Organization must be fied within 10074 Vail Avenue Cw Sate + 3 Ze CoH eeSter City, Iowa 50595-0304 Sen Sale TT Eaters towa 50271 Prone (515 ) 852-5324 Phone (515) 854-2486 mas silfidaySo@hotmall com entai_Connieln@praireinet net INDICATE PURPOSE OF COMMITTEE Check One Box CT Advocate frogs cardtes) [] Aavoras fr bait eG) Comment or deseripion D Advocat asia bolt iave() ‘AllGandldates Enter: ‘Counkycal Candies and Local Ballot Commitiees Ener Ore Sought County —eS Pte! Pay (appa. (Waste mapa Bat ae eons iach Tao coos Dati Date of eeton: ‘Yea Sanding tor Easton Bank Account Hams (mut match commiioe naa) ‘Sa name Aan Pant Eni PAGS Cana tt of ‘Alster Soonsar Hamiton County Republican Central Committee Nan of Francal Inetaontype of Acsunt tT ating Arose First State Bank / Checking Account ating Adsress 7 wT Bae te TT P.0. Box 70 Cuma ind fae ae TT | | ‘Webster City, Iowa 505960070 uals ea STATEMENT OF AFFIRMATION: By fing this document the commie aftrms the following 1. he commites ands persons connected wah the commitoe understand thal they ae subject to the laws in lowe Code chapors BEA and 6B andthe adminstratvo ‘en Chop 351 fhe lowe Aaintitve Cae 2, Tha lw Code section 884.402 andre 3514.9 requir the tng of lose foots an tha he ature ole these reports ono ele the requred due datos ‘subj tho candi or charporson (ho cave of commas ther tana candidate cme) othe alomatcasceomonl faci penal and the pousble impoaton o oer enninal and ca sanctions ‘3. That ona Code section 8A 405 and nes 3514.3 trough 443 rue the placement of he wor "paid for by” and he name of he commas on a otal imatral rca fr hose lem oxempled by ale ore. Acomsroe tha shes orgie a Conenton name for pips of cing th shore “pl oO and ‘oe nt inte o eae the $780 hn treed shal the Fonm OF SPA forme fg es or “4. That own Code sation 68A.503 an res 3514.44 hcugh 452 poi he recip of corpora contibutons by ll commons oxcopl fo statewide and kcal al ineve PAC. v's commit may ol expend campaign funds as pormtd by lova code section 63A301 though GEA.303 and le 3514.25. 6. Tat ine conte wll canine le ets opt nti all activity has cased, coments funds spent, debt eslved, a al rot and satan of