For Instructions, See Back of Form Check One: DRA

FOR INSTRUCTIONS, SEE BACK OF FORM
CHECK ONE:
0 This is an initial* Statement FORM STATEMENT
of Organization OF
DRA
[I This is an amended* Statement of Organization (REV. 1212005) 1 ORGANIZATION'
An initial Statement of Organization must be riled within 10 days of the committee's accepting contributions, For Office Use Only
making expenditures, or incuning indebtedness exceeding $750. Amendments must be riled within 30 days of Comm . #
a change. Penalties may be imposed for late-filed Statements of Organization. A candidate with an open Indexed
committee that exceeds $750 in activity for another office shall file within 10 days either a waded___
DR-1 disclosing information concerning the campaign for the new office sought. .A
COMMITTEE NAME 1 1
Citizen's Committee for NIACC's Plant Fund Renew

IMPORTANT: Indicate type of committee you are reporting for.
( 1 )Statewide/LegislativefJudge Standing for Retention Candidate (2 )Statewide entral Committee
( 5 )County Candidate ( 6 )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
COMMITTEE TREASURER (mandatory for all committees) COMMITTEE CHAIR (m andatory except for a candidate's committee),
Name ~ 1 Name 1 1
Joyce Hanes Jim Benie erdes
Mailing Address Mailing Address
15936 310 th St 1 1 23520 Olive Ave
City, State I1 Zi Code 1 I City, State 1 1. ZiACode
Mason City IA 50401 Mason - City 0401
Phone (641) 424-5254 Phone ( 641) 423-5979
e-mail dadhanes@rconnect .com I e-mail

INDICATE PURPOSE OF COMMITTEE - Check One Box Advocate forlagainst candidate(s) Advocate forlagainst ballot issue(s)
Comment or description : Renewal of Plant Fund Levy
All Candidates Enter :
Office Sought:
District:
Political Party (if applicable) Year Standing for Election:

County/Local Candidates and Local Ballot/Franchise Committees Enter :
Date of Election:
County :
Bank Account Name Candidate name & Address or Parent Entity (PACs . if aoolicable) .
Citizen's Committee for NIACC's 1 Affiliate, or Sponsor
Plant Fund Renewal NIACC Foundation, Inc .

Name of Financial Institutionftype of Account I Mailing Address 1
First Citizens Nat'l Bank 500 College Drive
Mailing Address City State
2601 4th St SW Mason City IA 50401

City I 1 State Zip 1. Phone ( 641) 422-4004
Mason City IA 50401
e-mail gobelsan@iowatelecom .net
STATEMENT OF AFFIRMATION : By filing this document the committee affirms the following:
1 . The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 688 and the administrative
rules in Chapter 351 of the Iowa Administrative Code .
2. That Iowa Code section 68A.402 and rule 351-4 .9 require the filing of disclosure reports. The failure to file these reports on or before the required due dates subjects
the candidate or chairperson (in the case of committees other than a candidate's committee) to the automatic assessment of a civil penalty and the possible imposition of
other criminal and civil sanctions pursuant to Iowa Code section 68B .32A(7) .
3. That Iowa Code section 68A .405 and rules 351-4 .38 through 4 .43 require the placement of the words 'paid for by' and the name of the committee on all political
materials except for those items exempted by statute or rule . A committee filing this statement for purposes of using the shorter "paid for by" and who have not crossed
the $750 shall notify the Board that the $750 threshold will not be crossed .
4 . That Iowa Code section 68A.503 and rules 351-4.44 through 4 .52 prohibit the receipt of corporate contributions by all committees except for statewide and local ballot
issue PACs.
5 . A candidate and a candidate's committee may only expend campaign funds as permitted by Iowa code sections 68A.301 through 68A.303 and rule 351-4 .25 .
6 . That the committee will continue to file disclosure reports until all activity has ceased, committee funds spent, debts resolved, and a final report and a statement of
dissolution (DR-3) has been filed.
ignature of Treasurer Date Signed
Signature of Candidate, OR, f~ Date Signed

/

For Instructions, See Back of Form Check One: DRA

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FOR INSTRUCTIONS, SEE BACK OF FORM

Citizen's Committee for NIACC's Plant Fund Renew

Phone (641) 424-5254 Phone ( 641) 423-5979

e-mail dadhanes@rconnect .com I e-mail

Political Party (if applicable) Year Standing for Election:

Plant Fund Renewal NIACC Foundation, Inc .

2601 4th St SW Mason City IA 50401

ignature of Treasurer Date Signed

Signature of Candidate, OR, f~ Date Signed

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