FORM DR-1: Statement of Organization Form Statement of

ID 6116 DR-1 Organization

Type Iowa PAC Web Reporting System Rev. 09/2003
Status Amended For Office Use Only
Name Political Action - Iowa Dealers #6116 Comm. # 6116
Indexed
Filed/Amended 8/15/2007 Audited
Date Computer

Committee Treasurer Committee Chair

Name Jim L. Van Arkel Name Tom Haley
Address IA/NEB Farm Equipment Assn. Address 19504 Hwy 30 W
1311 50th St, PO Box 65840
West Des Moines, IA 50265-0480 Carroll, IA 51401-9309
Primary Ph. (515) 223-5119 Primary Ph. (712) 792-3724
Secondary Ph. (nul) lnu-null Secondary Ph. (nul) lnu-null
e-Mail jimv@ineda.com e-Mail haleyeq@haleyequipmentinc.com
Purpose
Advocate for/against ballot issue(s)

Office Sought: District:

Party: Year Standing for Election:
County: Polk Date of Election:
Primary Bank Account PAC Parent Entity, Affiliate or Sponsor
Name Wells Fargo Bank Iowa Name Iowa-Nebraska Equipment Dealers Association
Address 666 Walnut Street Address 1311 50th St
PO Box 65840
Des Moines, IA 50309
Account Type Checking Primary Ph. (515) 223-5113
Account Name Political Action - Iowa Dealers PAC e-Mail paulac@ineda.com

Statement of Affirmation By Treasurer and Candidate; or Political Committees, By Chairperson

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 68B
and the administrative rules in Chapter 351 of the Iowa Administrative Code.
2. That Iowa Code section 68A.6 and rule 351-4.9 require the filing of disclosure reports and that 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.
3. That Iowa Code section 68A.14 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.
4. That Iowa Code section 68A.15 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.40 through 68A.42 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.

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Chair Person: Treasurer:
(signature and date) (signature and date)

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028
 Filed/Amended
Committee Accounts 8/15/2007
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Default
Checking Political Action - Iowa Dealers PAC
1 Wells Fargo Bank Iowa
Default Account 666 Walnut Street

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 Filed/Amended
Committee Officers 8/15/2007

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Role Name and Address

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 Filed/Amended
DR-1 Auditors Notes 8/15/2007

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