NOU-9-2005 18 :23 FROM :DEN HARTOG IND 7127529222 TO :15152813701 P :3

FOR INSTRUCTIONS, SEE BACK OF FORM

Reset Form FORM STATEMENT
CHECK ONE:
n Thia is an inl0at' Statement of Organization DR-1 of
(REv.05/2005) ORGANIZATION
Li ThIs is on amended' Statement of Organization
'An init)el Statement of organization must be filed within 10 days dthe committee's accepting conlnbutlorrs, For ce Use Oaly
making expenditures, or lncumng indebtedness exce"ng $730. Amendments must be filed within 30 days of Comm . sl
a change Ponaltted may be imposed for late-filed Statemente of Organization . A candidate with an open Indexed
commithre that exceeds 5730 in salvity for another ote shell Me within 10 days either a new or amended Audited
DR-1 fcJoelng Information concerning the campaign for the new office sought Computer

COMMITTEE NAME 1 1
2005
Steve Roesner for City Council
_
IMPORTANT: Indicate type of commWee you are reporting for.
( 1 )StatewldelLeglelatlve/Judge Standing for Retention Candidate (2 )Statewide PAC ( 3 )State Party (4 )County Central Cornrnlttse
( a )Courtly Candidate ( 6 )City Candidate (7)Schoot Board or Other Political subdivision Candidate (11 )County PAC (S)CRY PAC
(10 )Schoot Board or Other Political Subdivision PAC (11 )focal Ballot Issue
COMMITTEE TREASURER (mandxtory for all comm t~
Name -~-
Laurie Roe sner
mailing Address 1 1

City, State ZIp Code city. 1 Zip Code 1 4.

Orange City. IA 61041
Phone ( 712) 737-3e23 Phone ( )

smesner®orangedtycomm,nel e-mail
e-mail
INDICAYE PURPOSE OF COMMITTEE - Check one Box RI Advocate forlagainst candidate(&)
Comment or deacr~n : personally or_ganized and funded for city council election
All Candidates Enter.
Office Sought Orange City council
District
Ne 2005
political Party (Ifapplicable) Year Standing for Election:
CountylLocal Candidates and Local BalloWFranchtse Committees Enter
Date of Eledom 11108105
County : Sioux

andidab n m & Addyes or Parent Enft (PACs . if aooiigbiet .

AM
I iala, or Spvnso
all campaign expenese paid from personal funds Steve Roesner
Name of Financial Institution" of Account 1 1 Mailing Address -1 1
908 6th St Se
Malting Address 1 1 City 1 1 State zip -
Orerge Cily, IA 61041
City 1 1 State 1 1 zip 1 7373823
Phone ( 712 )

e-Mail sroesner@orangecitycomm .not

STATEMENT Op AFFIRMATION: By riling this document the committee affirms the follooorIng :

1 . The oommittae and ad persons connected with the committee understand MM they are subject to the tars In lows Code chapters 88A and 688and the administrative
rules in Chapter 361 of the Iowa Adm4wtxive Code.

2 That Ipwa Code sedan 88A402 and rule 351--4.® require the filing of disclosure reports and that the figure to RIO these reports on or before the required due dates
subjects the candidate or chairperson (n the case of committees other then a Candidate's Committee) to the automatic assessment of a evil penalty and the poseible
Imposhlon of other Crlmlnal end civil sanctions.
3. That Iowa Code section WADS end rules 351-r .38 tMaph 4.43 require theplacement of the vrords'paid for by' end the name of the committee on all yolk"
materials except for those Items exempted by statute a rue. Acommittee fling this statement for purposes of using the shorter 'paid for b)r and who have not crossed
the $760 shell no" the Board that the $750 threshold will not be crossed .

4 That lows Coda sedan 68A,603 and rules 351 -4_44 through 4.52 prohibit the 1`6=0 01! arporate contributions by all comminees except for statewide and local ballot
Issue PACs_
5. A Candidate end a candidate's committee may only expend campaign funds orepermitted by lows code sections 68A301 through 68A.303 end rule 351- .25
8.. That thecommittee well continue to We disclosure reports until ad activity has ceased, commieee funds sporit, debts madved, and afinal report and a statement of
dissolution (DR-3) has been filed

Derv Siwwd