ibew_8026_johnson_county

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I OWA ETHI CS AND CAMPAI GN DI SCLOSURE BOARD5 1 0 EAST 1 2 t h , S UI T E 1 A

DES MOI NES, I A 5 0 3 1 9www. l o wa . g o v / e t h i c s

` ' - VERI FI ED STATEMENT REGI STRAT I ON

COMMI TT EES NOT ORGANI ZED I N I OWA TOCOMPLETE I N DUPLI CATE .

SEND A COPY T O T HE BOARD WI T HI N 1 5 DAYS OF T HE CONTRI BUTI ON DATE AND

ONE COPY WI TH EACH CONTRI BUTI ON TO THE I OWA COMMI T TEE WI TH T HE CONTRI BUTI ON .

PLEASE REFER TO DETAI LED I NSTRUCT I ONS ON BACK OF FORM .

T HI S FORM MUST BE F I L ED FOR EACH CONTRI BUTI ON I N EXCESS OF $ 5 0

COMMI TT EE NAME

O f f i c i a l Na me o f O u t - o f - S t a t e Commi t t e e ( Do n o t a b b r e v i a t e c o mmi t t e e na me . Wr i t t e n e x p l a n a t i o n mu s t b e p r o v i d e d f o r A c r o n y m) .

I n t e r n a t i o n a l Br o t h er h o o d o f E l e c t r i c a l Wo r k e r s ( I B EW)

9 0 0 S ev e n t h S t r e e t , NW M a i l i n g A d d r e s s

Wa s h i n g t o n , DC C~ 6Ob y t e ,Z i p Code

STATE OR FEDERAL J URI SDI CT I ONWHERE COMMI TT EE

I S REGI STERED OROPERATES

F. E . C .

Na me o f J u r i s d i c t i o n I I I I BEW

9 9 9 E S t r e e t , NWt a s l t ~ 1 P bde20463

T a l e p ~

9

e 1 69 4 - 1 1 3 7

PURPOSE OF COMMI TT EE

No n - Pa r t i s a n P o l i t i c a l L e a g u e

I OWA RESI DENT AGENT

S a n d y Op s t v e d t

1 4 3 5 N. E . 5 4 t h A v e n u e

( O u t - o f - S t a t e Commi t t e e)

M a i l i n g A d d r e s s

T y p e d Na me o f I o wa R e s i d e n t

M a i l i n g A dd r e s s

C i t y , S t a t e , Z i p C o d e T e l e p h on e I I I Da t e

Des Mo i n e s , I A

V ERI F I E D STATEMENT OF COMMI TT EE :

5( 1 5 ) 2 6 5 - 6 1 9 4 1 1 1 1 0/ 2 8 / 2 00 5

Re ' s ' e t Fo r t a

Na me

90 0 S ev e n t h S t r e e t ,NWMa i l i n g A d d r e s s

t y , S t a t e , Z i p C o d eWa s h i n g t o n , DC 2 0 0 ~ ~

Amo un t

$ 2 5 0 . 0 0

Co nt r i b ut i o n

Che c k#~

7 6 2

F o r o f f i c e u s e o n l y

Comm. #

I n d e x e d

A u d i t e d

Che ck e d

Compu t e r

Af ~ Cod j7 2 8 - 6 0 T ~ , ' p h

o n e No .

I OWA COMMI TTEE RECE I V I NG CONTRI BUT I ON

Na me o f Commi t t e e

Co al i t i o n t o Pr e ser v e Sa f e a n d Re l i a b l e E ne r g y


4 1 0 Hi g h l a nd Avenue , I o wa C i t y , I A 5 2 2 4 0

I f I n - K i n d C o n t r i b u t i o n , D e s c r i b e

= T r e a s u r e r 1 0/ 2 8/ 2 00 5 _

o mi t t i n g f o r m ) ( T i t l e ) ( D a t e )

G_ ~Fo r m

VERI F I ED STATEMENTREGI STRAT I ON

( O u t - o f - S t a t e C o mmi t t e e s )

( Re v . 0 7 / 0 3 )

PARENT ENT I T Y, AFFI L I AT E, SPONSOR OFCOMMI TTEE

( U s e s e p a r a t ep a g e

i f needed t o l i s tmo r e t h a n o n e e n t i t y )

Co mmi t t e e . I D #

8 0 2 6

I J on F . Wa l t e r s, a t t e s t t h a t t h e c o n t r i b u t i o n r e p o r t e d a b o v e i s a c c u r a t e and t h a t t h e i n f o r ma t i o n a b o u t t h i s o u t - o f - s t a t e

c o mmi t t e e i s c o r r e c t a n d a c c u r a t e t o t h e b e s t o f my k n o wl e d ge . I a l s o a t t e s t t h a t t h e r e p o r t s f i l e d i n t h e named j u r i s d i c t i o n c o mp l y w i t h r e q u i r e me n t s t h a t a r e

s u b s t a n t i a l l y s i m i l a r t o I o wa Co d e s e c t i o n 6 8 A . 6 , i n c l u d i n g t h e d i s c l o s u r e o f a l l c o n t r i b u t i o n s r e c e i v e d a n d a l l e x p e n d i t u r e s ma de . I f u r t h e r a t t e s t t h a t t h e

c o n t r i b u t i o n r e p o r t e d a b o v e wa s ma de f r o m a n a c c o u n t t h a t d o e s n o t a c c e p t c o n t r i b u t i o n s f r o m c o r p o r a t i o n s o r o t h e r p r o h i b i t e d c o n t r i b u t o r s u n d e r I o wa Co d e

s e c t i o n 68A . 1 5 , u n l e ss t h e I o wa r e c i p i e n t c o i t t e e i s a b a l l o t i s s u e c o mmi t t e e . I u n d er s t a n d t h a t p o t e n t i a l c i v i l a n d c r i m i n a l p e n a l t i e s may a pp l y u n l e s s a c o p y o ft h i s f o r m h a s b e e n f i l e d w i t h t h e I o wa E t h i c a n Ca mp a i g n D i s c l o s u r e Bo a r d w i t h i n 1 5 d a y s o f t h e d a t e o f t h e c o n t r i b u t i o n .

Check #11762 returned, this VSR is VOID....11/14/2005



ETHI CS AND CAMPAI GN DI SCLOSURE BOARD5 1 0 EAST 1 2 t h , SUI T E 1 ADES MOI NES, I A 5 0 3 1 9www. l o wa . g o v / e t h i c s

I ED STATEMENT REGI STRATI ON( O u t - o f - S t a t e Co mmi t t e e )

OMMI TTEES NOT ORGANI ZED I N I OWA TO COMPL ETE I N DUPLI CATE .

SEND A COPY TO THE BOARDWI T HI N 1 5 DAYS OF THE CONTRI BUTI ON DATE ANDONE COPY WI T H EACH CONTRI BUTI ON TO THE I OWA COMMI TTEE WI T H THE CONTRI BUTI ON .

PLEASE REFER TO D ET A I L E D I NSTRUCTI ONS ON BACK OF FORM.

T H I S FORM MUST BE F I L E D FOREACH CONTRI BUTI ON I N EXCESS0$ 5 0

COMMI TT EE NAME

o b o i OSTX)F o r m

V ER I F I E D STATEMENTREGI STRATI ON

( O u t - o f - S t a t e C o mmi t t e e s )( R e v . 0 7 / 0 3 )


Co mm. #- _

I n d e x e dA u d i t e d

C h e c k e d

C o mp u t e r

O f f i c i a l Name o f O u t - o f - S t a t e C o mmi t t e e ( D o n o t a b b r e v i a t e c o mmi t t e e n ame . W r i t t e n e x p l a n a t i o n mu s t b e p r o v i d e d f o r A c r o n y m ) .I n t e r n a t i o n a l B r o t h e r h o o d o f E l e c t r i c a l Wo r k e r s ( I BEW) PAC

1 1 2 5 1 5 t h S t . , N. W .


Wa s h i n g t o n , DC Ob ? t e , Z i p C o d e

I o lC o d e

STATE OR FEDERAL J URI SDI CT I ON WHERE COMMI TT EEI SREGI STERED OR OPERATES ( U s e s e p a r a t e p a g e i f n e e d e d t o l i s t m o r e t h a n o n e e n t i t y )

_ F e d e r a l E l e c t i o n CoName o f J u r i s d i c t i o n

9 9 9 E . S t r e e t , N. W .


q%f t g ~ , " 20463 T e l e2 ( T 2 _ 1 6 9 4 - 1 1 3 7

I BEWName

M a i l i n g A d d r e s s1 1 2 5 1 5 t h S t . , N. W .

Wa s h i n g t o n , DC 2 0 0 6 ? 'S t a t e , Z i p C o d e

PURPOSE OF COMMI TT EE

N o n - p a r t i s a n P o l i t i c a l L e a g u e

PARENT E NT I T Y, AF F I L I AT E, SPONSOR OF COMMI TTEE

I OWA RESI DENT AGENT I OWA COMMI TT EE RECE I V I NG CONTRI BUTI ON

S a n d y O p s t v e d t

T y p e d Name o f I o w a R e s i d e n t


1 4 3 5 N. E . 5 4 t h Av e .

C i t y , S t a t e , Z i p C o d eDe s Mo i n e s , 1 A 5 0 3 1 3

T e l e p h o n e

5 1 5 2 6 5 - 6 1 9 4( - _ - )

p a i n -0 1/ 2 5 / 2 0 06

5 0 . 0 0

Name o f C o mmi t t e e

I o wa C i t y St o p Wa l - Ma r t

M a i l i n a A d d r e s s

8 3 1 Ma g g a r d , I o wa C i t y , I A 5 2 2 4 0

I f I n _ K i n r 1 Rn n f r i h uf i n n n as r r i M

C h e c k #9 3 7 3

C o n t r i b u t i o n

8 0 2 6

VER I ED STA MEr&4 $/MyT~~

a t t e s t t t h e c o n t r i b u t i o n r e p o r t e d a b o v e i s a c c u r a t e a n d t h a t t h e i n f o r m a t i o n a b o u t t h i s o u t - o f - s t a t ec o mmi t t e e i s c o r r e c t a n d a c c u r a t e t o t h e b e s t o f my k n o w l e d g e . I a l s o a t t e s t t h a t t h e r e p o r t s f i l e d I n t h e n am e d j u r i s d i c t i o n c o mp l y w i t h r e q u i r e m e n t s t h a t a r es u b s t a n t i a l l y s i m i l a r t o I o w a C o d e s e c t i o n 6 8 A . 6 , i n c l u d i n g t h e d i s c l o s u r e o f a l l c o n t r i b u t i o n s r e c e i v e d a n d a l l e x p e n d i t u r e s m a d e . I f u r t h e r a t t e s t t h a t t h ec o n t r i b u t i o n r e p o r t e d a b o v e wa s ma d e f r o m a n a c c o u n t t h a t d o e s n o t a c c e p t c o n t r i b u t i o n s f r o m c o r p o r a t i o n s o r o t h e r p r o h i b i t e d c o n t r i b u t o r s u n d e r I o w a C o d es e c t i o n 6 a A . 1 5 , u n l e s s t h e I o w a r e c i p i e n t 6 o mmi d e s i s a b a l l o t i s s u e c o mmi t t e e . I u n de r s t a n d t h a t p o t e n t i a l c i v i l a n d c r i m i n a l p e n a l t i e s ma y a p p l y u n l e s s a c o p y o ft h i s f o r m h a s b e e n f i l e d w i t h t h e I o wa Et h i c s a n d C a mp a i g n D i s c l o s u r e B o a r d w i t h i n 1 5 d a y s o f t h e d a t e o f t h e c o n t r i b u t i o n .

0 1/ 2 5 / 2 0 06( P e r s o n s u b m i t t i n g f o r m ) ( T i t l e ) ( D a t e )

_ JonF. t i ' I a l r p - s Secretary- Treasurer



I OWA ETHI CS AND CAMPAI GN DI SCLOSURE BOARD5 1 0 EAST 1 2 t h , S UI T E 1A

DES MOI NES, I A 5 0 3 1 9

, , www. l o wa . g o v / e t h i c s

VERI F I ED STATEMENT REGI STRAT I ON

COMMI TT EES NOT ORGANI ZED I N I OWA TO COMPL ETE I N DUPLI CATE .

SEND A COPY TO THE BOARDWI THI N 1 5 DAYS OF THE CONTRI BUTI ON DATE ANDONECOPY WI TH EACH CONTRI BUT I ON TO T HE I OWA COMMI TT EE WI TH THE CONTRI BUTI ON .

PLEASE REFER TO DETAI LED I NSTRUCT I ONS ON BACK OF FORM .

T HI S FORM MUST BE F I L E D_ FOREACHCRIBT I ON I N EXCESS OF 5 0

COMMI TT EE NAME

( O u t - o f - S t a t e Co mmi t t e e )

O f f i c i a l Name o f O u t - o f - S t a t e Co mmi t t e e ( Do n o t a b b r e v i a t e c o mmi t t e e n ame .I n t e r n a t i o n a l B r o t h e r h o o d o f E l e c t r i c a l Wo r k e r s ( I BEW)

9 0 0 S e v e n t h S t r e e t , NWM a i l i n g A d d r e s s

Wa s h i n g t o n , DC(: NOb T t e ,

Z i p C o d e

STATE OR FEDERAL JURI SDI C T I ON WHERE COMMI TTEE

I SREGI STERED

OR OPERATES

999 E S t r e e t , NW

CN%, ~ f t t & l ? T 5 1 - d e 2 0 4 6 3 T e l e p e 6 9 4 - 1 1 3 7

F . E. C .

PURPOSE OF COMMI TTEE

Name o f J u r i s d i c t i o n



1 1 T y p e d Name o f I o wa R e s i d e n t

PARENT ENT I T Y , AF FI L I AT E, SPONSOR OF COMMI TTEE

( U s es e p a r a t e p a g e i f n e e d e d t o l i s t mo r e t h a n o n e e n t i t y )

I BEW

A- -- l x s a c s ' X0 1 C) 6 l c

Fo r mVERI F I EDSTATEMENT

REGI STRAT I ON( O u t - o f - S t a t e C o mmi t t e e s )

( R e v . 0 7 1 0 3 )


Comm. #

I n d e x e d

A u d i t e d

C h e c k e d

Co mp u t e r

Wr i t t e n e x p l a n a t i o n must b e p r o v i d e d f o r A c r o n y m) .

Cod e T h o n e No ._ 7 2 8 - 6 0 ~ e p -

Na me

90 0 S e v e n t h S t r e e t ,NWMa i l i n g A d d r e s s

Wa s h i n g t o n , DC 2 008V ,S t a t e , Z i p C o d e

I OWA COMMI TTEE RECEI VI NG CONTRI BUTI ON

Name o f Co mmi t t e e

C o a l i t i o n t o P r e s e r v e S a f e a n d R e l i a b l e En e r g yS a n d y O p s t v e d t

1 4 3 5 N. E . 5 4 t h Av e n u e

C i t y , S t a t e , Z i p C o d e T e l e p h o n e

De s Mo i n e s , I A 1 5 ) 2 6 5 - 6 1 9 4

V ERI F I E D STATEMENT OF COMMI TTEE :

I J on F . Wa l t e r s , a t t e s t t h a t t h e c o n t r i b u t i o n r e p o r t e d a b o v e i s a c c u r a t e a n d t h a t t h e i n f o r ma t i o n a b o u t t h i s o u t - o f - s t a t e

c o mmi t t e e i s c o r r e c t a n d a c c u r a t e t o t h e b e s t o f my k n o wl e d g e . I a l s o a t t e s t t h a t t h e r e p o r t s f i l e d i n t h e na med j u r i s d i c t i o n c o mp l y w i t h r e q u i r e me n t s t h a t a r es u b s t a n t i a l l y s i m i l a r t o I o wa C o d e s e c t i o n 6 8 A . 6 , i n c l u d i n g t h e d i s c l o s u r e o f a l l c o n t r i b u t i o n s r e c e i v e d a n d a l l e x p e n d i t u r e s m a d e . 1 f u r t h e r a t t e s t t h a t t h ec o n t r i b u t i o n r e p o r t e d a b o v e wa s m a d e ma n a c c o u n t t h a t d o e s n o t a c c e p t c o n t r i b u t i o n s f r o m c o r p o r a t i o n s o r o t h e r p r o h i b i t e d c o n t r i b u t o r s u n d e r I o wa C o d es e c t i o n 6 8 A . 1 , u n l e s s t h e

owe

r e c i p i n t mmi t t e e i s a b a l l o t i s s u e c o mmi t t e e . 1 u nd e r s t a n d t h a t p o t e n t i a l c i v i l a n d c r i mi n a l p e n a l t i e s may a pp l y u n l e s s a c o p y o ft h i s f o r mhaeenr i l e d w i t h t h e l g wa . t h i s b p d Ga r p a i g n D i s c l o s u r e Bo a r d w i t h i n 1 5 d a y s o f t h e d a t e o f t h e c o n t r i b u t i o n .

M a i l i n g A d d r e s s M a i l i n g A d d r e s s

4 1 0 H i g h l a n d A v e n u e , I o wa C i t y , I A 5 2 7 4 0


~ ~ C h e c k #

3 9

- L - I S e c r e f ~ i r y - T r e a s u r e r 101212005

I f I n - K i n d C o n t r i b u t i o n , D e s c r i b e

( P e r s o n s u bmi t t i n g f o r m ) ( T i t l e ) ( D a t e )

C o mmi t t e e . I D #

8 0 2 6



COMMI TTEES NOT ORGANI ZED I N I OWA TO COMPLETE I N DUPLI CATE .SEND A COPY TO THE BOARD WI THI N 1 5 DAYS OF THE CONTRI BUTI ON DATE AND

ONE COPY WI TH EACH CONTRI BUTI ON TO THE I OWA COMMI TTEE WI TH THE CONTRI BUTI ON .

PLEASE REFER TO DETAI LED I NSTRUCTI ONS ON BACK OF FORM .THI S FORMMUST BE F I LED FOR EACH CONTRI BUTI ON I N EXCESS OF 1 5 0

COMMI TTEE NAME

HI CS AND CAMPAI GN DI SCLOSURE BOARD5 1 0 EAST 1 2 t h , SUI TE 1 ADES MOI NES, I A 5 0 3 1 9www. l o wa . g o v / e t h i c s

FIEDSTATEMENTREGISTRATION

( O u t - o f - S t a t e Co mmi t t e e )

O f f i c i a l Name o f O u t - o f - S t a t e C o mmi t t e e ( D o n o t a b b r e v i a t e c o mmi t t e e n ame . Wr i t t e n e x p l a n a t i o n mu s t b e p r o v i d e d f o r A c r o n y m ) .I n t e r n a t i o n a l Br o t h e r h o o d of E l e c t r i c a l . Wo r k e r s ( I BEW) PAC

1 1 2 5 1 5 t h S t . , N. W.M a i l i n g A d d r e s s

Wa s h i n g t o n , DC(: N6 B? t e '

Z i p Code Code7 2 s - 6 o Tt e p h o ne

No .

STATE OR FEDERAL J URI SDI CTI ONWHERE COMMI TT EE

I S REGI STERED OROPERATES

F e d e r a l E l e c t i o n C o r n m i s so f J u r i s d i c t i o n

9 9 9 E . S t r e e t , N. W.M a i l i n gAd d r e s s 1 1 1 1 1 2 5 1 5 t h S t . , N. W.

o 1 a s 2 0 4 6 3 T e l ec v a - ) 6 9 4 - 1 I 3 7

Na me

M a i l i n g A dd r e s s

Wa s h i n g t o n , DC 200'S t a t e , Z i p Code

PURPOSE OF COMMI TTEE

No n - p a r t i s a n P o l i t i c a l L e a g u e


S a n d y Op s t v e d t

1 4 3 5 N. E . 5 4 t h Av e .

T y p e d Na me o f I o w a R e s i d e n t


C i t y , S t a t e , Z i p Code T e l e p h o n e

De s Mo i n e s , I A 5 0 3 1 3 5 1 5 2 6 5 - 6 1 9 4

PARENT ENTI TY, A FF I L I A TE , SPONSOROF COMMI TTEE

( U s e s e p a r a t e p a g e i f n e e d e d t o l i s t mo r e t h a n o n e e n t i t y )

I OWA COMMI TT EE RECEI V I NG CONTRI BUTI ON

r a t a

0 1/ 2 5 / 2 00 6

Fo r mVERI F I EDSTATEMENT

REGI STRATI ON( O u t - o f - S t a t e C o mmi t t e e s )

( R e v . 0 7 / 0 3 )


Comm . #-_

I n d e x e d-~-

A u d i t e d -l--.Ch e c k e d _rComp u t e r

Name o f Co mmi t t e e

Ni c k Ma y b a n k s f o r Co u n t y A t t o r n e y

MaWno Add r e s s

P . O . Box 5 7 0 1 , C o r a l v i l l e , I A 5 2 2 4 1

- I f I n- K i nd Cn nf r i h uf i n n r l a sc r i h a

01FN S ( ~ ' 1


mk t e e . I D#

9 3 7 4 8 0 2 6

e c o n t r i b u t i o n r e p o r t e d a b o v e i s a c c u r a t e a n d t h a t t h e i n f o r ma t i o n a b o u t t h i s o u t - o f - s t a t ec o r r e c t a n d a c c u r a t e t o t h e b e s t o f my k n o wl e d g e I a l s o a t t e s t t h a t t h e r e p o r t s f i l e d I n t h e n am e d j u d s d k . , t i o n c o mp l y w i t h r e q u i r e m e n t s t h a t a r e

s u b s t a n t i a l l y s i m i l a r t o I o w a C o d e s e c t i o n 6 8 A . 6 , i n c l u d i n g t h e d i s c l o s u r e o f a l l c o n t r i b u t i o n s r e c e i v e d a n d a l l e x p e n d i t u r e s made . I f u r t h e r a t t e s t t h a t t h ec o n t r i b u t i o n r e p o r t e d a b o v e wa s made f r o m a n a c c o u n t t h a t d o e s n o t a c c e p t c o n t r i b u t i o n s f r o m c o r p o r a t i o n s o r o t h e r p r o h i b i t e d c o n t r i b u t o r s u n d e r I o w a C o d es e c t i o n 6 6 A . 1 5 , u n l e s s t h e I o w a r e c i p i e n t c o mmi t t e e i s a b a l l o t i s s u e c o mmi t t e e . I u n d e r s t a n d t h a t p o t e n t i a l c i v i l a n d c r i mi n a l p e n a l t i e s ma y a p p l y u n l e s s a c o p y o ft h i s f o r m h a s b e e n f i l e d w i t h t h e I o w a E t h i c s a n d C a mp a i g n D i s c l o s u r e B o a r d w i t h i n 1 5 d a y s o f t h e d a t e o f t h e c o n t r i b u t i o n .

J o n F . Wa 1 t e r s - _ __Sec r e t a r y - Tr e as ur e r 0 1/ 2 5 / 2 00 6

( P e r s o n s u b mi t t i n g f o r m ) ( T i t l e ) ( D a t e )

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