8/7/2019 Kaufmann, Jeff_Jeff Kaufmann for State Representative_1497_DR1_05-03-2010

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IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 1 of 2

DR-1 Statement of Organization

563-732-2902Phone:

Last Name: Kaufmann First Name: Jeff MI:

2125 Old Muscatine RoadAddress:

City: Wilton State: IA 52778Zip Code:

E-Mail: jefkauf@netwtc.net

Candidate

563-732-2902Phone:

Last Name: Kaufmann First Name: Jeffrey MI: A

2125 Old Muscatine Rd.Address:

City: Wilton State: IA 52778Zip Code:

E-Mail: jefkauf@netwtc.net

Committee Chairperson

319-480-2199Phone:

Last Name: Owens-Kirkman First Name: Staci MI: D

2107 National AveAddress:

City: Moscow State: IA 52760Zip Code:

E-Mail: stacidok@gmail.com

Treasurer

District: 79

County: NA

Committee Name: Jeff Kaufmann for State Representative

State HouseCommittee Type:

Status: Amended Date: 5/3/2010

Political Party: Republican

Committee Code: 1497

Jeff Kaufmann for State RepresentativeType: Checking

COMMUNITY BANK210 W. 4th St. Wilton, IA 52778 563--73-2-20

Account Name Bank

Bank Accounts

Purpose

DR-1IndexedAudited

Computer

Year Standing for Election: 2010

Date of Election: 11/2/2010

RepresentativeOffice Sought:

8/7/2019 Kaufmann, Jeff_Jeff Kaufmann for State Representative_1497_DR1_05-03-2010

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Generated On: 5/3/2010 6:15:05 PM

IOWA ETHICS AND CAMPAIGN DISCLOSURE BOARD | 510 EAST 12th, SUITE 1A | DES MOINES, IA 50319 | (515) 281-4028 2 of 2

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

STATEMENT OF AFFIRMATION: By filing this document the committee affirms the following1. The committee and all persons connected with the committee understand that they are subject to the laws in Iowa Code chapters 68A and 68Band 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 failure to file these reports on or before therequired due dates subjects the candidate or chairperson (in the case of committees other than a candidate's committee) to the automaticassessment 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 forstatewide 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 andrule 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 reportand a statement of dissolution (DR-3) has been filed.

Candidate: Treasurer:(signature and date) (signature and date)