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Independent Expenditure

This form may not be used by a candidate, candidate’s committee, or a political committee.

Organization Details

Organization Making the Expenditure
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Contact First Name
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Contact Middle Initial

Contact Last Name
*

Address
*
Address
City
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State
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Zip Code
*
Email
*
Phone
*

Source of funding provided for the purpose of furthering the expenditure.

Enter NONE or the source of funding for the purpose of furthering the expenditure.
NONE

This expenditure expressly advocates:

For a candidate:
Enter name or id of candidate:
For a ballot issue:
Enter name or id of committee, if known. Otherwise, enter description of issue:
Against a candidate:
Enter name or id of candidate:
Against a ballot issue:
Enter name or id of committee, if known. Otherwise, enter description of issue:

Expenditure Details

Date of Expenditure
Show Calendar *

Amount (total amount of completed expenditure)
*
Type of Communication (Newspaper ad, Radio, Television, Flier, etc)
*
Vendors (to enter more than one separate by comma)
*
Distribution Date
Show Calendar *


Review the Terms of Agreement

Criteria to use this form:

  • The organization filing this statement made one or more expenditures in excess of $1000 in the aggregate for the communication that expressly advocates the nomination, election, or defeat of a clearly identified candidate or the passage or defeat of a ballot issue that is made without the prior appoval or coordination with a candidate, candidate's committee, or a ballot issue committee.
  • The organization's board of directors, executive council or similar organizational leadership body authorized the disbursement of funds for the expenditure in the same calendar year in which the expenditure was incurred.
  • The organization shall disclose any donor or other source of funding which was provided for the purpose of furthering the expenditure.
  • The organization did not engage or retain an advertising firm or consultant that had also been engaged or retained within the prior 6 months by the candidate, candidate's committee, or ballot issue committee that is benefited by the independent expenditure.
  • The communication which is the subject of this statement complies with the attribution requirements of Iowa Code section 68A.405.
  • The organization is not a foreign national and no foreign national provided funding for this expenditure. A "foreign national" means a person who is not a citizen of the United States and who is not lawfully admitted for a permanent residence. "Foreign national" includes a foreign principal, such as a government of a foreign country or a foreign political party, partnership, association, or other combination of persons that has its primary place of business in or is organized under the laws of a foreign country.

Statement of Certification

I affirm that the independent expenditure reported above is accurate and complete. I also affirm that this expenditure was made without the prior approval or coordination with a candidate, candidate's committee, or a ballot issue committee. I understand that by filing this form, I am subject to the campaign laws in Iowa Code chapter 68A and rules in chapter 351 of the Iowa Administrative Code. I also understand that the failure to timely file this form leads to the imposition of civil penalties and the intentional failure to file this form may lead to additional civil and criminal sanctions.

Name
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Date
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