Review the Terms of Agreement
Criteria to use this form:
- One campaign contribution in excess of $1000 was made to a state or local candidate,
party, political committee (PAC) for either a candidate or a ballot issue, or any
other organization that advocates the election or defeat of a candidate or ballot
- Must be a permanent organization not established for election purposes.
- No person gave money to the organization for the purpose of the organization then
using the money to make the contribution.
- If the contribution was made to a candidate, no funds from a corporation or other
prohibited contributor under Iowa Code section 68A.15 were used to make the contribution
(this does not apply to a contribution made to a ballot issue committee).
- Only one contribution to any campaign committee except for a ballot issue committee
was made in a calendar year. No more than one contribution may be made to any one
ballot issue committee during a ballot issue election. If more than one contribution
and the total amount of the contributions exceeds $1000, the organization must register
with the Board as a political committee (PAC) within 10 days of crossing the $1000
Statement of Affirmation:
I affirm that the contribution reported above is accurate. I further affirm that
the information concerning the organization is correct and true to the best of my
knowledge. I understand that by filing this form, I am subject to the laws found
in Iowa Code chapter 68A and administrative rules found in chapter 351. I also understand
that the failure to timely file this form leads to the imposition of civil penalties
and the intentional failure to file the form may lead to additional civil and criminal