Lzl26lt99B 21232 3L97324334 BRENDA PAGE g4

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NOTICEOF
ErssoLunoN

For Ofllca.UsaOnlv

Comm.#
lndexed
Audited
Compuler
Noticeof Dissolution Gerilfled Date ol DlgSoltltlon

Msil to:
IgCDB
5l(l liust12"'.SuitclA
DcsMoincs, lowo503t9
(irnrrnlnccto clccrln UowmmMayor

OfflclalNameol Commntee
-il2 witd InrligoCitclu
Sfeet

Wiltrrn.lA 53771{
City, State. Zip Code

,563.7124215
Area Telephone
Gode

WHEi{ TO FILE:
The Noilce of OissolutlonmuBtbe filed wlthlnthlrty (30) days of completionof all the following:

1. All dgbts, lqans end obllgallgnshave beEnpaid or transfsnedi

2. All campalgntunds have been spenl;
3. Alt campaignpropertysold or tr?nsfened(candldatesonly); and
4. A final report disolosingall transqctlonsclosingthe commltteo.

For siatg candidatessnd sbte PACa.a tlnal bank Etatementmust be fll€d wlth the Notlosol Dlssolutlonor as soon as
posslblelf the bank statementls not avsllableat the tme th€ Notlcegf Dlssotutonls fllett.

s@surer(|fcand|ttate.scomm|ttee)/S|gnatureofCha|rorTreasu'er(||PAc}
3- /t- to
Datc Slgned

FORtNSTRUcTfoNs, sEEBACKOFFORm
to sbtutorypoliticalcommittees.
Thlslorm is notappllcable

V-5