01/C5 /1 2005 14 :23 5417923711 DOtJ8,SHAPOtJ IPELAPl PAGE 04

(Rw . 07103)
Notice of Dissolution
FORM
DR-3
NOTICE OF
DISSOLUTION
Mall to :
IECDE3
510 East 12'h. Suite 1 A For office Use Only
Des Moines, Iowa 50319

Indexed 113111
Audited
Computer aln
Certified Date of Dissolution
JAN ° 5 200-j

COMMITTEE NAME

"Li
10 1
Official Name of Committee

rep-
u--

City, State, Zip Code

Arja Telephone
Code

WHEN TO FILE :
The Notice of Dissolution must be filed within thirty (3t)) days of completion of all the following:

1. All debts, loans and obligations have been paid or transferred ;

2. All campaign funds have been spent;
3. All campaign property sold or transferred (candidates only); and
4. A final report disclosing all transactions closing the committee.

For state candidates and state PACs . a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed .

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f

Signature of Candidate or Treasurer (if candidate's at , of Chair or reasurer (if PAC)

Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM

This fornt la not applicable to statutory political committees .