Notice of Dissolution FORM

DR-3
(Rrw . 07p3)

NOTICE OF
DISSOLUTION
Mall to :
[ECDB
510 East 12"', Suite lA For Office Ua4 Only
Des Moines, Iowa 50319
Comm . #
'Indexed
Audked
Computer
Certified Date of Dissolution

rl a l~ 4 M on 4k Pol oCommittee
A HT, Cnur 7~tr~5~r
.r
Official Name of

LL4 315 t St
Street

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City, State, Zip Code

{t1~.1 ?5 ;t - d~ bq
Area Telephone
Code

WHEN TO FILE :
The Notice of Dissolution must be flied within thirty (30) 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
posslble if the bank statement is not available at the time the Notice of Dissolution is filed .

of Candidate or reasurer (if candidate's cornmittoe)1Signature of Chair or Treasurer (if PAC)

Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM

This form Is not app icable to statutory political committees .