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NOTICEOF
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For Off,ce Use Only

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Indexed
Audited
Computer
Noticeof Dissolution CertifiedDate of Dissolution

Mail to:
IECDB
510 Eastllh, SuitelA
DesMoines,Iowa 50319
Vote Yes For OwNeighbors
Official Name of Commiftee

100First SheetSW

Sfeet

CedarRapids, lA 52404

City,State,Zip Code

r3l9 I 363-5209
Area Telephone
Code

WHENTO FILE:
The Noticeof Dissolutionmust be ftledwithinthirty (30) days of completionof all the following:

1. All debts,loansand obligations havebeenpaidor transfened;

2. Allcampaignfundshavebeenspent;
3. All campaignpropertysoldor transfened(candidates only);and
4. A finalreportdisclosingall transactions
closingthe committee.

For state candidatesand state PACs,a final bank statementmust be filed with the Noticeof Dissolutionor as soon as
possibleif the bankstatementis not availableat the time the Noticeof Dissolution
is filed.

Signature Candidateor Treasurer(if candidate'scommittee/Signatureof Chair or Treasurer(if PAC)

'Aa\-
Date Signed

FORINSTRUGTIONS, SEE BACK OF FORM

This form is not appllcable to statutory political committees.