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NOTICEOF
DISSLUTTON

Cornrn.#
Indexed
Cornpubr
Noticeof Dissolution CertfiedDateof Dbsolution

Mail to:
IECDB
510 Eastt23, suirelA
Veuedahl FosSnpcvisor Conniuee DesMoines"Iowa50319

Offidal Name ol Commtttee

l4l2 A Avenue

Street
Vimon, lowa52349

Gity, Sbte, Zlp Code

Telephone

WI{ENTO FILE:
The Notioeof Dissolutionmust be filed wlthin thirty (30) days of completionof Elltfie tolorMng:

1. All debts, Ioans and obllgatons have been pald or translened;

?. All campaignfunds hava been speng
3. A,[ campaignpropefiy sold ortpnEferad (endldates onty);and
4. A ffal report disclosingall bansactionscloslng lhe comniittee.

For gtat€ candidetesand sEte PACs, e final bank statement mus'lbE filed with the Notics of Dlssoludonor as soon as
possibleffthe bank slatement b not a\railableat the flme thE Notice of Dlssoluton is llld.

tlt/1./'
Signatrre of Candldab or Tres:rer (lf oFChairor Treasurgr(if pAC)
ndidale'scommftt€€yslgndure
t2.3-ffi
tlate Signed

FORINSTRUCTTONS, SEE BACK OF FORM

Thls form ls not applicabl€to statrtory polltcal committees.