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Noticeof Dissolution CenifiedDateof Dissolution

Mail to:
IECDB
StOeasttf, Suite1A
l) DesMoines,Iowa50319
brn*lffuh Official
nm <,^ h.t,un"nJ
Nameof Committee
4
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6/;a3
City, State, Zp Code

(7bt 773"-q/y'f
Area Telephone
Code

WHEN TO FILE:
The Notce of Dissolutionmust be filed within thirty (30) days of completionof all the following:

1. All debts, loans and obligationshave been paid or fansferred;

2. Allcampaign funds have been spent;
3. All campaignpropertysold or fansfened (endidates only); and
4. A final report disclosingallfansactions closingthe committee.

For state candidates and state PAGs, a final bank statement must be filed with the Notice of Dissolution or as s@n as
possibleif the bank statementls not availableat the time the Noticeof Dissolutionis filed.

Signatureof Candidateor Treasurer(if candidate'scommittee/Signature

of Chairor Treasurer(if PAC)

FOR INSTRUCTIONS, SEEBACKOF FORM

This fomr is not applicable to statrtory political commifree.