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I NOTICEOF
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For Offlce Use Only

Comm.#
Indexed
Audited
Computer
Noticeof Dissolution CertifiedDate of Dissolution

Mail to:
IECDB
510 Eastl2th, Suite1A
DesMoines,Iowa 50319
VoteYesCliveLibrary
OfficialNameof Committee
c/oRonniF. Begleiter,l48l NW 108thSteet

Street
Clive,IA 50325

City,State,Zip Code

frs \ 242-2463
Area Telephone
Code

WHENTO FILE:
The Noticeof Dissolutionmust be filedwithinthirty(30) daysof completionof all the foilowing:

1. All debts,loansand obligationshavebeen paid or transfened;

2. All campaignfundshave beenspent;
3. All campaignpropefi sold or transferred(candidatesonly);and
4. A final reportdisclosingall transactions
closingthe commiftee.

For statecandidatesand statePACs,a final bankstatementmust be filedwith the Noticeof Dissolutionor as soon as
possibleif the bankstatementis not availableat the time the Noticeof Dissolutionis filed.

committee)/Signature
of Ghairor Treasurer(if PAC)

FOR INSTRUCTIONS, SEE BACK OF FORM

This form is not applicableto statutory political committees.