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Noticeof Dissolution Certified Date of Dissolution

Mail to:
IECDB
510 Eastl2th,SuitelA
DesMoines,Iowa 503l9
C 5 i d tDi nch4 t {or S utqtr vt sDr
OfficialNameof Gommittee

/oos E./oU S+.

Street

fr. 5oo
, State,Zlp Code

('ltAt e43 - 3b tb
Area Telephone
Code

WHENTO FILE:
The Noflceof Dlssolutionmust be filed wlthinthirty (30) days of completionof allthe foltowing:

1. All debts,loansand obllgatonshave been paldor fansfened;

2. Allcampalgnfundshavebeenspent;
3. All campaignpropertysold or transfened(candldatesonly);and
4. A final reportdlsclosingall transactlonscloslngthe committee.

For state candldatesand state PACs,a final bank statementmust be filed with the Noticeof Dissolufionor as soon as
possibleif the bank statementis not availableat the time the Noticeof Dissoluffonis filed.

(if candidate'scommittee/Signature
of Chairor Treasurer(if PAC)
b - t'7- to
DateSlgned

FOR INSTRUCTIONS, SEE BACK OF FORM

Thls form ls not appllcable to shtutory potiticat committees.