FORM (Rev.

06/10)
DR-3
STATEMENT OF
Statementof Dissolution DISSOLUTION

For Office Use Onlv

EffectiveJanuary1,2010,thisform mustbe filedelectronically by
moststatecommittees. EffectiveJanuary1,2011,thisformmust comm.- 17544
be filedelectronically
by mostlocalcommittees. Pleasecheck lndexed
withthe Boardto see if you are requiredto file it electronically.
Computer
Independent expenditure committeesmustfile thisform CertifiedDateof Dissolution
electronically.
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GREENFOR COTINTYATTORNEY CON,IMTTEE t ,t-:' i;}

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OfficialNameof Committee t\t '--.-

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P. O. Box 190 C.D tril

Street
Primghar,IA 51245

City,State,Zip Code

95745
(7t2 \
Area Telephone
Code

WHENTO FILE:
TheStatement
of Dissolution
mustbe filedwithinthirty(30)daysof completion
of all thefollowing:
1. All debts,loansand obligations havebeenpaidor transferred;
2. Allcampaignfundshavebeenspent;
3. All campaignpropertysoldor transfened(candidatesonly);and
4. A final reportdisclosingall transactionsclosingthe committeehas beenfiled.

For statecandidatesand statePACs,a final bankstatementmustbe filedwith the Statementof Dissolutionor as soonas
possibleif the bankstatementis not availableat the timethe Statementof Dissolutionis filed.

committee)/Signature
of Chairor Treasurer(if PAC)
07/07 /20LO
DateSigned

FOR TNSTRUCTIONS,
SEE BACK OF FORM

BoardAddress:510 E 12eStreetSte 14, DesMoines,lA 50319 Fax Number:515-2814O73