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STATETENTOF
Statementof Dissolution DrssoLtmoN

ForOfFce tlse Onlv

EffectiveJanuary1,2O1O,this form must be filed electronicallyby
most state committees.EffectiveJanuary1,2011,this form must comm.. flsqa
be filed electronicallyby most localcommittees.pleasecheck Indexed
with the Boardto see if you are requiredto file it eletronically.
Independentexpenditurecommittee mustfile this form Certifid Date of Dissolution
Electronically.

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WHENTO FILE:
The Slatementof Dissolutionmust be filed within thirty (30) days of completionof ail the foltowing:

1. All debts,loansand obtigationshave been paid or tansfened;

2. Allcampaignfunds have been spenf
3. All campaignpropertysold or transfened(candidatesonly);and
4. A final report disclosingall hansactionsclosing the committeehas been filed.

For state candidatesand state PACS,a final bank statemeril must be filed with the Statementof Dissotutionor as soon as
possibleif the bank stratementis not available at the time the Statementof Dissolutionis filed.

'of
Candidateor Treasurer(if candidate'a

Date Signed

FOR INSTRUCTIONS,SEE BACK OF FORM

BoardAddres: 510 E 12frSfeet Ste 1A"De Moines,l{ 50319 FaxNumber51+2814073