Professional Documents
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C4rxo
For Office Use Only /
VI S (~"'5 (o ro l l+~f Comm . # /
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CANDIDATE NAME AND ADDRESS TO WHOM PURPOSE AMOUNT
DATE ID NUMBER EXPENDITURE (DESCRIBE TRANSACTION) EXPENDED
EXPENDED (if applicable) (Disbursement) WAS MADE
(MM/DD/YR) AND PAC
CHECK
NUMBER
I D#
ID#
CK#
ID#
CK#
ID#
CK#
1D#
C K#
1D#
CK#
ID#
CK#
ID#
CK#
SUB-TOTAL $
Purchases of certain campaign property costing $500 or more must also be inventoried on Schedule H . (Refer to Schedule H instructions .)
Expenditures to persons/entities providing consulting, advertising, fund-raising, polling, managing, organizing services must also be detail itemized on
Schedule G by the amount, purpose, and date of each type of expenditure made by the person/entity on behalf of the candidate's committee . (Refer to
Schedule G instructions and Iowa Code 68A .402(3)(i) .)
(for Schedule B)
DeWitt Bank STATEMENT
Member FDIC
815 6th Avenue " P.O . Box 260 " DeWitt, IA 52742-0260 " Phone (563) 659-3211
REPORT ANY DIFFERENCES WITHIN 14 DAYS .
NOTE : SEE REVERSE SIDE' FOR IMPORTANT
INfORMATION .
36
MARTY MURRELL p PR~xtEO W ~
F I N A L S T A T E M E N T
OTHER DEBITS
DESCRIPTION DATE AMOUNT
DEBIT MEMO 01/13 109 .00
DAILY BALANCE'- ,
DATE . . . . . . . . . . . BALANCE DATE . . . . . . . . . . . BALANCE
01/13 .00
FORM (Rev . 07103)
Notice of Dissolution
DR-3
NOTICE OF
DISSOLUTION
Mail to :
IECDB
510 East 12`h ,Suite 1A ' -F4 Offce Use Only
Des Moines, Iowa 50319
100S Commt+h. #
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v' C%
Il lnd~xed r~1~1
A~ited
Computer ~~ln
Certified Date of Dissolution
COMMITTEE NAME
(g$~65g-~Z3~
Area Telephone
Code
WHEN TO FILE :
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following :
For state candidates and state PACs, a final bank statement must be filed with the Notice of Dissolution or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed .
a ('3h
Date Signed