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Notice of Dissolution FORM (Rev . 07A3)

DR-3
NOTICE OF
Mail to: DISSOLUTION
fECD13
510 Fast 12`h, Suite lA For Offi ce Use Only
Des Moines . Iowa 50319
Comm . #
Indexed
Audited `
Computer
Certified Date of Dissolutlorr

COMMITTEE NAME

Official Name of Committee

/4z 'V, og/~ ~2

street

..City, State,21p Code

.3/t' -,
67-00-!5-
Area Telephone
Code

1hIP~~'~O .T:I<liE :
The NMCW d'f Dissolution must be filed within thirty (30) days of completion of all the following :

1. All dialMA, loans and obligations have been paid or transferred :

2. All campaign funds have been spent;
3. All campaign property sold or transferred (candidates only) ; and
4. A final report disclosing all transactions closing the committee .

For state candidates and state PACs, a final bank statement must be flied 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.

re rer (if candi e's committee)/Signature of Chair or Treasurer (if PAC)

FOR INSTRUCTfONS, SAE BACK OF FORM

This form is not appliaia#ile to statutory political committees .