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,. .  ~. . GARNER : LIBRARY ----------- PAGE 01

Notice of Dissolution FORM

DR-3
(Ra. 07103)

NOTICE OF
DISSOLUTION
Mall to :
JECDB
510 East 12'', Supt IA Ex 9m" Un Qnly
Des Moines, Iowa 50319
Comm .
Indtuted
Audited
COnlPliler
Certified Date of Dissolution

COMMITTEE NAME

Official Name of Committee

` 2~tt6l L-J 44
i
Stt9dt

City, State, Zip Code

9,23 -,23 .2
Area Telephone
Code
t I
I
WHEN TO FILE : .t
The Notice of Dissolution must be filed within thirty (30) days of completion of all the following: t

1 . All debts, 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 !
d . A final report discaa6ing all Uan~ocalvns elosiny the committee. '

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. ,

-fignatu
-;~Weg A0ZW
urre of Candidate or Treasurer (if candidate's commiHee)ISignatun of Chair or Treasurer (if PAC)

Date Signed

FOR INSTRUCTIONS, SEE BACK OF FORM

This form Is not applicable to statutory political committesa .

TOTAL P .03