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Notice of Dissolution (Rev . 07103)

DR-3
NOTICE OF
w DISSOLUTION
)hall t0 :
Acr--n
14V v
1 RECEIVED
510 East 12"', Suite IA.
ro X For OMce Ues Only
Des Moines, low-3 50319
ZUUU Comm.
Indexed
Audited
Computer
Certified Date of Dissolution

rgi4 M!TTFE NAME

9
Coutimituc to Elact Bill Hayes
r cie! Na_ma of Committee

2221 US kiwy 169

Street
I
Afton, [A 50830

City . Stage, Zip r=te

641 316-2245
c
Area Telephone
Code

WHEN TO FILE:
The Notice of DissnWtion must be filed within thirty (30) days of completion of all the following-

1. All debts, loans end obligations have been paid or transterrbd :

2, AV L:ampalgn vnw have O6on spent ;
3 . All campaign properly sold or vansferred (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 filed with the Notice of Dissolution or as soon as
possibte if the bank statement is not available at the time the Notice of Dissolution is filed.

er (if candidate's committee)/Signature of Chair or Treasurer (if PAC)

gnature of Candidate 3r Treasu

FOR IN ;TRUCTIONS, SEE BACK OF FORM

This fo rrt is not applicable to statutory political cornrmittess .

Ti-ITHL P .04