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,,,.,,0,1,t0F,t$fis,-tB[i* FORM (Rev.

DR€
?s0eBEc-8AHIffiA NOTICEOF
DtssoLunoN

For Office Use Onlv

Comm.#
Indexed

Noticeof Dissofution Date of Dissolution_

Mail to:
IECDB
510 Eastllh, SuitelA
DesMoines,Iowa 50319
Ken Bresnanfor Mayor

OfficialNameof Committee
801W.Ashland

Street
Indianola,Iowa 50125

City, State,Zip Code

(515 ) 961-0ul
Area Telephoire
Code

TIVHEN
TO FILE:
The Noticeof Dissolutionmust be filed withinthirty (30) days of completionof all the following:

1. All debts,loansand obligations havebeenpaidor transfened;

2. Allcampaignfundshavebeenspent;
3. All campaignpropertysold or transfened(candidatesonly);and
4. A final reportdisclosingall transactionsclosingthe committee.

For state candidatesand state PACs,a final bank statementmust be filed with the Noticeof Dissolutionor as soon as
possibleif the bank statementis not avaibble at I're time the Noticeof Dissolutionis filed.

of Chair or Treasurer(if PAC)

Signatureof Candidateor Treasurer(if candidate'scommittee)/Signature

DateSigned

FOR INSTRUGTIONS, SEE BACK OF FORM

Thls form is not applicable to statutory political committees.