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NOTICEOF
DISSOLUTION
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For Offlce UsE Onlv

Comm.#
Indexed
Audited
Computer
Notice of Dissoltition CertifiedDate of Dissolution

Mail to:
IECDB
510 Eastllh, SuitelA
DesMoines,Iowa 50319
Lac-kox- 5^ Suoo/ Bo,a-d
OfficialNameof Committee

e Dni+
Street

TA 60a)Q
City,State,Zip Code

,61{.; ?gt/.-"Qq44/ .r; .j

-Ar'ea'. " ,'Telephone
Code

WHENTO FILE:
The Noticeof Dissolutionmust be filed within thirty (30) days of completionof all the following:

1. All debts,loansand obligationshave beenpaidor transfened;

2. All campaignfundshavebeen spent;
3. All campaignpropertysold or transferred(candidatesonly);and
4. all transactionsclosingthe committee.
A final reportdisclosi.ng
.:
For state candltlatEiand,statepACs,'a finil bank:staiemontmust be ftled with the Noticeof DirEsolUtion
or as soon as
possibleif the bankstatementis not availableat the time the Noticeof Dissolutionis filed..

>{tu of Chairor Treasurer(if PAC)

Signatureof Candidateor Treasurer(if candidate'scommiftee)/Signature
/4- e3- O 7
Date Signed

FORTNSTRUCTTONS, SEEFAgK-OFFORM --
This form is not applicableto statutory political coininittees.