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?010 NOTICEOF
DISSOLUTION

For Offlce Use Onlv

Comm.#
Indexed
Audited
Computer
Noticeof Dissolution CertifiedDate of Dissolution

Mail to:
IECDB
510 Eastllh, SuitelA
INGERSLEV FOR HOSPITAL TRUSTEE DesMoines,Iowa503l9

OfficialNameof Committee
23II IOTHAVE.N.

Sheet
DENISON,IA51442

City, State,Zip Code

263-3t06
Telephone

WHENTO FILE:
The Noticeof Dissofutionmust be fted withinthifi (30) days of comptetion
of a1 the foltowing:
1. All debts,roansand obrigations havebeenpaidor transfened;
2. All campaignfunds have been spent;
3' All_campaign propertysordor transfened(candidatesonly);and
4. A final reportdiscrosingail transactionscrosingthe committee.

For state candidatesand state PACs,a final bank statementmust be filed with
possibleif the bank statementis not availableat the time the Notice the Noticeof Dissolutionor as soon as
of Dissolutionis filEd.

or Treasurer(if candidate'scommitte

FORINSTRUCTIONS, SEE BACK OF FORM

Thls form is not applicable to statutory political commlttees.