FORM (Rev.

07/03)
, or/,t$1j,,{,r?
illit., DR.3
" NOTICEOF
?0foJurot,
PHt&t2
DISSOLUTION

For Offlce Use Onlv

Gomm.#
Indexed
Audited
Computer
Noticeof Dissolution CertifiedDateof Dissolution

Mail to:
IECDB
510East126,SuitelA
DesMoines,Iowa50319

Street

tLfl t*?2,--za? ce,tl Ltlt-gr taAa

Area Telephone
Code

WHENTO FILE:
mustbe filedwithinthirty(30)daysof completion
The Noticeof Dissolution of all the following:

1. All debts,loansandobligations havebeenpaidor transferred;

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

Forstatecandidates andstatePACs,a finalbankstatementmustbe filedwiththe Noticeof Dissolution

or as soonas
possibleif the bankstatementis notavailableat thetimethe Noticeof Dissolution
is filed.

of Chairor Treasurer(if PAC)

DateSigned

FOR INSTRUGTIONS, SEE BACK OF FORM

This form is not applicable to statutory political committees.