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Notice of Dissolution
Reset Form

COMWTTEE NAME

Official Name of mittee

Street

' City, State, Zip Code

~lr 59j`_-3
i
Area Telephone
Code

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

1 All debts, loans and obligations have been paid or transferred ;

2. All campaign funds have been spent ;
3. All campaign property sold or transferred (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
possible if the bank statement is not availab*~ time the NPQ of Dissolution is filed .

mmittee)1Signature of Chair or Treasurer (if PAC)

FOR INSTRUCTIONS, SEE BACK OF FORM

This form is not applicable to statutory political committees .
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NS, SEE BACK OF FORM Reset FORM

FOfm
DISCLOSURE SUMMARY PAGE DR-2 DISCLOSURE
(Rev. 1212005) 1 REPORT
COMMITTEE NAME (Must be same as on Statement Of Organization)
For Office the Only
0 .- AN Comm * -
I WORTANT . Indicate by # type of committee you are reporting for. Logged In
( 1 iStatewideJLeglslativOIJudge Standing for Retention Candidate ( )State PAC ( 3 )State Party Scanned
(4 )County Central Committee ( 5 )County Candidate (5 )City Candidate (7 )School Board or Outer POfitlOW
Subdivisiion Candirtete (8 )C3Wty PAC (9)Clty PAC ( 10 )School Soard or Other Political Subdivision PAC Computer
( 11 ) Local Ballot Issue_ Audited
CANDIDATE COMMITTEES ONLY
Political Patty (if applicable)

District (if Senate or House)

and criminal penalties . Pursuantto Iowa Code section 68B.32A(7) the candidate, for a candtdale's committee,
o"mmMee, is the individual responsible 10f filing timely and accurate reports.

a]
REPORT FOR (1) ELECTION I(2)NON-ELECTION-YEAR.
(report date) Indicate by 0

Local Committees, enter Date or Election

CQCHECK IF AMENDMENT TO REPORT DATED

1. 1

QY.Ghedt i( this is final (termination) report and attach Notice of Dissolution Form DR-3 . County 8 Local Committees, enter County in
(You must continue to file reports unfit a DR-3 is tiled .) which Election is held

STATEMENT OF CASH ON HAND

CASH ON HAND at the beginning of the reporting period . (Total of all funds held by the
committee. This amount MUST be the same as the cash on hand at the end
of the last reporting period or must be zero if this is first report flied .) . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . .$
ADD TOTAL MONEYTAKEN IN THIS PERIOD
Schedule A: Cash Ctmdibutonr total (Attach Schedule A) ('also see in-kind below) . . . . . . . . . . . . . . . . . .
Schedule F: Loans Received total (Attach Sohedute F) . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . ., . . . . . . ... . . . . . . . . . . . . .
Schedule H: Total Sales of Campaign Property (Attach Schedule H) . . . . . . . .------- . . . . . . . . . . .. . . . . . . . . . . . . . .
(SSchedtde H aooiles to Candldates' Cmmlam Onhr)
SUB-TOTAL . . . . . . . . . . . . .f
SUBTRACT TOTAL MONEY SPENT THIS PERIOD
Schedule B: Expenditures total (Attach Schedule B) (-also see debts and loans below) . ., . . . . ., . . .
Schedule F: Loan Repayments total (Attach Schedule F) . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . ., ... . . . . . . . . . . . . . . . . .
CASH ON HAND at the end of this reporting period (it final report balance must
be zero) (Attach OR-3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . .. . . . . . . . , . . . . . . . . . .5

"UNPAID BILLS (From Schedule D-Attach Schedule ()) . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . ... . . . . . . . . . . . .. .. . . . E

'IN KIND CONTRIBUTIONS (From Schedule E - Attach Schedule E) . . . . . . . . . . . . .. . ., . . . . . . . . .. . . . ., . . . . . . ---1
--OUTSTANDING LOANS (From Schedule F - Attach Schedule F) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ._S
CONSULTANT BREAKDOWN (Schedule G Attached?) YES rNO
CANDIDATE COMMITTEES ONLY :
VALUE OF CAMPAIGN PROPERTY (From Schedule H -Attach Schedule H) 1i
STATE COMMITTEES : Submit a reconciled campaign account bank statement in January of each year .