2005 01 18 - DR3

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FORM jl (Rev .

07/03)
Notice of Dissolution DR-3
NOTICE OF
DISSOLUTION
Mail to:

I
IECDB
510 East 12'h, Suite lA For Office Use Only
Des Moines, Iowa 50319
Comm. #
Indexed
Audited
Computer
~fy1 ~NK Certified Date of Dissolution

COMMITTEE NAME

?ARC*Y5'UF4fR
- 0s 69 co
Official Name of Committee

Po aax 6C,2 , ig// 6 Al/S--~


Street

,~A c-0A/A, /A S2 2 q- ~-
City, State, Zip Code

~3R G
.56 s3C.S
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 he filed with the Notice of Disso!uticn or as soon as
possible if the bank statement is not available at the time the Notice of Dissolution is filed .

Signature of Candidate or Treasurer (if candidate's committee)/

t/z 0 5~ 1 - 12 --oS

FOR INSTRUCTIONS, SEE BACK OF FORM


This form is not applicable to statutory political committees .

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