12/08/2010 wep 9:54 FAX 319 837 6043 aoos/oos Be a, DR-3 : : STATEMENT OF Statement of Dissolution DIssoLyTION Effective January 1, 2010, this form must be fled electronically by |FatSticeUseOny | most state committses, Effective January 4, 2011, this form must. |Conm.¥ 4\ be filed electronically by most local committees. Please check Indexed wih he Board to ee f you are rqurod to fl elesronicaly, |e Independent expenditure committees must fie this form D Independent Cered Dae of Doon FEDLER FOR REPRESENTATIVE Official Name of Committee D0y 6+ ST ‘Sweet WesT POINT ZA _ S3es¢ City, State, Zip Code 39) 237 C074 ‘area “Telephone Code WHEN TO FILE: ‘The Statement of Dissolution must be fled within thity (30) days of completion of all the folowing: 4. 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 ail transactions closing the committee has been filed, For state candidates and state PACS, a final bank statement must be filed withthe Statement of Dissolution or as soon as Possible ifthe bank statement is not available atthe time the Statement of Dissolution is file. ‘Signature of Candidate or Treasurer (if candidate's committee)/Signature of Chair or Treasurer (if PAC) lA-P-/0 Date Signed FOR INSTRUCTIONS, SEE BACK OF FORM Board Address: 510 E 12" Street Ste 1A, Des Moines, IA 50319 Fax Number: 515-281-4073,