02/27/2005 19 :24 15159574745 STEVIE OVERTON PAGE 04

FOR INSTRUCTIONS, SEE BACK OF FORM FORM (Rev . 07)98)

This form is not applicable to statutory political committees .
DR-3
NOTICE OF
Notice of Dissolution DISSOLUTION
OCT 1 9 2095
For Office Use Onhr
Every Notloe of Dissolution shall be accompanied by a
completed Disclosure Report Form current to the date of Comm. #
dissolution. Indexed _
Audited
Computer
Certified Date of Dissolution
COMMITTEE NAME

Official Name of Committee

Street

A:5-6V ~~ 96-W"
City, State, Zip Code
sue-
~3ozs- 1a ot~
Area Telephone
Code

6,25)- a-55- -aS-~ ~-,

Effective date of dissolution :

20

4zfe4
Signature of TAasurer

-1p~ 7
Date Signed
-off

THIS BOX APPLIES TO CANDIDATES' COMMrTTEES ONLY'

I, the candidate, certify that my candidate oommlttee's cash balance is zem, all debts, obligations and loans have been paid or satisfied In accordance
with law as shown on my oommktee's final report and all campaign property end leftover funds have been distributed In accordance with my
committee's Last filed Statement of Organization,

Signature of Candidate - Required for Candidate's Committee Date signed

WHEN TO FILE :
The Notice of Dissolution must be filed within thirty (30) days of the committee's dissolution, with a copy of the
final bank statement attached .