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RECIPIENT COMMITTEE <br /> STATEMENT <br /> OF <br /> TERMINATION <br />Recipient Committ.ee WHERE TO FLEE: <br />Statement of Termination File original and one copy of this form with: <br /> <br />This form must be completed by r~ipient committees ~e4~tical Reform <br />that are eligible to terminate pursuant to Government P.o. Box la67 For Officml Use Onl), <br />Code Section 84214. Sacramento, CA 95812-1467 <br /> <br /> Type m' print in ink. And. if applicable° file one copy of this form <br /> The crt), or county officer, it any. who recewE <br /> committee's camDmgn disclosure statement. <br /> <br />J Recipient Committee Information II Treasurerlnformation <br /> <br /> --~/~ <br /> <br /> <br /> <br /> <br /> on <br /> DATE FILING OBLIGATIONS WERE COMPLETED <br /> <br /> IV Verification A. This committee has ceased to receive contributions and make expenditures; <br /> <br /> B. This committee does not anticipate receiving contributions or making expenditures in the future; <br /> <br /> C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, loans received, and other obligations; <br /> <br /> D. This committee has no surplus funds; and <br /> <br /> E. This committee has flied all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> <br /> I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained <br /> herein is true and complete. I certify under penalty of perjury under the laws of the State~.~of California that the foregoing is true and correct. <br /> <br /> ~,ecuted ~ At By <br /> Executed on At By <br /> <br />foe ~mOmdAzme4 ~OU~eZn ~O ~ ~OVm~O TO YOU eU~SUANT ZO mE .e~OeMGT~O~ PaACZ~CES ~C~ O~ ~e;?. St t ~aFOR~A~ aANUAt Oa CG~PA~N msc~osuaE ~ows~oas OF z.f ~otrr*cAL ~o~ ~. <br /> State of ~lifornb Fai~ PolRi~I ~a~ices C~miss~ <br /> <br /> <br />