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STATEMENT OF TERMINATION <br />Recipient Committee WHERETO F~L£: ~ <br />Statement of Term in ation File original and one copy of this form with: <br /> Secretary of State <br />This form must be competed b? recioie~t committees ~ol~ttcal R~om Omsm~ IECEIVE D AN D FI LE r <br />that are eficjJbie to terminate pursuant ~o Government P.o. ~ox ~ a67 t the 0 ce 0t the Secfeta~ 0t Stat ~or Off~mt Use Only <br />Code Section 84214. Sacramento, CA 95812-1467 of the State d <br /> <br /> Type or print in ink. And. Jf applicable, file one copy of this form with: <br /> The c~ty or county officer, if any, who reca,ves the JA~ 3 <br /> comm*ccee's cam Dmgn ciiscJosure s~atements. · <br /> <br />I Recipient Committee Information II Treasurerlnformatioh~jLLd°i~'ue~et~/°~ <br /> NAME OF TREASURER <br /> <br /> ~- ~ ~-~/~ III Effective Date of Termination <br /> DATE FtLING OBLIGATiON~ WERE COMPLETED <br /> <br /> IV Verifi~tion ~ This commi~ee has ceased to receive contributions and make expenditures; <br /> <br /> B. This commi~ee does not anticiDate receiving contributions or making expenditures in ~e future; <br /> This commi~ee has eliminated or declares that it has no intention or abiii~ to discharge all deb~, loans received, and other obligations; <br /> <br /> O. This commi~ee has no surplus funds; and <br /> <br /> E. This commi~ee has flied all campaign s~[emen~ required by the Political Reform A~ disclosing all repo~abie ~an~ions. <br /> <br /> I have us~ a [reasonable diligence in ~reoaring this ~atement. I have reviewed the statement and to the be~ of my knowledge the information con~in~ <br /> herein is true an~ complete. I ce~i~ under ~nalty of ~equ~ under the laws of the State of ~iifornia th&t the foregoing is true and corr~ <br /> <br /> <br />