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RECIPIENT COMMITTEE <br /> Recipient Committee WHERE TO FILE: STATEMENT OF TERMINATION <br /> Date Stamp <br /> Statement of Termination File orlginal and one copy of this foTm with: ~ , <br /> This form must be completed by recipient committees Secretary of State <br /> that are eligible to terminate pursuant to Government Poht,cal Reform Divas,on i~ i:i ii!" <br /> P.O. Box 1467 ' ' '" ' For Offlc~al Use Only <br /> Code Scction 84214. Sacramento. CA95812-1467 ~i h f N0~/ O t~ <br /> i~'' ' ~ U <br /> Type or print in ink. And. If applicable, file one copy of thli form with: <br /> The c~ty or county officer, if any. who receives the ~ <br /> comm~ee's campaign disclosure statement. ~ ~l[~ 0~"}:~ :~:,,.; - ~-~ <br /> I Recipient Committee Information II Treasurerlnformation <br /> NAME OF COMMITTEE ll.D. NUMBER NAME OF TREASURER <br /> ~'~ </~Y (aU~Ci~ ~/~ / MAILIN~ ADDRESS OF TREASURER NO. ANDSTREET <br /> <br /> 7~/ ~EA COOE~AYTIME NUMBER <br /> /~'~ Ill Effective Date of termination <br /> DATE FILING OBLIGATIONS WERE COMPLETED <br /> <br /> IV Verification ~ <br /> A. This committee ha~ [ea~ed lo receive contributions and make expenditures; <br /> <br /> B. This committee does not anticipate receiving contributions or making exp~nditur,s in the <br /> <br /> C. This committee has eliminated or deglare~ that it has no intention or ability to dischar~ all debts, loans received, and other obligations; <br /> <br /> D. This committee has no surplus funds; and <br /> <br /> E. This committee has filed all campaign statements required by the Political Retorm A~ disdosin~ all r~po~able transa(tiom. <br /> I have used ~11 reasonable diligence in preparing this statement. I ha~e reviewed the ~tatem,nl and o th~ best otm kn ' · <br /> hereln~tru~andcomplete. Ice~ilyunder halt of r'ur underlhel . y_._o~ledgethe,nto[~atmn <br /> : ,. /o,-~ ~_.~ , y ~ ] y - aws of the State ofg~,f~.~ !theforegu, ng ,s true and corre~, contained <br /> <br /> ./ E ~ ~ . · ,f, <br /> <br /> Executed on At ~~ ~/~/ ~/~/ B ~ /~ ~ '~/ G . <br /> <br /> DATE ~G 0 <br /> G tlICiltOID[R ~NDIDAI[ OR~IAIEMEASUR[ <br />[OR INI O~MAI ION ~[ QUlR[D 10 8[ PROVIDE O 10 YOU PURSUANI IO IH[ l~lOR~lllO~ P~CII([ } ICl Ol I~11. ~[[ [~iOa~RllO~ ~l~Rt O ~ DI~[O}~[ P~VI$1~t IHI POI II1(~1 ~[ t OR~ <br /> <br /> <br />