Laserfiche WebLink
OFFICEHOLDER AND CANDIDATE <br />Officeholder and Candidate STATEMENT OF TERMINATION <br />Statement of Termination <br />This form must be completed by officeholders and WHERE TO FILE: <br />candidates that are eligible to terminate pursuant Officeholders and candidates must file <br />to Government Code Section 84214. Form 416 with the filing officer with ~J~ 3 0 ~1~ <br /> whom they filed their original campaign <br /> Type m print in ink. statements (Form 470 or 490). <br /> <br />I Officeholder or Candidate Termination II Office Sought or Held <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD FOR WHICH YOU ARE FILING THIS STATEMENT <br /> <br /> RESIDE NTIAL OR BUSINESS ADDRESS NO. AND STREET JURISDICTION' (IF APPLICABLE) ] DISTRICT NUMBER (IF APPLICABLE) <br /> I <br /> CiTY STATE ZiP CODE <br /> ~&~o~[ Ci~/, C~ c~4b~ / III Effective Date °f Termination <br /> AREA CODE~)AYTIME PHONE NUMBER ) DATE FILING OBLIGATIONS WERE COMPLETED <br /> <br />IV Verification <br /> <br /> For the office listed in Part II of this form, I verify that: <br /> <br /> A. do not hold or am no longer a candidate for the office; <br /> <br /> B. have ceased to receive contributions and make expenditures; <br /> <br /> C. do not anticipate receiving contributions or making expenditures in the future; <br /> <br /> D. have eliminated or I declare that I have no intention or ability to discharge all debts, loans received, and other obligations; <br /> <br /> E. have no surplus campaign funds; and <br /> <br /> F. have filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> <br /> I have used ail 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 /> on ' DATE / CITY AND $1AIE ' // By ~ SIGNATURE OF OFFICEHO~.DER OR CANDIDATE <br /> <br /> FOR INfORMAtION REQUIRED IO BE PROVIDED TO YOU PURSUANt 10 1HE INFORMATION PRACTICES ACI Of 1977, S[[ INfORMAIION MANUAL ON CAMPAIGN DI$CLO$~JI~ PROVISIONS Of THE POLItiCAL REFORM ACCT. <br /> <br /> State of California Fair Political Practices Commission <br /> <br /> <br />