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TERMINATION <br />Statement of Termination Typ, orPrintlnlnk. <br /> Dale Slam~ <br />This form musl b~ compl¢l~d by officcholders, candidates, md recipient comm <br /> I <br />· al wish m m~inale pmsu~t to Government C~ Section ~214. <br /> A Fei Ollici~ Uso Oni~ <br /> <br /> OfFmehol&rs ~d c~dida~s file an origin~ of Ibis fo~ with ~e filing officer wi~ <br /> whom ~ey file ~e origin~s of ~eir c~ign smmmen~. <br /> Commit~ file ~ miginal of ~is fo~ with lbo S~re~ of Sram and, if a~licable, ~ ~ ~E~ <br />a ~py wi~ ~e I~al filing officer. <br />I OHio~hold~r or Oandidat~ T~l~lion I N~oipi~nt Oo~itteo T~r~nation <br /> <br /> ~[~ DATE~ l[~ J~ v~ ~ <br /> <br />I~ ~erilicalion III ~erilicalion <br />1 b~vc u~ ali rc~able dUi~ce ~ p~cpm~ ~ sralcm~l. I have ce~ <br />c~o~ ~d m~ ex.dieu; do .~ micip~ r~giv~l ~.~[io~ o~ ~a~u o[ ~cccivc ~.uibu~ ~ m~c cx~.di~c~; dogs ~1 ~icip~ rgcgiv~ conUibudons or <br />o~I Ion made ~ o~l et ~y o~er recoils, or m~ng ex~dil~es ~ & ~e; tepa~enm of oulsl~d~I Io~s m~ Io o~cts or ~y o~er r~ip~, or m~ing ex~dilmes in <br />have e~a~ or ~l~e ~t I ~ve no ~mn6~ or abi~ m d~ch~ge aH debm, ~ ~e ~e; h~ e~al~ m d~l~es ~ it hm ~ ~mnfion or abili~ to dish,ge di &b~. <br />t~iv~, ~ o~er ~lig~m; have ~ s~ius ~&; md ~ve fil~ ~ c~paign smmmen~ ~ t~iv~, ~d o~ obligafiom; hm no s~lus ~n&; ~ h~ fil~ all c~paign smm- <br />t~u~ by ~ Po~ Refo~ A~ d~c~s~g dl te~ble ~acliom. men~ r~u~ by ~ PoUfcd Refo~ Act d~closing ~1 te~rmble ~actiom. <br />i c~ un&r ~d~ of ~rj~ ~er ~e laws of ~e Sm~C~omia ~t &e f~ego~g is I c~6~ ~r ~ of ~rj~ u~er ~e laws of ~e S~le of California ~at ~e forego~g is <br /> <br /> x.cmd o.. <br /> -- · . <br /> <br /> By <br /> <br /> NOTE: ~ti~al filing o~igadons will be i~rred if ~ o~ce~ldm, ~n~ate. or <br /> b~lns r~sing or spewing ~s m r~elves the f~giveness of a ~an or repaym~ts of <br /> ~s ma~ ~o olhe~s ~ any o~er receipls. By <br /> <br />F~ I~TI~ RE~l~D TO ~ ~OY~EO TO Y~ ~f TO' THE I~OR~TI~ P~CT~ES ~CT ~ 1~77. ~E I~R~ION ~A[ ON C~AIGN ~1~i ~ ~O~ OF THK ~LITIC~ REF~M ACT <br /> <br /> State of Calilornla Fair Polillcal Practices Commisaion. <br /> <br /> <br />