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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />Diane Howard for Redwood City Council 2013 <br />4. Type of Committee (continued) <br />PROVIDE BRIEF DESCRIPTION OF ACTIVITY <br />NAME OF SPONSOR <br />STREET ADDRESS <br />Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br />❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee <br />List additional sponsors on an attachment. <br />NO. AND <br />Small Contributor Committee M <br />CITY <br />OFSPONSOR <br />11.11 Lur —UF <br />Page 3 <br />1357417 <br />Date qualified <br />5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met. <br />• This committee has ceased to receive contributions and make expenditures; <br />• This committee does not anticipate receiving contributions or making expenditures in the future; <br />• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; <br />• This committee has no surplus funds; and <br />• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br />-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government <br />Code Section 89519. <br />-- Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code sections 89511 - 89518, and are <br />subject to Elections Code Section 18680 and FPPC Regulation 18521.5. <br />FPPC Form 410 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />