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Statement of Organization <br />Recipient Committee STATEMENT OF ORGANIZATION <br /> <br />iNSTRUCTIONS ON REVERSE <br /> <br />4, Type of Commiffee (con, hued) <br /> <br />~e~zl-d~ze ~...z .~-f-.~ .~.m..~ ..... Not formed to support or oppose specific candidates or measures in a single election. Check only one box: <br /> ~'ClTY CornmlRee [] COUNTYComrntttee [] STATE Committee <br /> <br /> [] /_ / · . <br /> Check box ar'zl pro~de the date this committee qualified as a smal{ contributor cammlttee, if the commiffee qualified as a small <br /> Date quallrted co~tributor commiffee on Januat~ 1, 2001, enter 1 I1/01. <br /> <br />5. Termination Requirements Bysigningtheved~cat~n~thetmasurer~ss~tantb~easurer~nd/~rcandidate~cah~ld~r~rpr~p~nentca~t[fythata~fthef~I~w~ngc~nd~ti~nshavebeenmet: · This committee has ceased to receive contributions and make expenditures; <br /> <br /> · This committee does not anticipate receiving contributions or making expenditures in the future; <br /> <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 /> <br /> · This committee has flied all campaign statements required by the Political Reform Act disclosing all reportable transactions. <br /> <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 <br /> Government Code Section 89519. <br /> <br /> -- Additional filing obligations will be incurred if, after terminating, the commiffee receives or spends any funds, or receives the forgiveness of a loan, <br /> repayments of loans made to others, or any other receipts. <br /> <br /> FPPC Form 4~0 (Janl01) <br /> FPPC Toil.Free Heipitne: 866/ASK-FPPC <br /> <br /> <br />