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OFFICEHOLDER AND CA~N DIDA <br />Officeholder and Candidate STATEMENT OF TERMINATIO, <br />Statement of Termination D,t~ s~,mp <br /> <br />This form must be completed by officeholders and WHERE TO FILE: [~ ~ [~ 0 1~ [~ For Official Use Only <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 <br /> whom they filed their original campai, JAN 3 0 [998 <br /> Type or print in ink. statements (Form 470 or 490). <br /> <br /> OF RE0W00D OiTY <br /> <br />I Officeholder or Candidate Termination II Office Soughto~ <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD FOR WHICH YOU ARE FILING THIS STATEMENT <br /> <br /> RESIDENTIAL OR'BUSINESS ADDRESS NO. AND STREET JURIsDIcTION (IF APPLICABLE) <br /> I DISTRICT NUMBER (IF APPLICABLE) <br /> STATE ZIP CODE <br /> ClT~ <br /> ~~u~lO[~ ~ O~ fl~(/[~ III Effective Date of Termination <br /> DATE FILING OBLIGATIONS WERE COMPLETED <br /> AREA CODE/DAYTIME PHONE NUMBER <br /> I - ~.o ~:I ~" <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 all 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 /> Executed o By <br /> DATE CITY AND SLATE SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br /> <br /> FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUAN1 TO THE INFORMAIION PRACIICES AC1r OF 1977, S£E INFORMA11ON MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACT. <br /> <br /> State of Califmnia FaiF Political Practices Commission <br /> <br /> <br />