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oFFICEHOLDER AND CANDIDATE <br />Officeholder and Candidate STATEMENT OF TERMII~ATION <br />Statement of Termination Dar, <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 [ 1 official use Only <br />to Government Code Section 84214. Form 416 with the filing officer with I <br /> whom they filed their original campaign ~,/! ~i:~ '~ i~ 'tgg~ <br /> Type or print in ink. statements (Form 470 or 490). ~ ..... <br /> <br /> CT¥ OF REDWOOD CI-¥ <br /> <br />I Officeholder or Candidate Termination II Office Sought or H~[c] <br /> NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HEL[! FOR WHICH YOU ARE FILING THIS STATEMENT <br /> <br /> RESIDENTIAL OR BUSINESS ADDRESS NO. AND STREET JURISDICTION (IF APPLICABLE) I DISTRICT NUMBER (IF APPLICAELE) <br /> I <br /> CITY STATE ZIP CODE <br /> III Effective Date otTermination <br /> /~_.~ (~(:3 D ~ ~ ~/~ ?¢0 ~ '~ DATE FILING OBLIG~TIONS WERE COMPLETED <br /> AREA CODE/DAYTIME PHONE NUMBER <br /> <br />IV Verification ' <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 /> B. have ceased to receive contributions and make expenditures; <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 /> E. have no surplus campaign funds; and <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, certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br /> <br /> DATE CITY AND SLATE SIGNATURE OF OF~f~IOLDE R OR CANDIDATE <br /> <br /> FOR INFORMATION REQUIRED 1'O BE PROVIDED TO YOU PURSUANT 10 THE INFORMATION PRACTICES ACt Of Ig77. SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM ACI. <br /> <br /> State of California Fair Political Practices Commission <br /> <br /> <br />