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T~RMINATION <br /> Statement of Termination Tm, er P~int in Ink. <br /> This form must be completed by officeholders, candidates, and rccipicat commi,lccs <br /> that wish Io temlinatc pursuant m Government Code Sccdon 84214. ! & Fo~ official Use Only ' <br /> <br /> Officcholde~ and candidates file an original of thi~ fon~ with the filing officer with <br /> whom they file the odgianls of their campaign <br /> Commitlces file an o~igin~l ~ this form with the Secretary of Slate and, il'applicable. <br /> a copy with thc local filing officur. <br /> I Officeholder or Candidate Termination I Recipient Committee Termination <br /> <br /> II Information on Office Sought or Held II Treasurer Information <br /> I <br /> <br /> III Verification III Verification <br /> I have used all reasonable diligence in Ix'eparinll this statement* I have ceased to receive I have used all reasonable diligence in preparing this statement. This committee has ceased <br /> can~butions and make expanditorcs; do not L*iticipate receiving contributions or repa)qncnis of receive contrihadortz and make expcedhurcs; does not entieipam receiving cofltFib~*ions or <br /> outstending loans nmde to others or any other receipts, or making cxpendltu~cs in the ~utnse; repayments o~ outstanding loans made to others or any other receipts, or making expc~dilorns in <br /> have elhninated or declare that I have no intention or ability to discharge all debts, loans the ~*ure; has eliminated (z declares that it has no intention or abilit~ to discharge all debts, <br /> received, and other obligations; have no surplus funds; and have filed all campaign sialemenls loans received, and othm' obiigetinns; h~ no surplus funds; and has filed all campaign stele- <br /> rcquh'ed by the Politic~ R~onn Act disclosing all rClX~teble u'amactions, ments required by the Polldcal Reform Act disclosing all reportable transactions. <br /> I ce~'d~ ander portal, If of perjury under the laws of the State o~ California that the fore&oing is i card~ under i~nalty of pcrjary unde~ the laws of the Stere of California thai thc foregoing is <br /> Ex~ulndo~t~eandc°ffc~t'///'//.Z ~/~..~/ t / -/ ' In~endco~ <br /> <br /> By / <br /> <br /> NOTE: ^dd~llo~al fili~9 ol:4igallens will hs incurred if an officeholder, candidate, o~ commitlca Executed o~ Al <br /> begins raising or spending funds of receives the forgiveness of a loan or repayments of ~ <br /> loans made to others or any other receipts. By <br /> <br />FOR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATIC)N MANIIAI ON C, AMPAIGN 131~c.~,10~UR~: PRC, VI~IDN~ OF THF IPOI ITIC, AI REFORM ACT <br /> <br /> Slate el Calilornin Fair Polltlcad Pr&¢tlce~ Commits. inn. <br /> <br /> <br />