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Recipient Committee ~ / RECIPIENT COMMITTEI <br /> Statement of Termination WHERE T_O <br /> TEMENT OF TERMINATIOk <br /> File original and one copy of this form with: ~R~ <br /> This form must be completed by recipient committees Secretary of State i office of the Secretary 0f State <br /> that are eligible to terminate pursuant to Government Political Reform Division of the State of California <br /> Code Section 84214. P.O. Box 1,~67 <br /> Sacramento, CA 95812-1467 For Official Use Only <br /> Type or print ln ink. And, tfapplicable, file one ¢opy of this form wlth:FEB 07 1997 <br /> The city or county officer, if any, who receives the.. <br /> committee's campaign disclosure statements. BII JONES, Secret~of~ <br /> I Recipient Committee Information <br /> N~M[ O~COM~Z[[ ~ II Treasurer Information <br /> <br /> ADDRESS OF COMMITTEE <br /> CITY CITY <br /> ARE~E~AYTIMEFH~ENU ~f' ' <br /> <br /> Iii Effective Date of Terminatio~ <br /> <br />IV Verification ~' <br /> A. This committee has ceased to receive contributions and make expenditures; <br /> B. This committee does not anticipate receiving contributions or making expenditures in the future; <br /> C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, loans received, and other obligations; <br /> D. This committee has no surplus funds; and <br /> <br /> E. This committee has filed all campaign statements required by the Political Reform Act disclosing all repodable transactions. <br /> <br /> I have used all reasonable diligence in preparin this st <br /> herein is true and com let ' g ate~ent. I have reviewed the sta <br /> j j p e.I ce~,fy under penalty of perjury under the laws of the 5tat~i~;~~s~ ~r~°~l~dge th~ information contained <br /> Executedon )/~J~ At I~ ~ / ~ / _. ~"~"'~ g g strueanacorrect <br /> <br /> Executed on At / ........ Lu~OLLING OfFICEHOLDEr, CANDIDATE. ~ MEASURE PROPON[ <br /> O <br /> <br /> Executed on At 51GNAIUR~ OF CONIROLLING OFFICEHOLDER CANDIDATE OR 51alE MEASURE <br /> DATE By CiTY AND STALE <br /> SIGNATURE OF COFJ1ROLLING OrFICEHOLOER, CANDIDA/E, OR STATE MEASURE paOeO~E~a <br />tnt ORkeATION REQUIRE D TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION P~CTICE5 ACT OF 1977 SE E iNFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROV S ON5 Or TttE POL T CAt REFORM ACt <br /> <br /> <br />