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RECIPIENT COMMITTEE <br /> Recipient Committee WHERE TO FILE: STATEMENT OF TERMINATION <br /> Date Siam <br /> Statement of Termination File original and one copy of this form with: <br /> This form must be completed by recipient committees Secretary of State : ~' ~; ~; !,/ <br /> Political Reform Division ~ . : '~-, <br /> that are eligible to terminate pursuant to Government P.O. Box 1467 ~ ~. i For Official Use Only <br /> Code Section a4214. Sacramento. CA 95812-1467 FEB 2 1999 <br /> Ty~ or print in ink. A~, ff a~licaMe, fl~ ~e c~y M th~ lmm w~h: ~ ~ ~ ; <br /> The ctty or county officer, ifany, whorecei,st~j ':~ ~ ?:'~-~-~:~S~_ <br /> commi.ee'scampalgndlscl~ure.atemen~. L <br /> I Recipient Committee Information II Treasu~etlnfo~matJon <br /> NAME OF COMMITTEE I,.o..UMBER NAME OF TREASURER <br /> <br /> ~ ~ ~' ~ ~ ~'; ~O ~ C; / ~* / ~ / ~ MAILING ADDRESS OF TREASURER NO. AND STREET <br /> ADDRESS OF COMMITTEE ,/ NO. AND STREET <br /> <br /> ~t1~ SIA~E Zle CODE <br /> <br /> 'AREA ~ODE~AYTIME PHONE NUMBER <br /> <br /> ~. ~ ~ - ~ ~ ~ ~' I!1 Effective Date of Termination <br /> DATE FILING OBLIGATION5 WERE COMPLETED <br /> ' <br /> ' i~ / <br /> IV Verification " ' ' <br /> A, This committee has cea~d to receive contributions and make ex~itures; <br /> <br /> 8. This committee d~s not anticipate receiving contributions or making ex~nditures in the future; <br /> <br /> C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, loans received, a~ other obligations; <br /> D. This committee has no surplus funds; a~ <br /> E. This committee has fil~ all campaign statements requir~ by the Political Reform A~ disclming all re~a~e transactions. <br /> <br /> I have used all reasonable diligence in preparing this statement. I have review~ the statement and to the ~st of my knowl~ge the information contained <br /> herein is true and complete. I ce~ify under ~nalty of ~rjury under the laws of the State of California that the for~oi~ is true and corre~. <br /> <br /> ~ DATE/ CITY AND STATE <br /> <br /> OATE/ ~ITY AND <br /> $~NATU~ OF C~TROLL~G ~FICEHOt DER. ~NmDAT[. ~ STALE MEASURE <br /> <br /> Executed on At By <br /> $(GNATU~ OF CONTR~L~G OFFICEHOLDER. CANO/DATE. OR STATE MEA~U~ ~ON[NT <br /> Exe{uted on. At By <br /> DA~E CITY AND STAT[ SIGNAT~E Of C~TR~LING ~F~HOLDER. CANOIDAT[. ~ SIAT~ M~A~URE PR~ENI <br />OR ~ORMAflON REQUIRED 10 BE PROVIDED ~O V~ PUR~UAN~ ~O THE INFORMAIION P~CT~ES ACT Of l~rL SEE INFORMATI~ MAN~AL ON ~AMPA~N DISCL0S~E ~OV ~S ~ THE POLITICAl R[fO~ A~ <br /> <br /> State of ~lifornia Fab Pol~ical Practices Commission <br /> <br /> <br />