HomeMy WebLinkAboutForm 416s OFFICEHOLDER AND CANDIDATE
RECEIVED SEP - 9 1998 STATEMENT OF TERMINATION � w
Officeholder and Candidate Date stnp •,
Statement of Termination '
WHERE TO FILE RF-0IFIVFE; • ' m O
This form must be completed b officeholders and �
candidates that are eligible to terminate Officeholders and candidates must file For omanl Um only m .
d P ursuant to Form 416 with the filing officer With SEP - 9 199x8 rr
Government Code Section 84214, whom they filed their original campaign 0 0
Type or print in ink. statements (Form 470 or 400). ; y (,L`i�r�J Utt'T. m N
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I Officeholder or Candidate Termination II Office Sought or Held
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD FOR WHICH YOU ARE FILING THIS STATEMENT
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RESIDENTIAL OR BUSINESS ADDRESS NO, AND STREET JURISDICTION (IF APPLICABLE) DISTRICT NUMBER (IF APPLICABLE) f-
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�CnY STATE ZIP CODE
III Effective D of Termination i
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DATE FILING OBLIGATIONS WERE COMPLETED Ul
AREA CODEIDAYTIME PHONE NUMBER
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IV Verification
For the Office listed in Part II of this form, I verity that:
A. I do not hold or am no longer a candidate for the office;
1 have ceased to receive contrbutions and make expenditures;
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C. I do not anticipate receiving contributions or making expenditures in the future;
�0. I have eliminated or I declare that I have no intention or ability to discharge all debts, loans received, and other obligations; m
E. I have no surplus funds; and nnii
F. ! have filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
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I have used all reasonable diligence in preparing this statement. I have reviewed the statement and tothe best of my knowledge the information contained herein is ro
true and complete. I certify under penalty of perjury under the laws of the State of Califomla that the foregoing is true and correct. N
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Executed on ` BY m
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DATE SIGNATURE OFOFFICEHOLDFA ORCANOIOATE m
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Farm 416 [7ft)
For Technical Assistance: 9161322 -MO