HomeMy WebLinkAboutForm 415s �fl-! -, .ter'.
RE�C-1 y LLJ uL:?
RECIPIENT COMMI! 1�'_
N Recipient Committee WHERE TO FILE STATEMENT OF TERMINATION
W Statement of Termination File original and one copy of this form with; Date Stan
Secretary of state
4 This form must be completed by recipient committees Political Reform Division R E CE IV E D
IL that are eligible to terminate pursuant to Government P.O. Box 1467 ForOMO4t Use OWy
Code Section 84214. Sacramento. CA 95812.1367
SE P 9 1998 And, N applicable, fib one copy of this form with:
Type or print in Ink The eftyor cotM officer, d any, who receives the c .
comueee . a campaign c1sclosure staternents. CITY DEPT.
ED I Recipient Committee Information II Treasurer Information
9 NAME OF COLYRTEE 10. NUMBER NAME OF TREASURER
v�. vy._ 1�i"�- X C C ( �'r�l r a--.M .-a Q G A DDRE SS V C
N MAILIN ADDRESS OFT REASUR ER NO. AND STREET
N
�• ADDRESSOFcommr'TEE NO -AND STREET �}'�� h., ufhy.n.. CA` S
m i {`AIL l )A+ n f- i ' mct -(A C 6 �� S � Cm �¢r+C C_kA STATE ZIP CODE
Om STATE ZIPCODE 'Ro 6 9+
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C 1y C G C IS - S AREA CODEMAYTBAE PHONE NUMBER
.. AREA CODE/DAYTIME PHONE NUMBER 0V'rX- 4 1er- e¢T�
III Effective Date of Termination
DATE FILING OBLIGATIONS WERE COMPLETED
IV Verification
A. This cornrrdttee has ceased to receive contributlons and make expenditures;
V3 Q. This committee does not arm i mle receiving corrtributions or making expenditures in the future;
3 „
o C. This committee has eliminated or declares that it has no intention or ability to discharge all tt", loans received, and other obligations;
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E u D. This commtteee has no surplus funds; and
U °. E. This Committee has filed all campaign statements required by the Political Reform Act disciesing all reportable transactions.
IL
at W 1 have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information confained herein
., is true and complete. I certify under penalty of perjury under the laws of the State of Califo a e loregoin IS true and correct.
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° a Executed on 1 l `t � `i F At By ��'1 A
FI IL DATE CITY AND STATE !in:
UREOF TREASURER
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Exeartedon lovi '2 t Y At BY
DATE QTY AMD STATE CONTAMIM OF+IC8QLDER CANDDATE OR STATE WAWM PROPONENT
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.� Executed on At BY
+I r DATE CRY AND STATE SxWAGURE OF ODNTROlJWCIF FICEHODFR CANDIDATE OR STATE rF.ABJRE PRCPOEW
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In Executed on At BY
a 8 PACE SJIATURE DONTROILND OFFIfa9101DE7R CANDIDATE OR STATE IEA6URE PROPONE
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'� ' FOR iNFCriaN770M REQUIRED TO BE PRGNIDED TO YOU PURSUANT IF
TO THE tORMATIDII PPACTIO£S ACT DF 19". SEE MFORNATION l u ON [AYPAIfN d 0.51 RE PftDYI QI� ()F 11E PpL [ RF3AIS A
Sbft of CMornia Fair Political Practices co na"SUN