HomeMy WebLinkAboutROBINSON 415 ecipient Committee
Statement of Termination
This form must be completed by recipient committees
that are eligible to terminate pursuant to Government
Code Section 84214.
Type or print in ink.
I Recipient Committee Information
NAME OF COMMITTEE
IV
WHERE TO FILE:
Date Stamp
File original and one copy of this form with:
Secretary of State
Political Reform DivisiOn
P.O. Box 1467
r:'~ "'
Sacramento, CAgS812-1467 C~c.} C~I~
And, if applicable, file one copy of this form with: .,
The city or county officer, if any, who~J~i~i ~e
commlttee's campaign disclosure statements,
II Treasurer Information
I.D. NUMBER NAME OF TREASURER
NO. AND STREET
,;z / d-,/i 0 Y3 14 er- F, rid C' c-
CITY STATE ZIP CODE
AREA CODE/DAYTIME PHONE NUMBER
.~o 5' ,S ~ 7 2-
MAILING ADDRESS OF TREASURER
CITY
III
AREA CODE/DAYTIME PHONE NUMBER
Effective Date of Termination'
DATE FILING OBLIGATIONS WERE COMPLETED
Verification
A This committee has ceased to receive contributions and make expenditures;
B. This committee does not anticipate receiving contributions or making expenditures in the future;
RECIPIENT COMMITTEE
STATEMENT OF TERMINATION
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FOr Official Use Only
NO. AND STREET
STATE ZIP CODE
F OR INFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PROVISIONS OF THE POLITICAL REFORM A_~_~
State of California Fair Political Practices Commission
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDE R, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on At By
DATE CITY AND STATE
Executed on At By
DATE CITY AND STATE
Executed on At By
DATE CITY AND STATE
C. This committee has eliminated or declares that it has no intention or ability to discharge all debts, loans received, a~d other obligations;
D. This committee has no surplus funds; and
E. This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
I have used all reasonable diligence in preparing this statement. I have reviewed the statement and to the best of my knowledge the information contained
herei n is true and complete, I certify under penalty of perjury under the laws of the Sta~f~ California that the foregoing is true and correct.