HomeMy WebLinkAboutSHEARER 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.
Recipient Committee Information
NAME OF COMMITTEE
ADDRESS OF COMMITTEE
CITY
AREA CODE~AYTIME PHONE NUMBER
I.D. NUMBER
NO. AND STREET
STATE ZIP CODE
C'A q55o6
FILE COPY
STATEMENT OF TERMINATION
WHERE TO FILE: Date Stamp ':
Fileoriginalandonecopyofthisformwit.=
Secretary of State
Political Reform DivisiOn 97 J~,T~ t q P>~ 3: [:, i I ' '
P.O. BOx 1467 : FOr Offlcial Use Only
Sacramento, CA95812-1467 :jA~Li\T..ij'i~_L.L, :.,i ,
And, if applicable, file one copy of this form with:
The city or county officer, if any, who receives the
commtttee's campaign disclosure statements.
II Treasurer Information
NAME OF TREASURER
MAILING ADDRESS OF TREASURER NO, AND STREET
CITY STATE ZIP CODE
AREA CODE/DAYTIME PHONE NUMBER
III Effective Date of Termination'
IV 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; ,'
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
rue an certlf nder nde laws of the te of m a r
nd correct
DATE CITY AND STATE
Executed on At By
DATE CITY ANO STATE
Executed on At By
DATE CITY AND STATE
Executed on At By
DATE CITY AND STATE
SIGNATURE OF TREASURER
SIGNATURE OF CONTROLLING OfEICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE, OR STATE MEASURE PROPONENT
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FOR iNFORMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1971, SEE INFORMATION MANUAL ON CAMPAIGN DISCLOSURE PIIOVISIO NS OF THE POLITICAL REFORM ACT.
State of California Fair Political Practices Commission