HomeMy WebLinkAboutTermination Statement.pdfd11-29-16A09:5'
CITY/ TOWN OF r^mtuh HUM
POLITICAL COMMITTEE
TERMINATION STATEMENT
A.R.S.§§16-914 and 16-915.01
ID#
RCVD
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NAME OF POLITICAL COMMITTEE
SER &STREET)U\\ADDRESS (NUMBER &STREET)
MAILING ADDRESS (IF DIFFERENT FROM ABOVE)
CITY ,STATE
A*
ZIP
CITY STATE ZIP
COMMITTEE TELEPHONE #COMMITTEE FAX #COMMITTEE E-MAIL ADDRESS
jyv)Ha.va-n^'h £3/®a tnaj'A coyn
NAME OF SPONSORING ORGANIZATION OR CANDIDATE AND OFFICE
J-(r\cico ^ciu^haqA HctHDtz o?(zQMfaJn Mills,Az~
ADDRESS OF SPONSORING ORGANIZATION EMAIL ADDRESS AND FAX #
Select the boxes that apply:
A.V This is to certify that all contributions received and all expenditures made on behalf of the political committee
lzlJ indicated above have been reported as required by A.R.S.§16-913.We further certify that the political committee
will no longer receive any contributions or make any disbursements,thatthe committee has no outstanding debtsor
obligations,and that any surplus monies have been disposed of pursuant to A.R.S.§16-915.01.
Please mark the appropriate statement below to indicate which campaign finance report states the disposition of
any surplus monies.
B
•
The disposition of surplus monies was submitted on the campaign finance report filedon
The disposition of surplus monies is reported on the attached campaign finance report.
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This committee has terminated its activities in the above-named jurisdiction.The undersigned chairmanand
treasurer hereby attest that it is the intent of this committee to remain active in other jurisdictions and that all
remaining monies of this committee shall be used in other jurisdictions.
C j This committee has transferred the committee's debts and obligations to a subsequent committee.
Please enter the full name and ID#of the committee into which debts and obligations have been transferred.
Name of Committee ID#
We-Linda.-&k \la aa %a
Printed name of Chaiwian a
Cfcjzojd.Li M,'/e.s
i and Printed name of Treasurer
penaltyof perjurythat this statement oftermination pursuant to A.R.S. §16-914 is true and complete.
.certify under
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Signature gf Chairman
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Signature of Treasurer