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POLITICAL COMMITTEE
TERMINATION STATEMENT
A. R. S. §§ 16-914 and 9 fi-9 9 5. 0 � � �#n G� O�/� G, r
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ADDRESS (NUMBER � STREET) CITYr �, ST TE ZIP
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M� ADDRESS IF DIFFERENT FROM ABOV CITY STATE ZIP
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COMM�TTEEGE�L� �� �!� I COMMITTEE FAX # I C� ���� MAI�L� � SS r/
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NAVIAE OF SPONSORING ORGANIZATION OR CANDIDATE AND �FFICE
ADDRESS OF SPONSORING ORGANIZATION � EMAIL ADDRESS AND FAX # '
Select th boxes that apply:
A. This is to certify that all contributions received and all expenditures made on behalf of the political committee
indicated above have been reported as required by A.R.S. § 16-913. We further certify that the political committee
will no (onger receive any contributions or make any disbursements, that the committee has no outstanding debts
or obligations, and that any surplus monies have been disposed of pursuant to A.R.S. § 16-915.01,
B.
C.
Please mark the appropriate statement below to indicate which campaign finance report states the disposition
of any surplus monies.
❑ The disposition of surplus monies was submitted on the campaign finance report filed on:
The disposition of surplus monies is reported on the attached campaign finance report.
� his committee has terminated its activities in the above-named jurisdiction. The undersigned chairman and
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.
� 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:
we, ✓ �/�// � � ��/� /Z � � /%'
Printed name of Chairman and
ID #
�/'� �cr (�, �r��' j • ,certify under
Printed name of Treasurer
penalty of perjury that this statement of termination pursuant to A.R.S. § 16-914 is true and complete.
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Signature of Chairman /' Sign ure of Treasurer