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SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
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Attach additional information on appropriately labeled continuation sheets.
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This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
This committee has no surplus funds; and
This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
This committee does not anticipate receiving contributions or making expenditures in the future;
This committee has ceased to receive contributions and make expenditures;
5. Termination Requirements
By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met:
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INDUSTRY GROUP OR AFFILIATION OF SPONSOR
List additional sponsors on an attachment.
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CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
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Primarily formed to support or oppose specific candidates or measures in a single election. List below:
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NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
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• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan:'
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All committees must list the financial institution where the campaign bank account is located.
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