Margaret Clark - 415ecipient Committee DUPLICATE
tatement of Termination
its form must be completed by recipient committees 1�
at are eligible to terminate pursuant to Government
Ida Section 84214.
Type or print In ink.
Recipient Committee Information
OolnMif/ee- 7v
Ma ,-, a,-e -A- Clark
OF COMMITTEE
AREA CODEIDAYTIME PHONE NUMBER
(
WHERE TO FILE:
File original and one copy of this form with:
Secrcal Ref State ITY RECOVED
OF ROSEMEAD
Political 1467 Division PECJ�g A
P.O. Box to, �m , rlit�
Sacramento, CA 95812- 148?'��EO SE��A�0010ap 1TE JUN
0 >> 1997
And, if applicable, file one copy of this form witit:
The city or county officer, iA'�r}y, y{hp�rve �Th�e
committee's campaign disc osu l t nt (7 �0: - ITY CLERK'S OFD
' //
YO 3 --3 MA L NG
Verification
A. This committee has ceased to receive contributions and make expenditures;
errLP -,>L - CA- 9i -7 7 a
AREA
(�
III Effective Date of Termination
DATE FILING OBLIGATIONS WERE COMPLETED
,J- -.28 97
RECIPIENTCC
Jut 10 3 sg
Rr:el;rr:.' os,
ar; -REI
AND STREET
FE ZIP CODE
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, and 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 hel
is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on At _�`��,�47,1l dc� L%�i' By
DATE CITY AND STATE
Executed on _ _6 - 3 - y 7 At �OSern ecuC. CR By
DATE CITY AND STATE
Executed on At B y
DATE AN A SIG WNNE OF CONTROLLING OFFICEHOLDEA. CANDIDATE, OR STATE MEASURE PROPONE
Executed on At By
DATE CITY AND AT SIGNATURE OF CONTROLLING OFPICEIIOLDER, CANDIDATE, OR STATE MEASIIRE PnOPONE
40RMATION REQUIRED TO BE PROVIDED TO YOU PURSUANT TO THE INFORMATION PRACTICES ACT OF 1977, SEE INELflM TION MANUAL9fl' S�AM391GIiI11SG145llBE .1'fipyI51QNSOF TJJ F POLUICALHEEQBMEQL
State of California Fair Political Praclfces Comml
A