Free PAC Termination.indd - Wyoming

Political Action Committee Termination Report W.S. 22-25-106(b)
Upon retirement of all debts, the committee may terminate. Date last report filed Committee Name Mailing Address Phone Please report contributions and expenditures incurred since the last reporting period on a separate sheet. Total Receipts for this filing period $____________ $____________

Summary
Total Expenditures for this filing period

I hereby affirm that all debts of the above committee have been retired.

Chairman Chairman (E-mail Address) Date
Filing Offices County Clerk -

Treasurer Treasurer (E-mail Address) Date

Candidates for district attorney, county and municipal offices, magistrates, school and community college district trustees. Mail to: local County Clerk's Office. Contact information can be accessed on our website under Elections at: http://soswy.state.wy.us Candidates for state legislature, statewide office, circuit court, district court or supreme court. Mail to: Secretary of State, 200 W. 24th St., Cheyenne, WY 82002

Secretary of State -

Criminal Penalty Anyone violating any of the campaign reporting provisions of the Wyoming Election Code is guilty of a misdemeanor punishable by not more than six (6) months imprisonment in the county jail, a fine of not more than $1,000, or both. (W.S. 22-26-112) This form can be accessed on the Secretary of State's WEBSITE at: http://soswy.state.wy.us/Forms/FormsFiling.aspx
3/2009 PAC Termination