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rlwxm��� <br />DE r, - 6 2011 For Official Use Only <br />CRY of Riversid- <br />City Clerk's off <br />,e <br />[j Amendment (Must provide explanation in Part 3.) <br />Date of Original Filing: <br />(month, day, year) <br />Face Value of Each Admission $ 13.00 <br />ate(s) 11 25 11 11 30 11 <br />D <br />Ctmakthe Intomabox ifthoagafty Oftial claims 4ftifi$lOia as <br />ta�.AbJ6, income, ifffm agency official performed a ceremonial r010, <br />(Last,flrst) -- TtMium, bar of ' Agency <br />tume <br />Ar IiA-1—i—L&W I rMciAl <br />FPPC Form 802 (2/11; <br />27.15----3772� <br />Yes <br />Income <br />See attached <br />No <br />13 <br />Yes <br />Income <br />No <br />11 <br />Yes <br />[3 <br />Income <br />Na <br />[] <br />11 <br />Yes <br />[3 <br />Income <br />No <br />Y es <br />"T <br />Income <br />o <br />N 0 <br />[3 <br />E3 <br />13 <br />FPPC Form 802 (2/11; <br />27.15----3772� <br />