410 Gardner (08-03-09) Amendment R

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Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or / / Date qualified as committee 1. Committee Information NAME OF COMMITTEE Mike Gardner for City Council 2011 STREETADDRESS (NO P.O. BOX) Type or print in ink ® Amendment List I.D. number: # 1256312 07 1_23 t 08 Date qualified as committee (If applicable) ❑ Termination — See Part 59 List I.D. number: II Date of Termination CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA _ MAILING ADDRESS (IF DIFFERENT) Riverside, C� OPTIONAL: FAX / E- MAILADDRESS Riverside to StaW UL cd E C E I V1- AUG 0 3 2009 N' 2. Treasurer and Other Principal Officers NAME OF TREASURER Kathleen A. Dal STATEMENT OF ORGANIZATION For Official Use Only STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA - NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE 1 AREACODE/PHONE i NAME OF PRINCIPAL OFFICER(S) COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best perjury under the laws of the State of California that the foregoing is true and c( Executed on DATE 7 -� Executed on � F -0 , DATE Executed on Executed on DATE By By CITY STATE ZIP CODE AREA CODE/PHONE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)