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Statement of Organization <br />Recipient Committee <br />INSTRUCTIONS ON REVERSE <br />Mike Gardner for City Council 2011 <br />4. Type of Committee Complete the applicable sections. <br />STATEMENT OF ORGANIZATION <br />1256312 <br />• List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and <br />district number, if any, and the year of the election. <br />• List the political party with which each officeholder or candidate is affiliated or check "non - partisan." <br />• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. <br />NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD <br />(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY <br />Mike Gardner <br />City of Riverside Councilman Ward 1 <br />2011 <br />® Non - Partisan <br />❑ Non - Partisan <br />• List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) <br />NAME OF FINANCIAL INSTITUTION <br />Bank of America <br />AREA CODE /PHONE <br />BANK ACCOUNT NUMBER <br />ADDRESS CITY STATE ZIP CODE <br />Riverside CA <br />Primarily formed to support or oppose specific candidates or measures in a single election. List below: <br />CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION <br />(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE <br />FPPC Form 410 (June /09) <br />FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) <br />