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410 Gardner (08-16-10) Amendment R
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Statement of Organization <br />Recipient Committee <br />Statement Type ❑ Initial <br />Not yet qualified ❑ or <br />Type or print in ink <br />© Amendment <br />List I.D. number: <br />1256312 <br />❑ Termination — See Part 5 <br />List I.D. number: <br />I f 07 1 23 1 08 <br />Date qualified qualified as committee Date qualified as committee Date of Termination <br />(If applicable) <br />1. Committee Information <br />NAME OF COMMITTEE <br />Mike Gardner for City Council 2011 <br />STREETADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />Riverside CA <br />MAILING ADDRESS (IF DIFFERENT) <br />same <br />OPTIONAL: FAX /E -MAIL ADDRESS <br />COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT <br />THAN COUNTY OF DOMICILE <br />Riverside <br />Attach additional information on appropriately labeled continuation sheets. <br />Stamp <br />1I1. <br />E_ C. <br />�..,� <br />AUIG 1 6 2010 <br />2. Treasurer and Other Principal Officers <br />NAME OF TREASURER <br />Kathleen A. Daley <br />STREETADDRESS (NO P.O. BOX) <br />STATEMENT OF ORGANIZATION <br />For Official Use <br />S IAI t ZIP CODE AREA CODE/PHONE <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />STREETADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />STREETADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREACODE /PHONE <br />3. Verification <br />I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of <br />perjury under the laws of the State of California that the foregoing is true and corr <br />Executed on �? // ` / c By <br />DATE <br />TREASURER <br />Executed on f/ — / By <br />DATE <br />Executed on <br />DATE <br />Executed on <br />DATE <br />By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (June /09) <br />FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) <br />
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