410 Gardner (09-23-10) Amendment R

Home

Statement of Organization STATEMENT OF ORGANIZATION Recipient Committee Type or print in ink F_ p Date Stamp Statement Type ❑ Initial Not yet qualified ❑ or ® Amendment List I.D. number: 1256312 ❑ Termination – See Part 5 r List I.D. number: in 1 f 07 / 23 f 08 Date qualified as committee Date qualified as committee Date of Termination (If applicable) 1. Committee Information NAME OF COMMITTEE Mike Gardner for City Council 2011 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE Riverside CA MAILING ADDRESS (IF DIFFERENT) same OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Riverside Attach additional information on appropriately labeled continuation sheets. '.'#'EIVED AND office of the Secretary of state For Official Use Only of the State of California AUG 17 2010 DEBRA BODE %per atary of Sta a e-ti r r% r-- It 2. Treasurer and Other Principal Officers X NAME UI- IREASURER SEP 2 3 2010 Kathleen A. Daley STREETADDRESS (NO P.O. BOX) city 01 MIVUSZ, City Clerk's Off Ce ully STATE ZIP CODE AREACODE /PHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE 3. Verification 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 perjury under the laws of the State of California that the foregoing is true ar Executed on //` /(:-% By DATE Executed on e .–//— / ` By DATE Executed on DATE Executed on DATE 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 (8661275 -3772)