410 Gardner (12-30-10) Amendment R

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Statement of Organization Recipient Committee Statement Type (Jb O Initial Not yet qualified O or Date qualified as committee Amendment List I.D. number # 1256312 07/23/2008 Date qualified as committee O Termination - See Part 5 List I.D. number It Date of Termination in tie office of pia EW Jary of State of the State of California DEC 2 0 2010 DEBRA BOWEN Secretary of State STATEM 3M. For Official Use Only 10 DEC 30 AM 10: 32- i;EGISTR K DE VOTER' COUNTY OF RIVERSIDE 1. Committee Information 2. Treasurer and Other Principal Officers COMMITTTEE/FILER'S NAME NAME OF TREASURER Mike Gardner for City Council 2011 Richard Teaman STREET ADDRESS STREET ADDRESS NO PO BOX CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY CITY STATE ZIP CODE AREA CODE/PHONE Javier Carrillo Riverside CA STREET ADDRESS MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E -MAIL ADDRESS Riverside CA NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Riverside STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification I have used all reasonalbe diligence in preparing and reviewing 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 fore oin is true and correct. Executed Z �� D on By NATURE OF TREASURER OR ASSISTANT TREASURER �� - a Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT