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Recipient Committee <br />COVER PAGE <br />Date Stamp <br />Campaign Statement Type or print in ink. <br />(Government Code Sections 84200 - 84216.5) <br />Statement covers period <br />Date of election if applicable: <br />; t 1 n r 1/10 <br />0�0 <br />from 01/01/2010 <br />(Month, Day, Year) <br />For Official Use Only <br />SEE INSTRUCTIONS ON REVERSE through 06/30/2010 <br />06/07/2011 <br />1. Type of Recipient Committee: All Committees - Complete Parts 1,2,3, and 4. <br />2. Type of Statement: <br />Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee <br />State Candidate <br />❑ Pre - election Statement Quarterly Statement <br />Statement <br />Q Election Committee Q Primary Formed <br />Q Recall Q Controlled <br />x❑ Semi- annual Statement Special Odd -Year Report <br />❑ <br />(Also Complete Part 5.) Q Sponsored <br />❑ Termination Statement Supplemental Preelection <br />❑ pp <br />❑ General Purpose Committee <br />❑ Amendment (Explain below) Statement - Attach Form 495 <br />(Also Complete Part 6.) <br />Q Sponsored <br />❑ Primary Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />Q Political Party /Central Committee (Also Complete Part 7.) <br />3. Committee Information I 125631BER <br />1256312 <br />Treasurer(s) <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE <br />Mike Gardner for City Council 2011 <br />NAME OF TREASURER <br />Kathleen Daley <br />MiMmP.O. BOX) <br />CITY STATE <br />Riverside CA <br />CITY STATE ZIP <br />Riverside CA <br />DIFFERENT) NO. AND STREET OR P.O. BOX <br />NAME OF ASSISTANT TREASURER, IF ANY <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />MAILING ADDRESS <br />Riverside CA - <br />IL ADDRESS <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />OPTIONAL: FAX/E -MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the best tion contained herein and in the attached schedules <br />is true and complete. I certify under penalty of perjury under the laws <br />d correct. <br />Executed on 07/07/2010 By Kathleen Dale <br />dkF:ICEROF <br />DATE SIGNAT <br />Executed on 07/07/2010 By Mike Gardner <br />DATE SIGNATURE OF CONTROLLING OFFICEHO <br />SPONSOR <br />Executed on By <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />Executed on By <br />FPPC Form 460 (January/05) <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, <br />STATE MEASURE PROPONENT FPPC Toll -Free Helpline: 866 1ASK -FPPC <br />State of California <br />