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Recipient Committee <br />COVER PAGE <br />Date Stamp <br />CALIFORNIA ��O <br />2001/02 <br />Campaign Statement Type or print in ink. <br />(Government Code Sections 84200- 84216.5) <br />RECEIVEC <br />FORM <br />Statement covers period <br />Date of election if applicable: <br />JAN 2 4 2011 <br />1/21 <br />from 07/01/2010 <br />(Month, Day, Year) <br />For Official Use Only <br />City of Riverside <br />SEE INSTRUCTIONS ON REVERSE through 12/31/2010 <br />06/07/2011 <br />City Clerk's Office <br />1. Type of Recipient Committee: All Committees - Complete Parts 1,2,3, and 4. <br />2. Type of Statement: <br />Q Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee <br />❑ Pre - election Statement ❑ Quarterly Statement <br />O State Candidate Election Committee Q Primary Formed <br />Q Recall Q Controlled <br />Semi-annual Statement � Special Odd Year Report <br />(Also Complete Part 5.) Q Sponsored <br />Termination Statement ❑ ❑Supplemental Preelection <br />❑ General Purpose Committee <br />E] 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.D.NUMBER <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 />Richard Teaman <br />MAILING ADDRESS <br />CITY STATE <br />Riverside CA <br />CITY STATE ZIP CODE <br />Riverside CA <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />NAME OF ASSISTANT TREASURER, IF ANY Javier Carrillo <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />MAILING <br />IL ADDRESS <br />CITY STATE ZIP CODE <br />Riverside CA <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 of my knowledge the information contained herein and in the attached schedules <br />is true and complete. I certify under penalty of perjury under the laws <br />nd correct. <br />Executed on 01/21/2011 By Richard Teaman <br />DATE SIGNAT <br />Executed on 01/21/2011 By Mike Gardner <br />DATE SIGNATURE OF CONTROLLING OFFICEHO <br />OFFICER OF SPONSOR <br />Executed on By <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. STATE MEASURE PROPONENT <br />Executed on By <br />FPPC Form 460 (JAN /05) <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Toll -Free Helpline: 866 /ASK -FPPC <br />State of California <br />