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Recipient Committee <br />Campaign Statement <br />(Government Code Sections 84200- 84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Type or print in ink. <br />Statement covers period <br />from 01/01/2011 <br />through <br />04/23/2011 <br />1. Type of Recipient Committee: All Committees <br />- Complete Parts 1,2,3, and 4. <br />❑ Officeholder, Candidate Controlled Committee ❑ <br />Ballot Measure Committee <br />Q State Candidate Election Committee <br />Q Primary Formed <br />Q Recall <br />Q Controlled <br />(Also Complete Part 5.) <br />O Sponsored <br />❑ General Purpose Committee <br />(Also Complete Part 6.) <br />Q Sponsored ❑ <br />Primary Formed Candidate/ <br />Q Small Contributor Committee <br />Officeholder Committee <br />Q Political Party /Central Committee <br />(Also Complete Part 7.) <br />3. Committee Information <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMM <br />Mike Gardner for City Council 2011 <br />I.D.NUMBER <br />1256312 <br />CITY STATE <br />Riverside CA <br />RENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA - <br />DDRESS <br />Date of election if applicable: <br />(Month, Day, Year) <br />06/07/2011 <br />Date Stamp <br />RECEIVE <br />APR 2 8 2011 <br />City of Riverside <br />City Clerk's Office <br />2. Type of Statement: <br />El Pre - election Statement <br />❑ Semi - annual Statement <br />❑ Termination Statement <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Richard Teaman <br />CITY STATE <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />Javier Carrillo <br />COVER PAGE <br />CALIFORNIA <br />2001/02 460 <br />FORM <br />1/31 <br />For Official Use Only <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />❑ Supplemental Preelection <br />Statement - Attach Form 495 <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 knowled e the information contained herein and in the attached schedules <br />is true and complete. I certify under penalty of perjury under the laws of th rect. <br />Executed on 04/25/2011 By Richard Teaman <br />DATE SIGNATURE <br />Executed on 04/25/2011 By Mike Gardner <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER OF SPONSOR <br />Executed on By <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />Executed on By 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 />