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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 04/24/2011 <br />through 05/21/2011 <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 />0 State Candidate Election Committee <br />0 Primary Formed <br />0 Recall <br />0 Controlled <br />(Also Complete Part 5.) <br />0 Sponsored <br />❑ General Purpose Committee <br />(Also Complete Part 6.) <br />0 Sponsored ❑ <br />Primary Formed Candidate/ <br />0 Small Contributor Committee <br />Officeholder Committee <br />0 Political Party /Central Committee <br />(Also Complete Part 7.) <br />3. Committee Information <br />GUMMI I I EE NAME (OR CANDIDATE'S NAME IF NO <br />Mike Gardner for City Council 2011 <br />STREET ADDRESS NO P <br />I.D.NUMBER <br />1256312 <br />Date of election if applicable: <br />(Month, Day, Year) <br />06/07/2011 <br />Date Stamp <br />IECEIVE <br />MAY 2 6 2011 <br />City of Riverside <br />2. Type of Statement:' v <br />❑X 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 />COVER PAGE <br />CALIFORNIA <br />2001/02 460 <br />FORM <br />1/11 <br />For Official Use Only <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />❑ Supplemental Preelection <br />Statement - Attach Form 495 <br />CITY STATE CITY STATE ZIP CODE <br />Riverside CA Riverside CA <br />MAILING ADD NT) NO. AND STREET OR P.O. BOX NAME OF ASSISTANT TREASURER, IF ANY <br />Javier Carrillo <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA - <br />ADDRESS <br />MAILING ADDRESS <br />CITY STATE ZIP CODE ARE <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 <br />is true and complete. I certify under penalty of perjury under the laws o <br />Executed on 05/24/2011 By Richard Teaman <br />DATE SIGNATU <br />Executed on 05/24/2011 By Mike Gardner <br />DATE SIGNATURE OF CONTROLLING OFFICEHOL <br />Executed on <br />DATE <br />Executed on <br />DATE <br />By <br />By <br />SIGNATURE OF <br />CANDIDATE, STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />tained herein and in the attached schedules <br />SPONSOR <br />FPPC Form 460 (JAN /05) <br />FPPC Toll -Free Helpline: 866 /ASK -FPPC <br />State of California <br />