410 Soubirous (01-30-13) Initial R

Home

Statement of Organization Recipient Committee Statement Type ® Initial Not yet qualified or Date qualified as committee . Lommlttee Information t OF COMMITTEE Type or print in ink ❑ Amendment List I.D. number: Date qualified as committee (If applicable) Mike Soubirous for Riverside City Council - Ward 3, 2013 STREET ADDRESS (NO P.O. BOX) CITY Riverside MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY OF DOMICILE Riverside STATE CA ZIP CODE AREA CO COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to th perjury under the laws of the State of California that the foregoing is true Executed on _- 2 C/ - 013 B DATE Executed on -Z-0 f ?. DATE B ❑ Termination — See Part 5 List I.D. number: Date of Termination STATEMENT OF ORGANIZATION Date Stamp RECEIVE[ For JAN 3 0 2013 City of Riverside City Clerk's office 2. Treasurer and Other Principal Officers rN^wc: yr IKtASUKtK Dana Hopkins, CPA Riverside NAME OF ASS JUKt5S IF ANY CA Use ZIP CODE AREA CITY STATE ZIP CODE AREA CODE /PHONE NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE IV1,'MU U AUUKt55 CITY STATE ZIP CODE AREA CODE /PHONE herein is true and complete. I certify under penalty of Executed on aIUINAI UKt: OF CUNTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT DATE By Executed on SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)