410 Soubirous (02-22-13) Initial R

Home

Statement of Organization Recipient Committee Statement Type ® Initial Not yet qualified or RECEIVE o2 pn )013k\ RED ❑ t �� ' iverside Lis . u 6rrk'S Office Date qualified as committee Date qualified as committee (If applicable) 1. Committee Information NAME OF COMMITTEE Mike Soubirous for Riverside City Council - Ward 3, 2013 STREET ADDRESS (NO P.O. BOX) in the ❑ Termination - See Part 6 List I.D.: number: CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS COUNTY OF DOMICILE I COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Riverside Attach additional information on appropriately labeled continuation sheets. I Date of Termination EIXJEDDXWFIL ffice of the Secretary of the State of California FEB 0 4 2013 WkBOWEN �tary of State 2. Treasurer and Other Principal Officers NAME OF TREASURER Dana Hopkins, CPA STATEMENT OF ORGANIZATION For Official STREET ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE NAME AND POSITION OF OTHER PRINCIPALOFFICER(S), IF APPLICABLE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification have used all reasonable diligence in preparing this statement and to th tained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true Executed on 1- 2 "1 - .2-013 DATE Executed on �' Zq ' ?-01 7- DATE Executed on DATE Executed on DATE rHCEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT- By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)