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Recipient Committee <br />Campaign Statement <br />(Government Code Sections 84200 - 84216.5) <br />Type or print in ink. <br />Statement covers period <br />from 10/20/2013 <br />SEE INSTRUCTIONS ON REVERSE <br />I through 12/31/2013 <br />1. Type of Recipient Committee: All Committees - 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 1 <br />13555 1 <br />1355581 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE <br />Mike Soubirous for Riverside City Council - Ward <br />3, 2013 <br />STREET ADDRESS NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />Riverside CA _ <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />4. <br />OPTIONAL: FAX/E -MAIL ADDRESS <br />Date of election if applicable <br />(Month, Day, Year) <br />11/05/2013 <br />Date Stamp <br />RECEIVE <br />JAN 3 0 2014 <br />City of Riverside <br />City Clerk's Office <br />1 <br />2. Type of Statement: <br />❑ Pre - election Statement <br />❑X Semi- annual Statement <br />❑ Termination Statement <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Mrs. Dana Hopkins, CPA <br />COVER PAGE <br />CALIFORNIA 460 <br />2001/02 <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 />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />Riverside CA — <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />OPTIONAL: FAX/E -MAIL ADDRESS <br />Verification <br />I have used all reasonable diligence in p the information contained herein and in the attached schedules <br />is true and complete. I certify under pen g is true and correct. <br />Executed on 1-7-q- I LI By <br />DATE <br />Executed on L `Z07 — %'f t <br />By <br />DATE S ESPONSIBLE OFFICER OF SPONSOR <br />Executed on <br />DATE <br />Executed on By <br />DATE <br />By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT <br />FPPC Form 460 (JAN /05) <br />FPPC Toll -Free Helpline: 866 /ASK -FPPC <br />State of California <br />