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410 Soubirous (08-14-14) Amendment_R
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Statement of Organization Date Stamp <br />Recipient Committee FILED <br />Statement Type ❑ Initial 2 Amendment ❑ Termination - See Part 5 lh th I oft of the Sedetary of <br />Not yet qualified ❑ or List I.D. number: List I.D. number: of the State of Cardomia� <br />#1355581 # <br />AUG 0 12014 <br />02 /02013 <br />Date qualified as committee Date qualified as committee Date of Termination <br />(IfappIkab ) <br />NAME OF COMMITTEE <br />Re -Elect Mike Soubirous to Citv Council 2015 <br />CITY STATE LIP LUUE AxtA LUMIMUNC <br />Riverside CA - <br />MAILING ADDRESS (IF <br />FAX / E -MAIL ADDRESS <br />COUNTY OF DOMICILE a3RISDICTION WHERE COMMITTEE IS ACTIVE <br />Riverside <br />Attach additional information on appropriately labeled continuation sheets. <br />I have used all reasonable diligence in <br />penalty of perjjuurry l under the laws lof'th <br />Executed on <br />? DATE <br />Executed on <br />DATE <br />Executed on <br />DATE <br />Executed on <br />DATE <br />NAME OF TREASURER <br />Dana L. Hopkins, CPA <br />J Rik , " Lt7 �J6 0 iii <br />AUG 14 2014 <br />City of Riverside <br />CITY STATE ZIP CODE AREA <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE /PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE /PHONE - <br />the information contained herein is true and complete. I certify under <br />5 GNATURE Ur LUN I RULLINU Urr Lt DER, CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (Dec /2012) <br />FPPC Advice: advice @fppc.ca.gov (866/275 -3772) <br />www.fppc.ca.gov <br />
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