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460 Soubirous (07-01-14 - 10-18-14)_R
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11/20/2014 11:03:48 AM
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Recipient Committee <br />' ' ' 460 <br />Campaign Statement <br />O' <br />RM <br />Cover Page <br />Statement covers period <br />Date of Election If applicable <br />OCT 24 2014 Page 1 of 9 <br />from 07/01/2014 <br />For Official Use Drily <br />1 tVf! <br />through 10/18/2019 <br />9 <br />(Month, Day, Year) <br />11f <br />l Clerk's rS is <br />1. Type of Recipient Committee <br />2. T�pe of Statement <br />Officeholder, Candidate Controlled Committee <br />El Primarily Formed Ballot Measure <br />Pre - election Statement ❑ Quarterly Statement <br />O State Candidate Election Committee <br />Committee <br />❑ Semi-Annual Statement ❑ Special Odd -Year Statement <br />O Recall <br />Q Controlled <br />❑ Termination Statement ❑ Supplemental Pre - election <br />❑ General Purpose Committee <br />0 Sponsored <br />❑ Amendment Statement - Attach Form 495 <br />Q Sponsored <br />❑ <br />0 Small Contributor Committee <br />Primarily Formed Candidate/ <br />a <br />Officeholder Committee <br />Political Party /Central Committee <br />3. Committee Information <br />I I.D. Number 1355581 <br />Treasurer(s) <br />COMMITTTEE NAME <br />NAME OF TREASURER <br />Re -Elect Mike Soubirous to City <br />Council 2015 <br />Dana Hopkins, CPA <br />STREET ADDRESS <br />STREET ADDRESS NO PO BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA <br />CITY <br />STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br />Riverside <br />CA <br />MAILING ADDRESS (IF DIFFERENT) <br />STREET ADDRESS <br />CITY <br />STATE ZIP CODE <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX/ E-MAIL ADDRESS <br />OPTIONAL: FAX/ E -MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in prepz <br />complete. I certify under penalty of perjury <br />Executed on - ®� s ®;. <br />Executed on i <br />Executed on <br />best of my knowledge the information contained herein is true and <br />the foregoing is true and correct. <br />By <br />SIGNATURE W NG OFFICEHOLDER, CANDIDATE, A T <br />Executed on By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE NEN FPPC Form 460 - January/05 <br />State of Califomia/SI <br />
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