460 Soubirous (07-01-15 - 12-31-15)_R

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Recipient Committee Campaign Statement Cover Page Statement covers period from 07/01/2015 through 12/31/2015 1. Type of Recipient Committee Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled ❑ General Purpose Committee O Sponsored O Sponsored Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party /Central Committee 3. Committee Information I I.D. Number 1355581 COMMITTTEE NAME Re -Elect Mike Soubirous to City Council 2015 CITY OPTIONAL: FAX / E -MAIL ADDRESS / 4. Verification I have used all reasonable diligence in complete. I certify / /under 1penalty , of pi Executed on 1/ 2-7 1. o 11 t.0 Executed on °✓ Executed on STATE ZIP CODE ■ Date of Election if applicable JAN 2 7 2016 i INversi (Month, Day, Year) ' '", S office 2. Type of Statement ❑ Pre - election Statement ® Semi - Annual Statement ❑ Termination Statement ❑ Amendment Treasurer(s) NAME OF TREASURER Dana Hopkins, CPA STREET ADDRESS ❑ Quarterly Statement ❑ Special Odd -Year Statement ❑ Supplemental Pre - election Statement - Attach Form 495 CITY STATE ZIP CODE AREA CODE /PHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY / STATE ZIP CODE AREA CODE /PHONE in this statement and to the best of my knowledge the information contained herein is true and at the foregoing is true and correct. By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 460 - January/05 State of Califomia /Sl