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Recipient Committee <br />Campaign Statement <br />(Government Code Sections 84200 - 84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Type or print in ink. <br />Statement covers period I Date of election if applicable: <br />from 07/01/2015 fl (Month, Day, Year) <br />through 12/31/2015 <br />1. Type of Recipient Committee: All Committees - Complete Parts 1,2,3, and 4. <br />0 Officeholder, Candidate Controlled Committee <br />❑ Ballot Measure Committee <br />Q State Candidate Election Committee <br />Q Primary Formed <br />Q Recall <br />Q Controlled <br />(Also Complete Part 5.) <br />Q Sponsored <br />❑ General Purpose Committee <br />(Also Complete Part S.) <br />Q Sponsored <br />❑ Primary Formed Candidate/ <br />Q Small Contributor Committee <br />Officeholder Committee <br />Q Political Party /Central Committee <br />(Also Complete Part 7.) <br />3. Committee Information 1 1 <br />12256315631BER <br />2 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO <br />Mike Gardner for City Council 2015 <br />CITY STATE ZIP <br />Riverside CA <br />MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O. BOX <br />CITY <br />STATE ZIP CODE AREA CODE /PHONE <br />06/02/2015 <br />Date Stamp <br />FED ?016 <br />City of Riverside <br />City Clerk's Office <br />2. Type of Statement: <br />❑ Pre - election Statement <br />Semi - annual Statement <br />❑ Termination Statement <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Richard Teaman <br />COVER PAGE <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 />CITY STATE ZIP CODE AREA CODE /PHONE <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />Javier Carrillo <br />DDRESS CITY STATE ZIP CODE AREA CODE /PHONE <br />Riverside CA 92501 <br />ADDRESS <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules <br />is true and complete. I certify under penalty of perjury under the laws of the S nd correct. <br />Executed on 01/19/2016 By Rich_ and Teaman <br />DATE SIGNATURE OF <br />Executed on 01/19/2016 By Mike Gardner <br />DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CAN =EASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR <br />Executed on By <br />DATE <br />Executed on By <br />DATE <br />SIGNATURE OF CONTROLLING <br />TE, 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 />