460 Soubirous (07-01-16 - 12-31-16)_R

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Recipient Committee Campaign Statement Cover Page 1. Type of Recipient Committee Officeholder, Candidate Controlled Committee ❑ O State Candidate Election Committee Q Recall ❑ General Purpose Committee O Sponsored E] Q Small Contributor Committee Q Political Party/Central Committee 3. Committee Information Statement covers period Date of Election if applicable ( -7 Page 1 of 7 07/01/2016 .AN W from For Official Use Only through 12/31/2016 Primarily Formed Ballot Measure Committee O Controlled O Sponsored Primarily Formed Candidate/ Officeholder Committee I.D. Number 1355581 COMMITTTEE NAME Re -Elect Mike Soubirous to City Council 2019 STREET ADDRESS NO PO BOX CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA MAILING ADDRESS (IF DIFFERENT) CITY OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preps complete. I certify ;der pmalty of perjury Executed on t 372- C) 1 -1 Executed on ` Z 3 Executed on STATE ZIP CODE (Month, Day, Year) 2. Type of Statement ❑ Pre - election Statement 0 Semi - Annual Statement ❑ Termination Statement ❑ Amendment Treasurer(s) _¢ of R1 rsi ❑ Quarterly Statement ❑ Special Odd -Year Statement ❑ Supplemental Pre - election Statement - Attach Form 495 NAME OF TREASURER Dana Hopkins, CPA STREET ADDRESS r.ITV CTATC 710 f`lV1C AoCA F-ein-E-7BOUTOR Riverside NAME OF ASSISTANT STREET ADDRESS CITY CA STATE ZIP CODE AREA CODE/PHONE DRESS 1 of my knowledge the information contained herein is true and foregoing is true and correct. By SIGNATURE OF CONTROWNG OMCEHOLDER, CANDIDATE, STATE MEASURE PR PONENT Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 460 - (JAN/2016) State of Califomia/SI