460 Soubirous (01-01-17 - 06-30-17)_R

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Recipient Committee Campaign Statement Cover Page Statement covers period from 01/01/2017 through 06/30/2017 Date of Election if applicable (Month, Day, Year) COVER PAGE 1. Type of Recipient Committee a Officeholder, Candidate Controlled Committee O State Candidate Election Committee O Recall ❑ General Purpose Committee • Sponsored O Small Contributor Committee • Political Party /Central Committee Primarily Formed Ballot Measure Committee • Controlled • Sponsored Primarily Formed Candidate/ Officeholder Committee JUL 3.1 2017 City of Riverside City neck's Office 2. Type of Statement ❑ Pre - election Statement Semi - Annual Statement ❑ Termination Statement ❑ Amendment For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Statement ❑ Supplemental Pre - election Statement - Attach Form 495 3. Committee Information I.D. Number 1355581 COMMITTTEE NAME Re -Elect Mike Soubirous to City Council 2019 STREET ADDRESS NO PO BOX CITY Riverside STATE ZIP CODE AREA CODE /PHONE CA MAILING ADDRESS (IF DIFFERENT) CITY STATE ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS Treasurer(s) NAME OF TREASURER Dana Hopkins, CPA STREET ADDRESS CITY Riverside STATE CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE 4. Verification I have used all reasonable diligence in prepa e best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury at the foregoing is true and correct. Executed on —1(3i/V--0 OF TREASURER OR ASSISTANT TREASURER Executed on i f 1 17 ANDIDATE, STATE MEASURE PROPONENT OR RESPONSIBLE OFFICER OF SPONSOR Executed on Executed on By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 460 - (JAN /2016) State of Califomia /SI