410 Plascencia CC W5 (08-06-18)_R

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Statement of Organization Recipient Committee Statement Type 33 (q07551 ® Initial • Not yet qualified or O Date qualified as committee 1. Committee Information NAME OF COMMITTEE 0 Amendment 0 Termination — See Part 5 In Date qualified / / Date of termination I.D. Number (if applicable) Gaby Plascencia Riverside City Council Ward 5 2019 STREET ADDRESS (NO P.O. BOX) CITY Date Stamp 1?-ggitit416Setvoifyb dfiffigftiefafilltiffai, JUL 13 2018 F Official Use Only Ci 2Treasurer and Other Principal Officers E 6 2018 'V rode 's Office NAME OF TREASURER Martha Trujillo STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Riverside CA MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE Riverside STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Riverside Attach additional information on appropriately labeled continuation sheets. 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under r"v) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE penalty of perjuryunder the laws of the St Executed on Gl`/ di )".81 /' By (/J ATE Executed on 74 �� By y Executed on By DATE Executed on By DATE STANT TREASURER SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (February/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov