410 Plascencia CC W5 (07-11-18)_R Initial

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Statement of Organization Recipient Committee Statement Type ® Initial Not yet qualified or 0 Date qualified as committee 0 Amendment 0 Termination See Part 5 Date qualified as committee Date of termination RECE V D JUL 11 Z018 City of Riverside City Clerks Office For Official Use Only 1. Committee Information I.D. Number (if applicable) 2. Treasurer and Other Principal Officers NAME OF COMMITTEE Gaby Plascencia Riverside City Council Ward 5 2019 STREET ADDRESS (NO P,O, BOX) CITY NAME OF TREASURER Martha Trujillo STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE ZIP CODE AREA CODE/PHONE CA STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Riverside CA MAILING ADDRESS (IF DIFFERENT) EMAIL ADDRESS (REQUIRED) f FAX (OPTIONAL) COUNTY OF DOMICILE STREET ADDRESS (NO P.O. ROX) CITY STATE ZIP CODE AREA CODE/PHONE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICERS) Riverside Riverside Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification 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 penalty of perjury under the laws of the State of California t . . •.ing is true and correct. r Executed on /die d-PieSi By ATE Executed on ' 47 '/, By DATE Executed on By DATE Executed on By DATE 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