410 Gardner (08-22-18) Amendment_R

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Statement of Organization Date Stamp , e _ , Recipient Committee , 1 e - Statement Type El Initial ® Amendment ❑ Termination — See Part 5 For Official Use Only Q Not yet qualified AUG or 07 23 2008 • Date qualified as committee -1 City Date qualified as committee Date of termination City ClerWsoffice 1. "Committee Information I.D. Number1256312 2. Treasurer and Other Principal Officers (if applicable) NAME OF COMMITTEE NAME OF TREASURER Mike Gardner for City Council Ward 1 2019 Richard A. Teaman STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODE/PHONE STREET ADDRESS (NO P.O. BOX) CITY Riverside CA CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Riverside CA Javier Carrillo MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODEIPHONE E-MAILADDRESS REQUIRED FAX OPTIONAL) CITY Riverside CA COUNTY OF DOMICILE _ JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Riverside City of Riverside STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. 3..eVerification I have used all reasonable diligence in preparing this statement and to 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 that the fo Executed on 08/15/2018 By DATE IGNATURE OF TREASURER OR ASSISTANT TREASURER Executed on 08/15/2018 By DATE SIG TROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE Executed on DATE By 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