410 Plascencia CC W5 (10-05-18)_R Amendment

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Statement of Organization Recipient Committee Statement Type ❑ Initial Q Not yet qualified or • Date qualified as committee 09 11 2018 1 Amendment 1,,L) OCT p52018 + i o R1verside City C=,i2.,I,:s Office 0 Termination — See Part 5 RE In tl 09 11 , 2078 / Date qualified as committee Date of termination Date Stamp CEIVED AND i=ll e office of the Secretary of of the State of California SEP 20 2018 For Official Use Only 1. Committee Information NAME OF COMMITTEE I.D. Number (if applicable) 2. Treasurer and Other Principal Officers Gaby Plascencia Riverside City Council Ward 5 2019 STREET ADDRESS (NO P.O. BOX) CITY Riverside 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 CA MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS(REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE Riverside JURISDICTION WHERE COMMITTEE I5 ACTIVE Riverside Attach additional information on appropriately labeled continuation sheets. 3. Veri 'cation STREET ADDRESS (NO P.O. BOX) CIT Y SIAIE ZIP CODE AREA LODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 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 penalty of perjury under the laws of the correct. Executed on //ij/1/ !!A1E /I / By Executed on 9! 1� / (� By DATE Executed on By DATE Executed on By DATE ASURER OR ASSISTANT TREASURER OLDER,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