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

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Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Gaby Plascencia Riverside City Council Ward 5 2019 4. Type of Committee (Continued) enerdl Purpose Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY ✓Ponsored C9mi1110,eh, NAME OF SPONSOR STREET ADDRESS Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITY Committee 0 COUNTY Committee 0 STATE Committee 0 Political Party/Central Committee List additional sponsors on an attachment. INDUSTRY GROUP OR AFFIL. IATION OF SPONSOR NO. AND STREET CITY STATE ZIP CODE AREA CODE/PHONE tX�R� outributorl immittee.: / / Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. Clear Page Print FPPC Form 410 (February/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov