Laserfiche WebLink
Officeholder and Candidate <br />Campaign Statement - <br />Short Form <br />Date of election if applicable: <br />(Month, Day, Year) <br />0 Amendment (Explain Below) <br />RECEIVED <br />JAN 2 2 2019 <br />City of Riverside <br />City Clerk's Office <br />CALIFORNIA 470 <br />FORM <br />For Official Use Only <br />1. Statement Covers Calendar Year 20 <br />2. Officeholder or Candidate Information <br />NAME OF OFFICEHOLDER OR CANDIDATE <br />STREET ADDRESS <br />CITY <br />UeAS j s—`- <br />STATE ZIP CODE <br />AREA CODE/DAYTIME PHONE NUMBER <br />OPTIONAL: FAX! E-MAIL ADDRESS <br />3. Office Sought or Held <br />OFFICE SOUGHT OR HELD <br />JURISDICTION (LOCATION) <br />TeAS 1(2_9- <br />DISTRICT NUMBER <br />(IF APPLICABLE) 7 <br />4. Committee Information <br />List all committees of which you have knowledge that are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. <br />COMMITTEE NAME AND I.D. NUMBER COMMITTEE ADDRESS NAME OF TREASURER <br />5. <br />Verification <br />I declare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $2 ,000 and that I will spend less than $2,000 during the calendar year and that I have <br />used all reasonable diligence in preparing this statement. I certify under penalty of perjury under the laws of the State of Califgi ia`that the foreii g is true and correct. <br />Executed on <br />2"2_ —2-c_.)� <br />DATE <br />Prin <br />For <br />By <br />SIGNATURE OF OFFICEHOLDER OR CANDIDATE <br />FPPC Form 470/470 Supplement (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />