460 Soubirous (07-01-18 - 12-31-18)_R

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Recipient Committee Campaign Statement Cover Page 1. Type of Recipient Committee Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information Statement covers period from 07/01/2018 through 12/31/2018 ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored ❑ Primarily Formed Candidate/ Officeholder Committee I.D. Number 1355581 COMMITTTEE NAME Re—Elect Mike Soubirous to City Council 2019 STREET ADDRESS (NO PO BOX) LILY STATE ZIP CODE AREA CODE/PHONE Riverside CA CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE Date of Election if applicable COVER PAGE Page 1 of 5 For Official Use Only City of Riverside (Month, Day, Year) Citys, Office 2. Type of Statement ❑ Pre-election Statement ❑ Quarterly Statement ® Semi -Annual Statement ❑ Special Odd -Year Statement ❑ Termination Statement ❑ Supplemental Pre-election ❑ Amendment Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Dana Hopkins, CPA STREET ADD Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS / 4. Verification I have used all reasonable diligence in prepari he best of my knowledge the information contained herein is true and complete. I certify under enalty of perjury u hat the foregoing is true and correct. Executed on 1 l 3 t 2U t q g i � B E OF TREASURER OR ASSISTANT TREASURER Executed on STATE ZIP CODE AREA CODE/PHONE Executed on Executed on By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT FPPC Form 460 -(JAN/2016) State of California/SI