410 Mill CC W5 (01-31-19) Amendment_R

Home

Statement of Organization Recipient Committee Statement Type ❑ Initial Q Not yet qualified or O Date qualification threshold met NAME OF COMMITTEE ® Amendment Date qualification threshold met 01 / 08 / 2019 I.D. Number (if applicable) Sean Mill for Riverside City Council Ward 5 - 2019 1407130 0 Termination — See Part 5 Date of termination STREET ADDRESS (NO P.O. BOX) CITY Date Stamp RECEIVED JAN 31 2019 City of Riverside City Clerk's Office NAME OF TREASURER Dana Hopkins, CPA STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE ZIP CODE AREA CODE/PHONE CA STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Riverside CA FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) 1111 NTY OF DOMICILE Riverside JURISDICTION WHERE COMMITTEE IS ACTIVE Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE ;uerrncation I have used all reasonable diligence in preparin • this statem nt and to the best of my knowledge the information contained herein is true and complete. l certify under penalty of perjury unde the laws of the St Executed on 1131, ' ®{ Ct By ATE Executed on t/ 3 k/ .0 t 4 By 8888 I DATE Executed on By DATE Executed on By DATE true and correct. ATURE OF TREASURER OR ASSISTANT TREASURER G ATURE OF CONTROLLING OFFICEHOLDER, 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 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov