410 Falcone W1 (03-07-19) Amendment_R

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Statement of Organization Recipient Committee Statement Type 0 Initial Q Not yet qualified or Q Date qualification threshold met NAME OF COMMITTEE ® Amendment Date qualification threshold met 4 / 30 / 18 I.D. Number 1402303 (if applicable) Philip Falcone for Riverside City Council Ward 1 2019 Date Stamp ❑ Termination — See Part gECEIVED AND FILED in he office of the Secretary of State of the State of California Date of termination STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE CA ZIP CODE AREA CODE/PHONE FULL 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. / / FEB 272019 asurer and Other Princ NAME OF TREASURER Paula Leivas MAR 0 7 ?fl Ice STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE CA ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Michaela Montgomery STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE ZIP CODE AREA CODE/PHONE CA NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE (4RBA CODE/PHONE G Vrficat�on.;,; I have used all reasonable diligence in preparing th -dge the information contained herein is true and complete i i certify under penalty of perjury under the laws of the State of C. rect. Executed on ` ,1 5 I By DATE I ei Executed on .:z)- � 5r l By DATE Executed on By DATE Executed on By DATE SIGNATUR • F 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