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Statement of Organization <br />Recipient Committee <br />Statement Type <br />❑ Initial <br />Q Not yet qualified <br />or <br />Q Date qualification threshold met <br />1. Committee Information <br />NAME OF COMMITTEE <br />'Amendment <br />Date qualification threshold met <br />3 / /0 / !c <br />I.D. Number <br />(if applicable) / c <br />e , <br />ao Fty-zi �sti�l <br />617.3- <br />',. (:_ : 3 <br />0 Termination — See Part 5 <br />Date of termination <br />For Official Use Only <br />City of Riverside <br />City C, i;=:7T ss .m. <br />2. Treasurer and Other Principal Officers <br />NAME OF TRFpi}Cl'IfER <br />STRE <br />CITY <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />FULL MAILING ADDRESS (IF DIFFERENT) <br />E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL <br />COUNTY OF DOMICILE <br />JURISDICTION WHERE COMMITTEE IS ACTIVE <br />Attach additional information on appropriately labeled continuation sheets. <br />CITY <br />STATE ZIP CODE <br />‘oe_gOe 4- <br />I vii7: <br />NAM E OF ASSISTANT TREASURER, IF ANY <br />AREA CODE/PHONE <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />NAME OF PRINCIPALOFFICER(S) <br />STREET ADDRESS (NO P.O. BOX) <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />CITY <br />STATE <br />ZIP CODE <br />AREA CODE/PHONE <br />3. Verification <br />1 have used all reasonable diligence in pre. <br />penalty of perjury under the laws of the St <br />Executed on <br />Executed on <br />Executed on By <br />DATE <br />DATE <br />30119' <br />DATE <br />By <br />By <br />Executed on <br />By <br />DATE <br />ined herein is true and complete. I certify under <br />0 CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />