410 Jalani Bakari Darryl Martin W3 (04-04-19)_R

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Statement of Organization Recipient Committee Statement Type ❑ Initial Q Not yet qualified or Q Date qualification threshold met / I 1.: Committee Information NAME OF COMMITTEE RECEIIEP, ® Amendment Date qualification threshold met 03// 11 / 2019 I.D. Number (if applicable) Jalani Bakari for Riverside City Council Ward 3 2019 1416488 APR 0 4 2019 City of Riverside City Clerk's Office ❑ Termination — See Pa Date of termination / / STREET ADDRESS (NO P.O. BOX) CITY Date Stamp CEIVED AND FILE e officerof the Secretary of Stat of tff€State of California MAR 21 2019 • Treasurer and Other Principal Officers NAME OF TREASURER Susan Leivas Sturner For Official Use Only STREET ADDRESS (NO P.O. BOX) CITY Riverside STATE CA ZIP CODE AREA CODE/PHONE 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) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE I5 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 3.Verification I have used all reasonable diligence in preparing this statement and to the bestof my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of Cali T� 18.LCI Executed on By DATE Executed on 3 — , e ! 9 By DATE Executed on By DATE Executed on By DATE SSISTANT TREASURER IDATE, 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 (Adgast/2018) FPPC Advice: advice@fppc.ca.gov(866 375-3772) www.fppc.ca.gov