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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Date Stamp <br />RECEIVED <br />fro <br />Statement covers period <br />0 <br />through ;..J( l( p2i%, coo[ t <br />Date of election if applicable: <br />(Month, Day, Year) <br />Jam.Lf ago/ <br />APR 2 4 2019 <br />City of Riverside <br />City Clerk's Office <br />COVER PAGE <br />Page <br />of <br />For Official Use Only <br />1. TypeTyof Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. <br />IV Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />O State Candidate Election Committee Committee <br />O Recall 0 Controlled <br />0 Sponsored <br />(Also Complete Part 6) <br />(Also Complete Part 5) <br />❑ General Purpose Committee <br />O Sponsored <br />O Small Contributor Committee <br />O Political Party/Central Committee <br />D Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />2. Type of Statement: <br />LE7 Preelection Statement <br />❑ Semi-annual Statement <br />D Termination Statement <br />(Also file a Form 410 Termination) <br />O Amendment (Explain below) <br />O Quarterly Statement <br />O Special Odd -Year Report <br />3. Committee Information <br />I.D. NUMBER <br />COMMITTEE NAME (OR CANDIDATE'S pdgME IF Ni OMMITTEE) <br />�e� TI E % a-iS(''Y`��Y, ve,�, , c- 0,014 C <br />ele,m bex mid ? X6(9. <br />CITY i Ye(cSi STATE <br />ZIP CODE AREA CODE/PHONE <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY <br />STATE <br />ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAILADDRESS <br />Treasurer(s) <br />NAME OF TREASURER <br />6ftvi e,-7'aoh <br />MAILING ADDRESS <br />CITY • / STAT ZIP CODE CODE/PHONE <br />NAME OFASSIS ANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the b <br />certify under penalty of perjury under the laws of the State of California that the foregoin <br />Executed on <br />Executed on <br />Executed on <br />Executed on <br />Date <br />51/CQ� t <br />! Date <br />u l a3 /1 <br />Date <br />By <br />By <br />By <br />By <br />Signa <br />attached schedules is true and complete. I <br />Officer of Sponsor <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: (866/275-3772) <br />