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410 Booker CC W1 (05-23-19)_R Termination
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21P CODE <br />AREA CODE/PHONE <br />Statement of Organization <br />Recipient Committee <br />Statement Type <br />❑ Initial <br />• Not yet quaffed <br />or <br />Q Date qualification threshold met <br />f <br />0 Amendment <br />Date qualification threshold met <br />�.rermination — See Part <br />Date Stamp <br />RECEIVED <br />MAY 2 3 2019 <br />City of Riverside <br />City Clerk's Office <br />5 Date of rminatiar <br />ry <br />CALIFORNIA 4'1 V <br />n <br />FORM <br />For Official Use Only <br />1. Committee Information <br />I.O. Number (� <br />cif app/cabiej <br />2. Treasurer and Other Principal Officers <br />NAME OF COMMITTEE NAME DF TREASURER <br />y� n ii iSTREET ADDRESS (NO P.Q. BOYL <br />STREET ADDRESS (NO P.D�f.]X) CITY <br />FULL MAILING ADDRESS (IF DIFFERENT) <br />IP CODE <br />\RNINAP CC\ <br />AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY <br />,�+,LLI !UN wntne LUMP/14i It I HLI IVb--_, <br />\\t Q1 \ Q <br />Attach additional information on appropriately labeled continuation sheets. <br />STREET ADDRESS {NO P.O. BOX} <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />STREET ADDRESS (NO P,a 505) <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />3. Verification <br />I have used all reasonable diligence in pre <br />penalty of perjury and r the la s of the <br />6 <br />Executed on By <br />DATE <br />ge the information contained herein is true and complete. I certify under <br />ct. <br />OR ASSISTANT TREASURER <br />Executed on 1 �� By <br />CANDIDATE, OR STATE MEASURE PROPONENT <br />DAT <br />Executed on By <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDA-E, CR STATE MEASURE PROPONENT <br />DATE <br />Executed on By <br />DATE <br />SIGNATURE DF CONTROLLING OFFICEHOLDER, CANDEDATE, 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 />
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