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460 Booker CC W1 (04-21-19 - 05-23-19)_R Termination
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AREA CODE/PHONE <br />Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Stateme t covers period <br />from jz Lei i <br />2f <br />through <br />Date of election if applicable: <br />(Month, Day. Year) <br />Date Stamp <br />RECEIVE <br />COVER PAGE <br />CALIFORNIA 460 <br />FORM VV <br />MAY 23 2013 <br />City of Riverside <br />City Clerk's office <br />Page of Li <br />For Oficial Use Only <br />1. Type of Recipient Committee: All Committees— Complete Parts 1, 2, 3, and 4. <br />Flffceholder, Candidate Controlled Committee <br />❑ State Candidate Election Committee <br />❑ Recall <br />(Also Comptere Pal 5) <br />❑ General Purpose Committee <br />❑ Sponsored <br />❑ Small Contributor Committee <br />❑ Political Party/Central Committee <br />Primarily Formed Ballot Measure <br />Committee <br />❑ Controlled <br />❑ Sponsored <br />rats, Complete Pert 6) <br />Primarily Formed Candidate) <br />Officeholder Committee <br />(Also Complete Par! TJ <br />2. Type of Statement: <br />Pre lection Statement <br />tSemi-annual Statement <br />Q rmination Statement <br />(Also file a Form 410 Termination) <br />0 Amendment (Explain below) <br />❑ Quarterly Statement <br />❑ <br />Special Odd -Year Report <br />3. Committee Information <br />COMMITTEE NAME OR CANDIDATES NAME IF NO COMMITTEE) <br />STREET-ADDRESS'QL x P.O. OX \\ s:(s- e + C� <br />STATE ZIP CODE <br />MA LING ADDRESS (1F DIFFERENT} NO.AND STREET CR r. .. a. <br />nek2 <br />Treasurer(s) <br />NAME OF TREASURER <br />CITY <br />ST <br />NAME DF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />OPTIONAL: FAX 1 E-MAIL ADDRESS <br />4. Verification <br />have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I <br />certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. <br />Executed on <br />Executed on <br />Executed on <br />Executed on <br />Date <br />Date <br />B <br />By <br />By <br />nt Treasurer <br />Proponent or Responsible Officer of Sponsor <br />Signature of Controlling Officeholder Candidate, State Measure Proponent <br />Signature at Controlling Officeholder. Candidate, State Measure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />
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