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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />from <br />Statement covers period <br />5-1k 2011 <br />through <br />Date of election if applicable: <br />(Month, Day, Year) <br />,l - S 2611 <br />JUL 2 4 2019 <br />City of Riverside <br />City Clerk's Office <br />Page <br />of <br />For Official Use Only <br />1. Type of Recipient Committee: <br />All Committees — Complete Parts 1, 2, 3, and 4. <br />I1 Officeholder, Candidate Controlled Committee <br />O State Candidate Election Committee <br />• Recall <br />(Also Complete Pad 5) <br />❑ General Purpose Committee <br />O Sponsored <br />O Small Contributor Committee <br />O Political Party/Central Committee <br />O Primarily Formed Ballot Measure <br />Committee <br />O Controlled <br />O Sponsored <br />(Also Complete Part 6) <br />O Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />2. Type of Statement: <br />D Preelection Statement <br />® Semi-annual Statement <br />O Termination Statement <br />(Also file a Form 410 Termination) <br />O Amendment (Explain below) <br />❑ Quarterly :Statement <br />❑ Special Odd -Year Report <br />3. Committee Information I.D. NUMBER <br />141 61. <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Dr 1,,)11,11-40". d ec,r-ce..For Laird 7 2 01 <br />at <br />STREET ADDRESS NO P.O. BOX <br />CITY <br />Ver4f <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />STATE <br />AREA CODE/PHONE <br />CITY STATE <br />ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />Treasurer(s) <br />NAME OF TREASURER <br />OC./r ?eVln,nG r <br />MAILING ADD <br />CITY STATE ZIP CODE <br />AREA CODE/PHONE <br />NAME OF ASSISTANT TREASURER, IF ANY <br />(„) 1 l <br />MAILING A <br />CITY <br />14, frfr <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />STAT ZIP MO <br />AREA CODE/PHONE <br />4. Verification <br />1 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. <br />certify under penalty of perjury under the laws of the State of California that the foregoin is true and correct. <br />Executed on <br />Executed on <br />Executed on <br />Date <br />Executed on <br />7-2P ZON <br />Date <br />- Zo!' <br />Date <br />Date <br />By <br />By <br />By <br />By <br />reasurer or Assistant Treasurer <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible 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: advice@fppc.ca.gov (866/275-3'772) <br />