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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 04/21/2019 <br />05/18/2019 <br />through <br />Date of election if applicable: <br />(Month, Day, Year) <br />06/04/2019 <br />e c -t 4 - <br />Date Stamp <br />RECEIVE <br />JUL 31 2019 <br />City of Riverside <br />City Clerk's Office <br />COVER PAGE <br />Page <br />of <br />For Official Use Only <br />1. Type of Recipient Committee: All Committees—Complete Parts 1, 2, 3, and 4. <br />iZ Officeholder, Candidate Controlled Committee <br />O State Candidate Election Committee <br />O Recall <br />(Also Complete Part 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 />Wl Preelection Statement <br />O Semi-annual Statement <br />O Termination Statement <br />(Also file a Form 410 Termination) <br />• Amendment (Explain below) <br />information missing <br />O Quarterly Statement <br />O Special Odd -Year Report <br />3. Committee Information <br />I.D. NUMBER <br />1416494 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Maartin Rossouw for Riverside City Council, Ward 7 <br />STREET ADDRESS (NO P.O. BOX) <br />CITY <br />Riverside <br />STATE ZIP CODE <br />CA <br />AREA CODE/PHONE <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY 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 <br />certify under penalty of perjury under the laws of the State of California that the foregc <br />Executed on 07/31/2019 <br />Date <br />\ X11 Zcrii <br />Executed on <br />Executed on <br />Executed on <br />Date <br />Date <br />Date <br />By — <br />By -- <br />By <br />Treasurer(s) <br />NAME OF TREASURER <br />Donnie Harris <br />MAILING ADDRESS <br />CITY <br />Riverside <br />STATE ZIP CODE <br />CA <br />AREA CODE/PHONE <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />is is true and complete. 1 <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />