410 Gardner (08-09-19) Amendment_R

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Statement of Organization Date StampI I CALIFORNA4 1 10 Recipient Committee RECEIVES', FORM Statement Type El initial 0 Amendment El Termination — See Part 5 For Official Use Only • Not yet qualified AUG 0 9 2019 or • Date qualification threshold met Date qualification threshold met Date of termination City of Riverside] 07 23 2008 City Clerks Office I.D. Number I 1114INT (if applicable) 1256312 NAME OF COMMITTEE Mike Gardner for City Council Ward 1 2019 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA FULL MAILING ADDRESS (IF DIFFERENT) E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE'URISDICTION WHERE COMMITTEE IS ACTIVE Riverside City of Riverside Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing penalty of perjur ur der the laws of the State of Executed on q t q By D Executed on q - B, L, ATE Executed on By DATE Executed on DATE NAME OF TREASURER Mike Gardner STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE ent and to the best of my knowledge the information contained herein is true Sit the foregoing is true and correct. SIGNATURE OF TREASURER OR ASSISTANT TREASURER SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT under By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (August/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov