410 Gardner (08-22-19) Amendment_R

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Statement of Organization Date Stamp CALIFORNIA Recipient Committee FORM 410 Statement Type 14 ECEIVED AND FILE For Official Use Only 1. n Initial 0 Amendment El Termination — See Part ifelfify Qf a-% hip pffio@ pt the 60C . Mgt • Not yet qualified of the state of California ILj k: U V or F1 Ell' #Er • Date qualification threshold met Date qualification threshold met Date of termination AUG 12 2019 AUG 2 2 20119 07 23 2008 F, Q* TO gplftffl�* XA F,, #0 2, I.D. Number N -Ir IS R W (if applicable) 1256312 d NAME OF COMMITTEE Mike Gardner for City Council Ward 1 2019 STREET ADDRESS (NO P.O- BOX) CITY STATE ZIPCODE AREACODF/PHONE Riverside CA FULL MAILING ADDRESS (IF DIFFERENT) E-MAILADDRESS (REQUIRED) / FAX (OPTIONAL) COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Riverside I City of Riverside Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing penalty of perju u der the laws of the State of Executed on By DPftE Executed on e — By L, DTE Executed on DATE By NAME OF TREASURER Mike Gardner STREET ADDRESS (NO PO. BOX) CITY STATE ZIP CODE AREACODrJPHONE Riverside CA NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY and to the best of my knowledge the foregoing is true and correct. OFTHEASUKERORASSISIAN I IREASUKLK SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, UK SIAII: MEASURI, FKUFUNEN I SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT STATE ZIP CODE AREA CODE/PHONE STATE ZIP CODE erein is true and com AREA CODE/PHONE NM 0 3, --n ;U %.0 rT1 0 M < �0 0 1771 M M Executed on By DATE 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