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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 5119/2019 <br />through <br />6/30/2019 <br />1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. <br />Officeholder, Candidate Controlled Committee El Primarily Formed Ballot Measure <br />0 State Candidate Election Committee Committee <br />0 Recall 0 Controlled <br />(Also Complete Part 5) 0 Sponsored <br />(Also Complete Part 6) <br />El General Purpose Committee <br />0 Sponsored ❑ Primarily Formed Candidate/ <br />0 Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Also Complete Part 7) <br />3. Committee Information <br />4. <br />I.D. NUMBER <br />1407581 <br />Gaby Plascencia Riverside City Council Ward 5, 2019 <br />STREET ADDRESS (NO P.O. BOX) <br />Riverside CA _ <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREACODE/PHONE <br />OPTIONAL: FAX/ E-MAILADDRESS <br />I have used ail reasonable diligence in preparing and reviewing this statement and to the best of <br />certify under penalty of perjury under the laws of the State of California that the for <br />Executed on '11A) W B <br />Date 4) <br />Executed o&&�A BA <br />1.1 Date <br />Executed on <br />Date <br />Executed on I Date <br />Date of election if applicable: <br />(Month, Day, Year) <br />Date Stamp <br />RECEIVE <br />AUG 19 2019 <br />COVER PAGE <br />Page / of <br />For Official Use <br />11/5/2019 Cily of Riverside <br />I City Clerk's Office <br />2. Type of Statement: <br />0 Preelection Statement ❑ Quarterly Statement <br />1771 Semi-annual Statement El Special Odd -Year Report <br />El Termination Statement <br />(Also file a Form 410 Termination) <br />Amendment (Explain below) <br />to include schedule C and schedule F and to correct ending cash <br />balance typo. <br />Treasurer(s) <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILING ADDRESS <br />1A I T STATE ZIP CODE AREACODEIPHONE <br />Riverside CA � <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX/ E-MAIL ADDRESS <br />the information contained herein and in the attached schedules is true and complete. <br />By Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />By Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />FPPC Form 460 (1an/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />