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Statement of Organization <br />est m [—. V I <br />Recipient Committee <br />. <br />MM <br />Statement Type <br />• <br />SEP 2 © 2019 For Official UseOni v <br />❑ initial <br />❑ Amendment <br />Termination —See Part 5 <br />Q Not yet qualified <br />City of Riverside <br />or <br />O Date qualification threshold met Date <br />qualification threshold met <br />Date of termination <br />City Clerk S Office <br />i1 `Committee Inforrnatton <br />I.(DpNpu bb�r� <br />� �,,, <br />r y2 1Treasurerarid Other Principal Offic{ers�' ;� �� ,��R �� ��a 3 �� ��t , , <br />�� <br />` <br />NAME OF COMMITTEE .+< <br />NAME OF TREASURER <br />STREET ADDRESS (NO P.O. BOX) <br />FULL MAILING ADDRESS IIF DIFFEREN T( <br />E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) <br />Attach additional information on appropriately labeled continuation sheets. <br />I have used all reasonable diligence in pr( <br />penalty of perjury under the laws of the <br />Executed on 4� // Q ,By <br />DATE/ <br />Executed on 0 �L_ By <br />DATE <br />Executed on By <br />DATE <br />Executed on By <br />DATE <br />CITY STATE <br />,(V,er Ick C <br />NAME OF ASSISTANT TREASURER, IF ANY -. <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIPCODE AREA CODE/PHONE <br />NAME OF PRINCIPAL OFFICER(S) <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />n contained herein is true and complete. I certify under <br />TREASURER <br />E OF CONTROLLING OFFICEHOLDER -,CANDIDATE, -OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT <br />FPPC Form 410 (August/2018) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />