460 Taken CC W3 (04-21-19 - 05-18-19) Amendment_R

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Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Yq" O iiceholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) C MMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and certify under penalty of perjury un er the laws of the State of California that the fore Executed on C By Datb 41 Executed on By Date Executed on Date Executed on Date Date of election if applicable: (Month, Day, Year) COVER PAGE SEP 2 0 2019 1 Page d of City of Rive u N Cid Clerk's 2. Tyf Statement: Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also Ile a Form 410 Termination) mendment (Explain below) y Treasurer(s) For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent is true and complete. I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov