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Recipient Committee <br />Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Statem nt covers period <br />from 15 liq 4 <br />throu <br />1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. <br />Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />Q State Candidate Election Committee Committee <br />0 Recall 0 Controlled <br />(Also Complete Part 5) O Sponsored <br />(Also Complete Part 6) <br />❑ General Purpose Committee <br />0 Sponsored ❑ Primarily Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Also Complete Part 7) <br />3. Committee Information I I.D. NUMBER <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />-� & vk o jRx \2��N e�'s i <br />P <br />CITY <br />STATE <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX/ E-MAIL ADDRESS d y <br />t �} 1i p \A P -A Y ,-, ti G t <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and <br />certify under penalMSh <br />n er t laws of the State of California that the for <br />Executed onte % <br />Executedon 4-2008 <br />By <br />Date <br />CK61T/0aWIN! 0 <br />Date of election if applicable: SEI ,G Q 2019 Page _4-- of - <br />(Month, Day, Year) For Official Use Only <br />City of Riverside <br />9 City Clerk's Cff ,e <br />2. Type of Statement: <br />Preelection Statement ❑ Quarterly Statement <br />Semi-annual Statement ❑ Special Odd -Year Report <br />Termination Statement <br />(Also file a Form 410 Termination) <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREACODE/PHONE <br />OPTIONAL: FAX/E-MAILADDRESS <br />or <br />Executed on By <br />Date Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />Executed on By <br />Date Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />schedules is true and complete. I <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />