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Recipient Committee Dahillte Stamp i CO'TWER PAGN <br />CALIFORNIAA60 <br />Campaign Statement r FORM <br />-UE1VE_ <br />Cover Page R E.: <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 7/11/2019 <br />through <br />9/21/2019 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, a, and 4. <br />Officeholder, Candidate Controlled Committee D 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 El 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 <br />CA <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX/ E-MAILADDRESS <br />Date of election if applicable: <br />(Month, Day, Year) <br />Page i Of 4 !1 <br />For Official Use Only <br />CitY of Riverside <br />11/5/2019 City CleWs Office <br />2. Type of Statement: <br />W Preelection Statement El Quarterly Statement <br />F-1 Semi-annual Statement ❑ Special Odd -Year Report <br />F-1 Termination Statement <br />(Also file a Form 410 Termination) <br />El Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILING ADDRESS <br />ITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREACODE/PHONE <br />OPTIONAL: FAX/ E-MAILADDRESS <br />I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information Contained herein and in the attached schedules is true and complete. <br />certify under penalty of perjury under the laws of the State of California that the fore Din is true and correct. <br />Executed on C4 By t Treasurer <br />Executed on — q— <br />Date -ponent or Responsible Officer of Sponsor <br />Executed on <br />Date <br />Executed on <br />Date <br />By Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />By Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />. www.fppc.ca.gov <br />