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Recipient Committee Date Stamp CALIFORNIA COVER PAGE <br />Cam <br />pa460 ign Statement <br />C <br />FOR, M over Page RECEIVEJ <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 7/1/2019 <br />through 9121/2019 <br />Date of election if applicable: <br />(Month, Day, Year) <br />11/512019 <br />EMMM <br />City of Riverside <br />City ClerYs Office <br />Page — of— <br />For Official Use Only <br />1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. 2. Type of Statement: <br />Officeholder, Candidate Controlled Committee F-1 Primarily Formed Ballot Measure ❑ Preelection Statement El Quarterly Statement <br />0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd -Year Report <br />0 Recall 0 Controlled F-71 Termination Statement <br />(Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) <br />EJ General Purpose Committee (MSO complete Pad 6) Amendment (Explain below) <br />0 Sponsored El Primarily Formed Candidate/ changes to SCHEDULE C - Riverside Police OA $6,500 non - <br />0 Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Also Complete Pert 7) monetary contribution was cancelled and re -issued on 10/1112019 <br />3. Committee Information <br />13 <br />I.D. NUMBER <br />1407581 <br />Gaby Plascencia Riverside City Council Ward 5, 2019 <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA J <br />MAILING ADDRESS (IF DIFFERENT) NO.. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX/ E-MAIL ADDRESS <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREACODE/PHONE <br />Riverside CA M <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 />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 upder the laws of the State of California that the for <br />Executed on 11111'7' <br />I Dale urer <br />Executed on 4L/ I- — <br />f Date at 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 />