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Campaign Statement <br />Cover Page <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 9/2212019 <br />through 10/19/2019 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2,3, and 4. <br />EZ Officeholder, Candidate Controlled Committee El 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 Fort 6) <br />El General Purpose Committee <br />0 Sponsored Primarily Formed Candidate/ <br />0 Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Aso Complete Part 7) <br />3. Committee Information <br />I.D. NUMBER <br />1407581 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Gaby Plascencia Riverside City Council Ward 5, 2019 <br />STREET ADDRESS (NO P.O. BOX) <br />CITY STATE ZIP CODE AREAGODE/PHONE <br />Riverside CA � <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR RO. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Date of election if applicable: <br />(Month, Day, Year) <br />1115/2019 <br />2. Type of Statement: <br />Date Stamp <br />JAN 3 0 2020 <br />CitY of Riverside <br />1:1 Preelection statement <br />F -I Semi-annual Statement <br />El Termination Statement <br />(Also file a Form 410 Termination) <br />Amendment (Explain below) <br />To add Schedule B Part 1 <br />Treasurer(s) <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILINGADDRESS <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILINGADDRESS <br />COVER PAGE <br />Page f of ­!) <br />For Official Use Only <br />0 Quarterly Statement <br />F] Special Odd -Year Report <br />CITY STATE ZIP CODE AREACODE/PHONE <br />OPTIONAL: FAX/ E-MAIL ADDRESS OPTIONAL: FAX/ E-MAIL ADDRESS <br />4. Verification <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. I <br />certify under penalty of per ry Lin er the laws of the State of California that the foregoing is true and correct. <br />Executed on Z, / Date BY or <br />Executed on 120 By 20hon Wasure Procon.n:l'tor <br />Date Sionatur. of trollina Officeholder. C. dd.=tre Prononent or Resconsible Officer Of SOOhSor <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 />