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_T <br />Cover Page <br />Statement covers period <br />from 1/1/2019 <br />Date of election if applicable: <br />(Month, Day, Year) <br />Date Stamp <br />COVERPAGE <br />I of -- <br />For Official Use Only <br />SEE INSTRUCTIONS ON REVERSE through 4120/2019 06/0412019 JAN 3 0 2020 <br />1. Type of Recipient Committee: All Committees - Complete Parts 1, 2,3, and 4. 2. Type of Statement: City- Clerk% Office <br />Officeholder, Candidate Controlled Committee El Primarily Formed Ballot Measure El Preelection Statement 0 Quarterly Statement <br />0 State Candidate Election Committee Committee M Semi-annual Statement 0 Special Odd -Year Report <br />0 Recall 0 Controlled 0 Termination Statement <br />(Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) <br />F-1 General Purpose Committee (Also Complete Patt 6) W Amendment (Explain below) <br />0 Sponsored F Primarily Formed Candidate/ To add schedule B , <br />0 Small Contributor Committee Officeholder Committee Joftl�iz <br />0 Political Party/Central Committee (Also 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 AREA CODE/PHONE <br />Riverside CA = <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREACODE/PHONE <br />Treasurer(s) <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />Riverside CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILINGADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <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 <br />certify under penalty of Delrjury under the laws of the State of California that the <br />I '�'3 0 <br />Executed on - / <br />ID111 <br />Executed on 2-0 <br />Date <br />Executed on <br />Date <br />Executed on <br />Date <br />in the attached schedules is true and complete. I <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 />