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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84296.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 09/20/2020 <br />through 10/17/2020 <br />1. Type of Recipient Committee: All Committees— Complete Parts 1, 2, 3, and 4. <br />0 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />Q State Candidate Election Committee Committee <br />Q Recall O Controlled <br />(Also Complete Part 5) O Sponsored <br />(Also Complete Part S) <br />❑ General Purpose Committee <br />Q Sponsored <br />Q Small Contributor Committee <br />Q Political Party/Central Committee <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />3. Committee InformationI.D. NUMBER <br />1 1421003 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Andy Melendrez for Mayor 2020 <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 />N/A <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />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 <br />under penalty of perjury under the laws of the State of California that the foregoing is true and correc <br />Executed on <br />10/22/2020 <br />By <br />Date <br />Executed on <br />10/22/2020 <br />By <br />Date <br />Executed on <br />BY <br />Date <br />Executed on <br />BY <br />Date <br />COVER PAGE <br />Date Stamp <br />QALIFORNIA 46 <br />FORM <br />RECEIVE <br />Date of election if applicable: OCT 2 2 ZOZO Page 1 of 23 <br />(Month, Day, Year) <br />For Official Use Only <br />City of Riverside <br />11/03/2020 City Clerk's Ce <br />2. Type of Statement: 'T <br />Preelection Statement ❑ Quarterly Statement <br />❑ Semi-annual Statement ❑ Special Odd -Year Report <br />❑ Termination Statement ❑ Supplemental Preelection <br />(Also file a Foran 410 Termination) Statement - Attach Form 495 <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Andy Melendrez <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Riverside CA _ <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / <br />and in the attached schedules is true and complete. 1 certify <br />FPPC Forth 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www.fppc.ca.gov <br />