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Recipient Committee <br />Campaign Statement <br />Coyer Page <br />(Government Code Sections 84200-84216.5) <br />Statement covers <br />from 01/017.2020 <br />SEE INSTRUCTIONS ON REVERSE thrpugh 12/31/2020 <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 />O State Candidate Election Committee Committee <br />0 Recall Q Controlled <br />(Alwcomp/ete-Parts} O Sponsored <br />(AfsocompfetePart6) <br />❑ Genera{;Purpose'Committee <br />Q Sponsored ❑ Primarily Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />Q Political'Party/CentrailCommittee (AlSocompktePart�q <br />3. Committee Information <br />so <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Monrow Mabon for Riverside City Council 2021 <br />6458 <br />STREETADDRESS.,(NO P.O. BOX) <br />c/o <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />Covina CA <br />MAILING ADDRESS(IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />N/A <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />of election if applicable: <br />,(Month, Day, Year) <br />Date Stamp <br />ECEIVED <br />JAN 19 2021 Page 1 of 35 <br />For OfficiaWse Only <br />City ®f Riverside <br />06/,08;/2.021 City CieWs Office <br />2. Type of Statement: <br />❑ Preelection Statement ❑ Quarterly Statement <br />❑x Semi-annual Statement❑ Special Odd -Year Report <br />❑ Termination Statement ❑ Supplemental Preelection <br />(Also file a Form 410 Termination) Statement - Attach Form 495 <br />❑ Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Yolanda Miranda <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />Covina CA _ <br />IF ANY <br />MAILING' ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS' <br />4. Verification <br />have used all reasonable diligence in preparing and reviewing this statement and to the les is true and complete. 1 certify <br />under penalty of pejury under the laws of the State 'of California that the foregoing is true <br />Executed on 01/22/2021 <br />Dai <br />Executed on 01/22/2021 <br />Dam <br />Executed on <br />:Date <br />Executed on <br />�Dale, <br />www.t effi'le.com <br />By <br />By <br />By <br />SignaitueofCo3trolling Oiffcdldder, CaMidate,StafeMeasure Proponent <br />By <br />Signature of Confroiling OfiiceWder, Candidate, SYateMeasure Proponent <br />FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppc.ca.gov (866/276-3772} <br />v wwjppc.ca gov' <br />