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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />SEE INSTRUCTIONS ON REVERSE <br />Statement covers period <br />from 10/18/2020 <br />through 12/31/2020 <br />1. Type of Recipient Committee: Alf Committees — complete Parts 1, 2, 3, and 4. <br />❑x Officeholder, Candidate Controlled Committee ❑ Primarily formed Ballot Measure <br />0 State Candidate Election Committee Committee <br />0 Recall 0 Controlled <br />(Also CompleteFert5) 0 Sponsored <br />(Also CompletePart6) <br />❑ General Purpose Committee <br />0 Sponsored <br />0 Small Contributor Committee <br />0 Political Party/Central Committee <br />3. Committee Information <br />:OMMITTEE NAME (OR CANDIDATE'S NAME IF NO <br />Andy Melendrez for Mayor 2020 <br />STREET ADDRESS (NO P.O. BOX) <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />I.D. NUMBER <br />1421003 <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 <br />under penalty of perjury under the laws of the State of California that the foregoing is 1 <br />Executed on <br />02/01/2021 <br />By <br />Date <br />Executed on <br />02/01/2021 <br />By <br />Date <br />Executed on <br />By <br />Date <br />Executed on <br />By <br />Date <br />wwwe.neiri/e.com <br />Date of election if applicable: <br />(Month, Day, Year) <br />Date Stamp <br />COVER PAGE <br />Page 1 of 26 <br />For Official Use Only <br />11/03/2020 LIM <br />ity of Riverside <br />lark's i3ffiC� <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 />Treasurers) <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 />ADDRESS <br />herein and in the attached schedules is true and complete. 1 certify <br />....... FPPC Form 460 (Jan/2016) <br />FPPC Advice: advice@fppe.ca.gov (866(275-3772) <br />www.fppc.ca.gov <br />