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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 10/16/2020 <br />through 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 />Q State Candidate Election Committee Committee <br />Recall (:) Controlled <br />(Also Complete Part 5) Q Sponsored <br />(also CompfstePart6) <br />❑ General Purpose Committee <br />Q Sponsored <br />Q Small Contributor Committee <br />Q Political Parry/Central Committee <br />❑ Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />3. Committee InformationI I.D. NUMBER <br />1421003 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Andy Melendrez for Mayor 2020 <br />STREET ADDRESS (NO RO. BOX) <br />CITY STATE ZIP CODE AREA COD> IPHONE <br />Riverside CA — <br />MAILING ADDRESS (IF DIFFERENT) NO AND STREET OR P.O. BOX <br />N/A <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />OPTIONAL: PAX / 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 />Date of election if applicable: <br />(Month, Day, Year) <br />Date Stamp <br />MAR 0 5 2021 <br />COVER PAGE <br />Page 1 of 26 <br />For official Use Only <br />11/03/2020 City of Rivel-sid <br />Cid' Clerks Of <br />2. Type of Statement: <br />❑ Preelection Statement ❑ Quarterly Statement <br />Q Semi-annual Statement ❑ Special Odd -Year Report <br />❑ Termination Statement ❑ Supplemental Preelection <br />(Also file a Form 410 Termination) Statement -Attach Form 495 <br />Q Amendment (Explain below) <br />Amending Schedule A & E to include missing information. <br />Treasurer(s) <br />NAME OF TREASURER <br />Andy Melendrez <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />Riverside CA _ <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />"Al ADDRESS <br />herein and in the attached schedules is true and complete. I certify <br />Executed on <br />03/04/2021 <br />By <br />Date <br />or AssistantTreasurer <br />Executed on <br />03/04/2021 <br />B _ <br />y <br />Date <br />Measure Proponent or Responsible Officer o#Sponsor <br />Executed on <br />By _ <br />Date <br />ndidate, State Measure Proponent <br />Executed on <br />By — <br />Date <br />ndidate, State Measure Proponent <br />FPPC Form 460 (Jan12016) <br />FPPC Advice: advice@fppc.ca.gov (8881275-3772) <br />