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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 04/25/2021 <br />through 05/22/2021 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. <br />❑X Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure <br />Q State Candidate Election Committee Committee <br />0 Recall O Controlled <br />(Also complete Part 5) O Sponsored <br />❑ General Purpose Committee (Also Complete Part 6) <br />Q Sponsored ❑ Primarily Formed Candidate/ <br />Q Small Contributor Committee Officeholder Committee <br />Q Political Party/Central Committee (Also Complete Part 7) <br />3. Committee Information I I.D. NUMBER <br />1428458 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Monrow Mabon for Riverside City Council 2021 <br />STREET ADDRESS (NO P.O. BOX) <br />c/o <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />Covina CA <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />N/A <br />STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />4. Verification <br />1 have used all reasonable diligence in preparing and reviewing this statement and to the <br />under penalty of perjury under the laws of the State of California that the foregoing is true <br />Executed on 05/26/2021 <br />Date <br />Executed on 05/26/2021 <br />Date <br />Executed on <br />Date <br />Executed on <br />Date <br />www.netfile.com <br />By <br />By <br />Date of election if applicable: <br />(Month, Day, Year) <br />06/08/2021 <br />Date Stamp <br />'Tp.. <br />M 0 1202, <br />Cbof Riverside <br />Cfty Clerk's Oce <br />COVER PAGE <br />Page 1 of 31 <br />For Official Use Only <br />2. Type of Statement: <br />Preelection Statement ❑ Quarterly Statement <br />❑ 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 CODE/PHONE <br />Covina CA <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />herein and in the attached schedules is true and complete. I certify <br />By <br />Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />By <br />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 />