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Recipient Committee <br />Campaign Statement <br />Cover Page <br />(Government Code Sections 84200-84216.5) <br />Statement covers period <br />from 07/01/2021 <br />SEE INSTRUCTIONS ON REVERSE I through 12/31/2021 <br />1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. <br />Officeholder, Candidate Controlled Committee <br />0 State Candidate Election Committee <br />0 Recall <br />(Ailsa Complete part 5) <br />D General Purpose Committee <br />0 Sponsored <br />Q Small Contributor Committee <br />0 Political Party/Central Committee <br />3. Committee information <br />E] Primarily Formed Ballot Measure <br />Committee <br />0 Controlled <br />Q Sponsored <br />(Also Complete Pard 5) <br />[� Primarily Formed Candidate/ <br />Officeholder Committee <br />(Also Complete Part 7) <br />I.D. NUMBER <br />1428458 <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />Mcnrow Mabon for Riverside City Council 2021 <br />STREET ADDRESS (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 />OPTIONAL: FAX / E-MAIL ADDRESS <br />Date of election if applicable: <br />(Month, Day, Year) <br />Da!P_S�ampm <br />T_ 19N_ <br />V., Is- &_R <br />COVERPAGE <br />Rage 1 of G <br />f tit Q` Riverside �(_ For Official Use Only <br />'s Offi- <br />2. Type of Statement: <br />E] Preelection Statement <br />Semi-annual Statement <br />E] TerminationStatement <br />(Also file a Form 410 Termination) <br />Ej Amendment (Explain below) <br />Treasurer(s) <br />NAME OF TREASURER <br />Yolanda Miranda <br />MAILING ADDRESS <br />E] Quarterly Statement <br />Special Odd -Year Report <br />Supplemental Preelection <br />Statement - Attach Form 495 <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />Cpvilica CA _ <br />NAME OF ASSISTANT 'TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREA CODEIPHONE <br />OPTIONAL: FAX I E-MAIL ADDRESS <br />4. Verification <br />I have used all reasonable diligence in preparing and reviewing this statement and to the h,,t h—j and in the attached schedules is true and complete. 1 certify <br />under penalty of perjury under the laws of the State of. California that the foregoing is true <br />Executed on 01/28/2022 _ By <br />Date <br />Executed on 01/2G/2022 By <br />Executed on <br />Date <br />By <br />Signature of Controlling Officeholder, Candidate.. State Measure Proponent <br />Executed on By <br />Date Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />FPPC Form 460 (.tan12016) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />www,fppc.ca.gov <br />