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Recipient Committee Date Stamp COVER PAGE <br />Campaign Statement �'' • 1 <br />Cover PageR E C E 11V-1 <br />Statement covers period Date of election if appiicahie: Page of <br />from 1/112024 (Month, Day, Year) FEB 2 2 2024 FoT OiTscial Use Only <br />� <br />€ty Oi Riverside <br />SEE INSTRUCTIONS ON REVERSE 1/20/2024 3/5/2024a�.� <br />through City Clerk's Office <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 />0 State Candidate Election Committee Committee <br />0 Recall 0 Controlled <br />(Also Complete Part 5) 0 Sponsored <br />(Also Complete Part 8) <br />❑ General Purpose Committee <br />0 Sponsored ❑ Primarily Formed Candidate/ <br />0 Small Contributor Committee Officeholder Committee <br />0 Political Party/Central Committee (Also Complete Pert 7) <br />3, Committee Information W. NUMBER <br />1407581 <br />CANDIDATE'S NAME IF NO COMMITTEE) <br />Re-elect Gaby Plascencia Riverside City Council Ward 5 - 2024 <br />STREETADDRESS (NO RO, BOX) <br />CITY STATE ZIPCODE AREACODEIPHONE <br />Riverside CA _ <br />MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX <br />CITY STATE ZIP CODE AREA CODE/PHONE <br />OPTIONAL: FAX I E-MAItADDRESS <br />4. Verification <br />2, Type of Statement: <br />❑ Preelection Statement ❑ Quarterly Statement <br />❑ Semi-annual Statement ❑ Special Odd -Year Report <br />❑ Termination Statement <br />(Also file a f=orm 410 Termination) <br />® Amendment (Explain below) <br />to correct page 2 (Column B) Subtotal Cash Contributions to <br />$2,186A0 <br />Treasurer(s) <br />NAME OF TREASURER <br />Martha Trujillo <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREACODEIPHONE <br />Riverside CA _ <br />NAME OF ASSISTANT TREASURER, IF ANY <br />MAILING ADDRESS <br />CITY STATE ZIP CODE AREACODEIPHONE <br />OPTIONAL: FAX IE -MAIL ADDRESS <br />have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge <br />certify under penalty of perjury under the laws of the State of California that the for <br />Executed on �j -2 i Dam Jay <br />Executed on <br />Date <br />Executed on <br />Date <br />Executed on <br />Date <br />contained herein and in the attached schedules is true and complete. <br />By Signature of Controlling Officeholder, Candidate, State Measure Proponent <br />By <br />Signature of Controlling Officeholder, Candidate, Stale Measure Proponent <br />FPPC Form 460 (!an/2416) <br />FPPC Advice: advice@fppc.ca.gov (866/275-3772) <br />- fnne r= cnv <br />