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Recipient Committee <br />Campaign Statement <br />Goer Page <br />SEE INSTRUCTIONS ON REVERSE <br />1. Type of Recipient Committee: <br />from <br />Statement covers period <br />CQ/(&o)q <br />through " >{ Li i Z(a 1 <br />All Committees -Complete Parts 1, 2, 3, and 4. <br />❑ Officeholder, Candidate Controlled Committee <br />❑ State Candidate Election Committee <br />❑ Recall <br />(Also Complete Peri 5) <br />❑ General Purpose Committee <br />❑ Sponsored <br />❑ Small Contributor Committee <br />❑ Political Party/Central Committee <br />E Primarily Formed Ballot Measure <br />Committee <br />❑ Controlled <br />❑ Sponsored <br />�J [Also Complete Peri s) <br />[1Q Primarily Formed Candidate/ <br />Officeholder Committee <br />Ira Complete Pmt 7) <br />Date of election if applicable: <br />(Month, Day, Year) <br />June y; 0?6161 <br />Date Stamp <br />RECEIVEE <br />MAY 2 9 2019 <br />City of Riverside <br />City Clerk's Office <br />2. Type of Statement: <br />((Preelection Statement <br />❑ Semi-annual Statement <br />❑ Termination Statement <br />(Also file a Form 410 Termination) <br />O Amendment (Explain below) <br />COVER PAGE <br />CALIFORNIA 460 <br />FORM V <br />Page <br />of <br />For Official Use Only <br />❑ Quarterly Statement <br />❑ Special Odd -Year Report <br />3. Committee Information <br />COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) <br />OfeVi Tam - CYagickOr f otncij /,rn ( <br />cod 6 aal q <br />I.D. NUMBER <br />iv/ Ca-71-- <br />COMMITTEE <br />— <br />T <br />TE <br />M LING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O <br />21P CODE AREA rrlflPJPHnxiF <br />CITY <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 />certify under penalty of perjury under the laws of the State of Califomia that the foregoing <br />Executed on 5/102q/ <br />l <br />/10]q/I <br />bate <br />Executed on 5702/ /t <br />Executed on <br />Executed on <br />ate <br />Date <br />Data <br />By <br />By <br />By <br />By <br />Treasurer(s) <br />NAME OF TREASURER <br />JfeAd c ct? <br />MAii INr:AnnRFCC <br />C <br />NAME OF ASSISTANT TREASURER, IF ANY <br />Z <br />P cnnE <br />AREA r.4-1 PL -I flAJC <br />MAILING ADDRESS <br />CITY <br />STATE ZIP CODE <br />AREA CODE/PHONE <br />OPTIONAL: FAX / E-MAIL ADDRESS <br />Sior. <br />V p0 <br />dufes is true and complete. 1 <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 />