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Home My WebLink AboutRIVERA 410 INITIAL 8/3/15 NAME OF PRINCIPAL OFFICERISI STREET ADDRESS (NO P.O. BDR) CITY 3. Verification I have used all reasonable diligence in preparing this sta Ent d to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury u der he la�of the State of Cal' all that th going is t us and correct. Executed on ' By } / i EOF i0.EAEV RER OR ASE ISTANi TPEASV REP if Executed on /} By WE EIGNATUREO CONi KiNGOFnEEPOLUEk CANDIDATE.ORSTATEMEASUREPPOPONENT hxecuted on DATE by SIGNATURE OF CONTROLLING OFFICEHOLDER. CANDIDATE. OR STATE MEASURE CERIONENT Executed Bn Sy DATE SIGNATURE OF CONTROLLINGOFF¢FROLOOKCANDIAT m XTATEMEASU1Y11OPONENT FPPC FmTn 410(Dec/2012) FPPC Advice: advice ®fppe.ca.gov (666/2753772) www.fppc.ca.gov i Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Rivera for City Council 2018 All committees must list the financial institution where the campaign bank account is located. Commum Ty list Bank 2 of I 4. Type of Committee Complete the a Dip Iicible sections. City Council, Ward 1 2018 DnHnsf List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIOATE/ OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR Of ELECTION PARTY Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAN OIUATF EI NAME Oft MEASURfIS)FULL TITLE (INCLUDE BALLOT NO, OR LETTER) CANDIDATEISI OFFICE SOUGHT OR HELD OR MEAstra I IURISOICTION II NCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHOYOHF City of 9akeref field ... El PLAT Q Nonpartisan Willie Rivera City Council, Ward 1 2018 DnHnsf ❑ Nonpalo.s Primarily formed to support or oppose specific candidates or measures in a single election. List below: CAN OIUATF EI NAME Oft MEASURfIS)FULL TITLE (INCLUDE BALLOT NO, OR LETTER) CANDIDATEISI OFFICE SOUGHT OR HELD OR MEAstra I IURISOICTION II NCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHOYOHF FPPC Form 410 (Oec /20121 FPPC Advice: advice @tppc.ca.gov (86(1 wwwhapcaa.gov ... El PLAT OPPOSE Suu DnHnsf FPPC Form 410 (Oec /20121 FPPC Advice: advice @tppc.ca.gov (86(1 wwwhapcaa.gov Statement of Organization ISM Recipient Committee INSTRUCTIONS ON REVERSE l of ] Rivera for City Council 2018 ICU , 1 earl Not formed to support or oppose specific candid, t es or measures in a single electlon_ Check only one box i] CITY Committee i] COUNTY committee STATE Committee List additional sponsors on an attachment. call er ansss 5. Termination Requirements By signing the verificanor, tet ,ea jrent treasurer and /or candidate, dficcholdm or proponent econ, that all of the fg1lawring ,conavons haw been met • This cormittee has ceased to receive, contributions and make expendaures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • Thiscommittee has nosurplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held b r elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. -- Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Dec /2012) NEC Advice: advice @fppc.ca.gm 18661 ' wwwJ'pc.ca.gov https: / /www.fedex.com/ shipping /htmUen/PrintIFrame.html ° o i °y F _ .11.' �n�,' p J�m 4m9 cad . After printing this label: 1. Use the 'Print button on this page to print your label to your laser or inkjet printer. 2. Fold the printed page along the horizontal line. 3. Place label in shipping pouch and affix it to your shipment so that the baroode portion of the label can be read and scanned. Warning: Use only the printed original label for shipping. Using a photocopy of this label for shipping purposes is fraudulent and could result in additional billing charges, along with the cancellation of your FedEx account number. 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