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Recipient Committee <br />Campaign Statement <br />Cover Page <br />Statement covers pariod <br />from 01/01/2021. <br />FEE INSTRUCTIONS aN REVERS{= I � W3012021 <br />through <br />1. Type of Recipient Committee: Aii commtdoos-compiete.Parts 1, 2, 3, and 4: <br />ID Officeholder: Candidate Controlled Commitlee <br />0 State Candidate Election Committee <br />Recall <br />)oleo Comyfele Perti) <br />❑ General Purpose Committee <br />Sponsored <br />Small Contributor Committee <br />Political PartylCenlml Committee <br />3, Committee Information <br />U,CHEVARRIA FOR CITY COUNC11.201-0 <br />TORN E(CHE V r1RRIA <br />Q Primarily Formed Ballot Measure <br />Committee <br />V Conlrolted <br />Sponsored <br />IArsa Gwry.VeleNN of <br />❑ Pdinarily Formed Canclidatel <br />Officeholder Committee <br />(Ana r—AW Pal 7; <br />I.D. NUMBER <br />1423362 <br />STREET ADDRESS (NO. P.p. BOX) <br /> <br />CtTY STATE ZiP COOS AREA GL DriPHONE <br /> <br />M iMgG AOORESS-OF DIFFERENT) NO: AND STREET OR P.O. GOx <br /> <br />p FY STATE 'ZIP CODE AREA CODE(PHCNE <br />OPTIONAL: -FAX) E-PWLADDRESS <br /> <br />Date of election if applica6la: <br />(Month, Day, Year) <br />1a10312020 <br />RECENED <br />JUL 2 4 2021 <br />2. Type of Statement, t1l I Y <br />Q Preelection Statement <br />Z Semi-annual Statement <br />TerminahvnStatement <br />(Also file a Form 4.10 Termination) <br />❑ Amendment (Explain Below) <br />Page 1 of....2_ <br />❑ Quarterly Statement <br />❑ .Special Odd-Year.Report <br />Treasurer(s) <br />NAME OF TREASURER - <br />VBAOMCA EC.HEVARRIA <br />MAILING ADDRESS <br /> <br />CITY sTgre DpcoDE AREA Good PHONE. <br /> <br />NAME OF ASSISTANT TREAS UR ER, IF ANY <br />MAILINGAODRESS <br />CITY STATE ZIY CODE AREAC06EIPHONE <br />OPTIONALFAx f E-h1AIL AIA)RES$ <br />4. Verification <br />1 have uaed al! reasonable difigence in preparing and reviewirig This statement and to the best ufmy knowledge the inform lion contained herein and in the attached schedules is true and oompfete. i <br />certify under penalty of perjury under the laws of the State of California that the foregoing is Uue and carredt <br />Executed Sy <br />01/27/2021 VERONICA EGH WARRIA <br />on - <br />Executed By > <br />ara Signalu�aaF asp rAss�slen! easuner- <br />01/2712021 )OHN CHEVARRIA <br />un <br />' Laate , igttalure a' ,oitlrcNng 9lficehWder. pinata as <br />Ex.Quted 5m By . <br />Gate Signature of Gonuating.cr-7aer. Ca,dNare, State Measure Pwpm7i <br />Executed on By <br />Dare Sag-L.—I C,,rV 1,,a Offcehdde- G. .dlda[e: State M-5— Proponnu <br />FPPC Form 460 (lan/2016)) <br />FPPCAdvice: advice@tppc.ca.gov 19661275.3772) <br />w4nvfppc..ca.gov <br />