460 Gomez 2019 TerminationRecipient Committee
Campaign Statement
Cover Page
SEE IN®TRUCT10NS ON REVERSE
Statement covers pFrlod
from _ 1/1/2019
through . 7/30/2019
1. Type of Recipient Committee: All Commlttoo,% - Complete Pelts 1, 113, and 4.
® �fihcshoider, Candidate Controlled Committee ® Primarily Foal@d ®allot Me aaure
State Candidate Election Comniltlag Committee
® Recall ® Controll@d
(AW dompbk Part b) ® Sponsored
(Alan Cam*m NO 6)
®*floral Purpose Committee
Sponsored
Small Contributor Committe@
Political Parly/C@ntral Committ@@
® Primarily Form@d Candidate/
Officeholder Committee
(Ako CompW P&FI f)
3. Committee Information I:®, NUMBER
1410351
4.
Go with Gomez 2018, LQ City Council
®TREET ADDRESS (N®P 6.. 90X)
78070 Via Melodic
Of Y STATE ZIP CODE ARBA CODER-HdO €
La Quinta CA 92253 714 474 9680
MA I G ADDREss (IF 5WEPIENT) NOS A 9 BTREET OR P, , ISOX
Sam@
9 rITT STATE Z P 99BE ANtACODEIPL)
FAX 1 = RESS
gowlthgomez2018®gmail,cofn
I hav@ Wiled all reusonabl@ diligence in preparing and reviewing this stilt@m@nt and to the beat of my
certify under penalty of p@rjury under th@ laws of the state of California that th@ foregololg—joy@ and
Executed on 7/28/19 i 3
g!a
Executed on 7/25/10 _
@i@
Executed on-
�ty
Executed on
By
By
Data of election If aipplic
(Month, Day, Year)
November 8, 2018
Data Stamp
RECEIVED
JUL 25 2019
CITY OF LA OUINTA
YCLERK DEPARTMENT
2. Type of Statement:
®
Preelection statement
®
Semi-annual statement
®
Termination statement
(Also file a Form 410 Termination)
®
Amendment (Explain below)
COVER PAGE
Pape 1 of 3
For i0mclal use Only
® Quarterly Stilt@fil@flt
® special Odd=Y@ar Report
Treasurer(@)
F THE
®ante Gomez
G ADDR
78070 Via Melodle
STA ODE AREA C09EI�MUN€
1.0 Quinta _ CA 92253 714 474 9880
NAMC DFASSISrrAgNrfP,LASURER,
NIA
G ADDR
t T STATE ODE ARFA COD EUP H ON h-
OPTWNAL: FAX I WATFADDRESS
the information contained heroin and in the atteched achedulea 1® trW@ and complete, I
GF At
By SignmillF@ Ef F +iiir411ing F 1F1 @i, L aPld taste, 51®i@ [�rJF ropvnenl
By
Sigra4FJf5 Lf LElftllplling 0FfieEl'I3 d@{. @Fltlidete, St6 (? �@@SIJF@ Proponent
FPE€ form 460 (Jan/2016)
FPPC Advlcm advice90foo€:€a:ftov 1866/275.17721