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Recipient Committee Date Stamp COVER PAGE <br /> Campaign Statement CALIFORNIA 460 <br /> Cover Page FORM <br /> (Government Code Sections 84200-84216.5) ;>,. 4 � <br /> Statement covers period Date of election if applica{3 ;�a�., ,,iy ` g,y,' Page 1 of 10 <br /> (Month, Day, Year) I�' <br /> from 01/01/2018 <br /> DEC 03 2018 For Official Use Only <br /> SEE INSTRUCTIONS ON REVERSE through 09/22/2018 11/06/2018 <br /> City Of 41.41i(i0 Hills <br /> •..y 4'.'re,a uc}iaruuuelit. <br /> 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. 2. Type of Statement: <br /> ❑x Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 Preelection Statement ❑ Quarterly Statement <br /> Q State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report <br /> Q Recall 0 Controlled Termination Statement <br /> (Also Complete Part 5) 0Sponsored ❑ ❑ Supplemental AttPreach <br /> rn <br /> P (Also file a Form 410 Termination) Statement-Attach Form 495 <br /> (Also Complete Part 6) <br /> ❑ General Purpose Committee ❑x Amendment(Explain below) <br /> Q Sponsored ❑ Primarily Formed Candidate/ <br /> O Small Contributor Committee Officeholder Committee Amending Schedule F to correct information. <br /> Q Political Party/Central Committee (Also Complete Part7) <br /> 3. Committee Information I I.D. NUMBER Treasurer(s) <br /> 1408345 <br /> COMMITTEE NAME (OR CANDIDATES NAME IF NO COMMITTEE) NAME OF TREASURER <br /> Gabriel DeLuna for Chino Hills City Council 2018 Yolanda Miranda <br /> MAILING ADDRESS <br /> CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE <br /> OPTIONAL: FAX/E-MAIL ADDRESS <br /> ill= <br /> 4. <br /> I have used all reasonable diligence in preparing and reviewing this statement and tot d complete. I certify <br /> under penalty of perjury under the laws of the State of California that the foregoing is tr <br /> Executed on 11/29/2018 By <br /> Date <br /> Executed on 11/29/2018 By <br /> Date <br /> Executed on By <br /> Date Signature of Controlling Officeholder,Candidate,State Measure Proponent <br /> Executed on By <br /> Date 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.netfile.com www.fppc.ca.gov <br />