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Statement of Organization Date Stamp CALIFORNIA 41 0 <br /> Recipient Committee FORM <br /> Statement Type I=1 Initial 0 Amendment 0 Termination—See Part 5 11 For Official Use Only <br /> O Not yet qualified <br /> or 08 27 2018 12 31 2018 JAN 2 8 2019 <br /> O Date qualified as committee /--/ / / <br /> Date qualified as committee Date of termination Gicy of til?ino Hills <br /> / City Clerk's Department <br /> 1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers <br /> (if applicable) 1408345 <br /> NAME OF COMMITTEE NAME OF TREASURER <br /> Yolanda Miranda <br /> Gabriel DeLuna for Chino Hills City Council 2018 <br /> STREET ADDRESS(NO P.O.BOX) <br /> STREET ADDRESS(NO P.O.BOX) <br /> NAME OF ASSISTANT TREASURER,IF ANY <br /> MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O.BOX) <br /> N/A <br /> E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE <br /> COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) <br /> Los Angeles <br /> STREET ADDRESS(NO P.O.BOX) <br /> CITY STATE ZIP CODE AREA CODE/PHONE <br /> Attach additional information on appropriately labeled continuation sheets. <br /> 3. Verification <br /> I have used all reasonable diligence in ation contained herein is true and complete. I certify under <br /> penalty of perjury under the laws of th <br /> Executed on 1/12/2019 <br /> DATE SURER <br /> Executed on 1/12/2019 <br /> DATE TE MEASURE PROPONENT <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> Executed on By <br /> DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT <br /> FPPC Form 410(February/2018) <br /> FPPC Advice:advice@fppc.ca.gov(866/275-3772) <br /> www.fppc.ca.gov <br />