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Form 410 - 2011 AmendmentStatement of Organization Recipient Committee Type or print in ink /S� ttaatement Type [] Initial ® Amendment / / ] �( Not yet qualified [] or List I.D. number: �(J # 1327985 06 1 , 10 Date qualified as committee Date qualified as committee (If applicable) 1. Committee Information NAME OF COMMITTEE Peter Leroe -Munoz for City Council 2014 ❑ Termination — See Part 5 List I.D. number: — I Date of Termination ND F the of the State of californ MAY 2 4 2011 DEBRA BQW1 Secretary of S# 2. Treasurer and Other Principal Officers NAME OF TREASURER Eric Hernandez STREET ADDRESS (NO P.O. BOX) STATEMENT OF ORGANIZATION FgLOfficial USe Wp ,, JUN py2�011 � U WU1t7 � 1 145 Oak Street STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE 8200 Kern Avenue, Apt# 1 -202 CITY STATE ZIP CODE AREACODE/PHONE Gilroy CA 95020 (408) 427 -4697 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX/ E -MAIL ADDRESS peterforgilroy @gmaii.com COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE County of Santa Clara Attach additional information on appropriately labeled continuation sheets. San Jose CA 95110 (408) 216 -3938 NAME OF ASSISTANT TREASURER, IF ANY STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF PRINCIPAL OFFICER(S) STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 04/16/2011 DATE Executed on 04/16/2011 DATE Executed on DATE Executed on DATE _r SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) 11 Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Peter Leroe -Munoz for City Council 2014 STATEMENT OF ORGANIZATION Page 2 1327985 4. Type of Committee Complete the applicable sections. • 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 "non- partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Peter Leroe -Munoz Member; Gilroy City Council 2014 Non- Partisan ® ❑ Non - Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF ADDRESS IN5111 U I ION AREA CODE/PHONE CITY STATE ZIP CODE - . Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE OPPOSE FPPC Form 410 (June /09) FPPC Toll -Free Helpline: 866/ASK -FPPC (866/2753772) Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE 2/Amendment List I.D. number: t 3a W95- _rN txlp Date qualified as committee (If applicable) ',b-Date Stamp CALIFORNIA ❑ Termination — See Part 5 For Official Use Only g{ � List I.D. U. number: •,vo �� Date of Termination e-+P -( I_expe—M.Tno'L C L� STREET ADDRESS (NO P.O. BOX) 8).Oc) K< f n Arc AP+ Z -aoa CITY STATE ZIPCODE AREACODE /PHONE 2. Treasurer and Other Principal Officers NAME OF TREASURER _E(ic. HQrAf,,Aeir_1_ STREET ADDRESS (NO P.O. BOX) (NS O G k S4- re_ert CITY STATE ZIPCODE AREA CODE/PHONE i o[0-1 5o \0 („j t 'j�'L1 -401 Sc,\,\ ls oe r.., ....� 0 MAILING ADDRESS (IF DIFFERENT) NAME OF ASSISTANT TREASURER, IF ANY FAX/ E -MAIL ADDRESS Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX) -- - _ CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that ;he foregoing is true and correct. Executed on :Z IC-1 l 2-0 By 7Gt '7 OA�_— SIGNATVR E ER-0R ASSISTANT TREASURER Executed on 7 / J a t By DATE SIGNATURE OF CONTROLLI G OFFICEHOLDE , CANDIDATE, OR STATE MEASURE PROPONENT Executed on y DATE / SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE - SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER 0' - (L4 ao(oo358i ADDRESS CITY STATE ZIP CODE 7 1 M on %�f rc y_f- . (�� l �o ( A 9Sad v 4. Type of Committee Complete the'applicable sections. • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY �-f e � eve - u � /l �u � 1 c e� ���`F Nonpartisan SUPPORT ❑ Nonpartisan Committee Primarily Formed Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY. AS APPLICABLE) FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE SUPPORT 0[1 FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee I FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER - Pc"'f�< - Iv1I '1C)'Z- �7 }1 C,, 4,1 i Z>,-),l<, I ;A of I 3D- 1 4. Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY I 19 • • • • • List additional sponsors on an attachment. NAME OF SPONSOR II NDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor Committee Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and /or candidate, officeholder, or proponent certify that all of the following conditions have been met: • This committee has ceased to receive contributions and make expenditures; • 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; • This committee has no surplus 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 by 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) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement.of organization Recipient Committee Statement Type, [] Initial Not yet qualified ❑ or --✓� Date qualified as committee Amendment List List I.D. number: (3a 7 V - --(1 1i Date qualified as committee (If applicable) ❑ Termination —See Part 5 List I.D. number: — �_�_ Date of Termination NAME OF COMMITTEE A,,AQ -L fl)( Q124 CT i .-)ACA\ U(1- STREET ADDRESS (NO P.O. BOX) S I OC) tc-c m Avc CITY STATE ZIP CODE AREA CODE /PHONE b0co-A 0,A (-i MAILING ADDRESS (IF DIFFERENT) FAX / E-MAIL ADDRESS 0)' .& ! yM ti � I . c-vAA, IURI TION WHERE COMMITTEE IS ACTIVE Attach additional information,on appropriately labeled continuation sheets. NAME OF TREASURER L Date Stamp FILED in haoffice of the Secretary of of the State of Califomia AUG 0 4 2014 For Official Use Only STREET ADDRESS (NO P.O. BOX) INS O� ILSkre.�+ CITY _ STATE ZIP CODE AREA CODE /PHONE SGT, 1OS4 r A 95i t o Nosa -24('-3 q 3V0 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIPCODE AREA CODE /PHONE I have used all reasonable diligence in preparing this statement and to the best of my knowledge the penalty of perjury under the laws of the State of California that he foregoing is true and correct. Executed on %L By DATE c� _ SIGNATURE E ERCR ASSISI Executed on 7 3 6 1 2 c? // By DATE SIGNATURE OF CONTROLLIbrG OFFICEHOLDE , CANDIDA Executed on OF contained herein is true and complete. I TREASURER STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER; CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410,(Dec /2012) FPPC Advice: advice @fppc.ca:gov(866 /275 -3772) www.fppc.ca.gov Staten ent of Organization CALIFORNIA.- Recipient Committee ® - INSTRUCTIONS'ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER o ac 85 ' • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE - BANK ACCOUNT NUMBER v - QI1q o(C) 035 8i ADDRESS /n► CITY STATE ZIP CODE -7 M vn+e rcu rn�A 111-A 9soa0 • 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 CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER`IF APPLICABLE) YEAR OF ELECTION PARTY e +e- r eooe - v i vu 1 c 10c, 11� 9v14 Nonpartisan SURPQB.Ti , ❑ Nonpartisan • Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURES) JURISDICTION . (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form,A10;(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 =3772) www.fppc.ca:gov SUPPORT OPPOSE EL SURPQB.Ti , O FPPC Form,A10;(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 =3772) www.fppc.ca:gov