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Peter Leroe-Munoz - Form 460 - 2014/01/01 - 2014/06/30 AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) Type or print in ink. Statement covers period from January 1, 2014 SEE INSTRUCTIONS ON REVERSE I through June 30, 2014 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) O Sponsored ❑ General Purpose Committee (Also Complete Part 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party /Central Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER tIa15�s COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Peter Leroe -Munoz for City Council 2 $1 `i STREET ADDRESS (NO P.O. BOX) 8200 Kern Ave., Apt. 1 -202 CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408) 427 -4697 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS Date of election If applicable:' (Month, Day, Year) 4 A014 November COVER PAGE Page _.�— of L For Official Use Only 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi - annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ® Amendment (Explain below) Loan carries over, and is not forgiven. Treasurer(s) NAME OF TREASURER Eric Hernandez MAILING ADDRESS 145 Oak St. CITY STATE ZIP CODE AREA CODE /PHONE San Jose CA 95110 (408) 216 -3938 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is Executed on 8/04/2014 Date Executed on 8/04/2014 Date Executed on Date Executed on By Data Signature of Controlling Officeholder, Candidate, Slate Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) State of California SCHEDULE B - PART 1 Schedule B — Part 1 "U may ' ' Amounts may be rounded Statement covers period p Loans Received to whole dollars. January 1, 2014 CALIFORNIA ' • from FORM June 30, 2014 '-?- SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER A/ et r- )-,e- (01, P1u�oZ � 3�7Q06 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL ENTER , OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE (b) AMOUNT (c) AMOUNT PAID (d) OUTSTANDING BALANCEAT (e) INTEREST V) ORIGINAL (g) CUMULATIVE OF LENDER (IFCOMMn7EE, ALSO ENTER I.D.NUMBER) (IF SELF - EMPLOYED, ENTER NAMEOFBUSINESS) BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN THIS PERIOD' CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE Peter Leroe -Munoz In -House Counsel, ❑ PAID CALENDAR YEAR 8200 Kern Ave., #1 -202 Dale Scott & Co., Inc. $ 0 $ 12,773.7 % $ 15,000 $ 0 ❑ FORGIVEN PERELECTION- Gilroy, CA 95020 RATE s 12,773.7 $ 0 $ 0 s 6/10/10 s 0 t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATEINCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION*" RATE tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s s s s s DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION'* t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s $ s $ S DATE DUE DATE INCURRED SUBTOTALS $ $ C) $ a -713 .1$ Schedule B Summary 1. Loans received this period .......................................... ............................... (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ............................... ............................... (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............................. Enter the net here and on the Summary Page, Column A, Line 2. `Amounts forgiven or paid by another party also must be reported on Schedule A. '" If required. ............. $ O .................. $ ......................... NET $ v (Maybe a negative number) (toter (e) on Schedule E, Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)