HomeMy WebLinkAboutBallesteros Form 410 07-07-2016 Amended RedactedStatement of Organization
Recipient Committee
Statement Type ❑ Initial
Not yet qualified ❑ or
Date qualified as committee
® Amendment
List I.D. number:
41382699
03 ' 120 2016
Date qualified as committee
(If applicable)
NAME OF COMMITTEE
Mona Lisa Ballesteros for Dublin City Council 2016
Date Stamp
❑ Termination -See Part S
List LD, number:
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREACODE /PHONE
Dublin CA 94568
MAILING ADDRESS (IF DIFFERENT)
Date of Termination
NAME OF TREASURER
Linda Pern
For OHsioMft QED
JUL 07 2016
CITY OF DUBLIN
CP-Y KANAGER'S OR
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
NAME. OF PRINCIPAL OFFICER(S)
Mona Lisa Ballesteros Candidate /Chair
STREET ADDRESS (NO P.O.
CITY STATE ZIP CODE AREA CODE /PHONE
Attach additional information on appropriately labeled continuation sheets.
Dublin CA 94568
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I have used all reasonable diligence in pre rmation contained herein is true and complete. I certify under
penalty of perjury nder helalaws of the S
Executed on n �( r By
DATE REASURER
'1
Executed on 1 1 By
DATE v k.,4PSMPNJATUREOFMNTRt)LLINGOFFIICEROLDER-,.-CANDID E, R STATE MEASURE PROPONENT
Executed on By
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 (Jan /2016)
FPPC Advice: advice @fppc.ca,gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA t
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME 1.0 NUMBER
Mona Lisa Ballesteros for Dublin City Council 2016 1382699
- All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION
ADDRESS
CITY
BANK ACCOUNT NUMBER
STATE ZIP CODE
• 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.
NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY
Mona Lisa Ballesteros
City Councilmember, City of Dublin
2016
Q Nonpartisan
SUPPORT
❑ Nonpartisan
Primarily Formed Committee -� 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) CNFCK ONE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
SUPPORT
OPPOSE
SUPPORT
OPPOSE
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee FORM Me
INSTRUCTIONS ON REVERSE Page 3
COMMITTEE NAME 10. NUMBER
Mona Lisa Ballesteros for Dublin City Council 2016 11382699
Not formed oo support or oppose specific candidates or measures ina single election. Check only one box:
EICITYCommittee []COUNTY Committee E] STATE Committee
wvm, BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors ononattachment.
NAMEOFSPONSOR I INDUSTRY GROUP OR AFFILIATION Of SPONSOR
STREET ADDRESS NO. AND STREET CITY STAT E ZIPCODE
Small Contributor Committee
m=ctwlifi.d
°
This committee has ceased tv 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 mquivedbythePoUdcaiKeformActdisdosinnaUveportab|rtrao`acdun,.
—
There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Kefe,toGovemmnru
Code Section uyszy.
—
Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511 ny518, and are
subject to Elections Code Section znsun and FpPc Regulation zoszz.s.
FPPC Form mm(Jan/20u6)
rppc Advice: aumm@hppc.o.gm(86o/275-3r72)