HomeMy WebLinkAboutBallesteros Form 410 02-05-2015 Initial_Redactedr
Statement of Organization
Recipient Committee
Statement Type W Initial ❑ Amendment
Not yet qualified M or List I.D. number:
it
❑ Termination —See Parts
List I.D. number:
/-/ /---/ / -/
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
NAME OF COMMITTEE
Date Stamp
CALIFORNIA
RECEIVED
FORM
For Official Use Only
FEB 5 2016
CITY OF DUBLIN
ITY MANAGER'S OFFICE
NAME OF TREASURER
Mona Lisa Ballesteros for Dublin City Council 2016 Mona Lisa Ballesteros
MAILING ADDRESS (IF DIFFERENT)
Attach additional information on appropriately labeled continuation sheets.
I nave usea all reasonaoie aulgence in pr
penalty of perjury under the laws of the S 02/04/2016
Executed on By
02/04/2016
DATE
Executed on By
DATE
Executed on
Executed on
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
pre this statement and to the best of my knowledge the information contained herein is true and com
By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE,.OR STATE MEASURE PROPONENT
I certify under
PPPC Form 410 (]an /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
'
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
V onaDIsa Baliesteros for Dublin City Council 2016 I.D. NUMBER
•
All committees must list the financial Institution where the campaign bank account Is located.
NAME OF FINANCIAL INSTITUTION AaEArnnciounue I . .. . .» ........
ADDRESS
CITY
STATE ZIPCODE
4. Type of Committee - Complete the applicable sections.
• List the name of each controlling
g officeh Ider, 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
Dublin City Council
2016
® Nonpartisan
.
❑ 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
hNrlilnrnIgrRIrrmrh rnvnRrn11AITV ACAnb11rAb1C1
FPPC Form 410 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
' Pega 3
Ballesteros for Dublin City Council 2016
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
Sponsored Committi-e List additional sponsors on an attachment.
SPONSOR
STREETAODRESS NO.ANDSTREET
'1, �4
Date qual&4
GROUP OR AFFILIATION OF SPONSOR
STATE 21PCODE
S. 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;
s 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 may be 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 ()an /2016)
FPPC Advice, advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov