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Home My WebLink AboutBallesteros 460_01-01-2017-06-30-2017 COVER PAGE Recipient Committee RIVED • 1 Campaign Statement . . ' Cover Page y q Statement covers period Date of election if applicable: JUL 3 1 2017 Page 1 of 6 01/01/2017 (Month, Day,Year) For Official Use Only from CITY OF DUBLIN SEE INSTRUCTIONS ON REVERSE through 06/30/2017 11/06/2018 MY MANAGER'S OFFIC E 1. Type of Recipient Committee: All committees-complete Parts 1,2,3,and 4. 2. Type of Statement: W Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement O State Candidate Election Committee Committee V Semi-annual Statement ❑ Special Odd-Year Report O Recall O Controlled ❑ Termination Statement (Also Complete Part 5) O Sponsored (Also file a Form 410 Termination) (Also Complete Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) • Sponsored ❑ Primarily Formed Candidate/ • Small Contributor Committee Officeholder Committee • Political Party/Central Committee (Also Complete Pat 7) 3. Committee Information I.D.NUMBER Treasurer(s) 1382699 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Mona Lisa Ballesteros for Dublin City Council 2018 Linda Perry MAILING ADDRESS STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREACODE/PHONE CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAILADDRESS 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 knowled a the information cont ' d herein and in the attached schedules is true and complete. I certify under penalty of;�rl/nder th aws of the State of California that the foregoing is true and corre Executed on By Datte� Executed on D ^ ` / By Date Signature of Controlling Office of ,Can a e,S ate easure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov COVER PAGE-PART 2 Recipient Committee CALIFORNIA , Campaign Statement FORM Cover Page — Part 2 Page 2 of 6 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Mona Lisa Ballesteros OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER 7URISDICTION ❑ SUPPORT OPPOSE City Councilmember, City of Dublin F-1 RESIDENTIAL/BUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD DISTRICT NO.IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES E] NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [] YES F-1 NO ❑ SUPPORT ❑ OPPOSE COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE to whole dollars. Summary Page Statement covers period • . . ' from 01/01/2017 FORM through 06/30/2017 Page 3 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Mona Lisa Ballesteros for Dublin City Counciil 2018 1382699 Contributions Received TOTAL A Column B Calendar Year Summary for Candidates THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and 0.00 0.00 General Elections 1. Monetary Contributions................................................... Schedule A,Line 3 $ 0.00 1500.00$ 1/1 through 6/30 7/1 to Date 2. Loans Received................-............................................. Schedule,B,Line 3 0..00 1500.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines 1+2 $ $ Received $ $ 4. Nonmonetary Contributions............................................ Schedule C,Line 3 0.00 0.00 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ 0.00 $ 1500.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E,Line 4 $ 0.00 $ 0.00 Candidates 7. Loans Made....................................................................... Schedule H,Line 3 0.00 0.00 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ 0.00 $ 0.00 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses(Unpaid Bills)..........................................Schedule F,Line 3 0.00 0.00 Date of Election Total to Date 10. Nonmonetary Adjustment.........................................................Schedule C,Line 3 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE........................................Add Lines 8+9+10 $ 0.00 $ 0.00 $ Current Cash Statement $ 14 12. Beginning Cash Balance............................ Previous Summary Page,Line 16 $ 1706. To calculate Column B, 13. Cash Receipts........................................................... Column A,Line 3 above 0.00 add amounts in Column 0.00 A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash.................................. Schedule I,Line 4 amounts from Column B reported in Column B. 15.Cash Payments......................................................... Column A,Line 8 above 0.00 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12+13+14,then subtract Line 15 $ 1706.14 be negative figures that should be subtracted from If this is a termination statement,Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ Schedule B,Part 2 $ 0.00 filed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from 2,7,and 9(if 18. Cash Equivalents................................................ See instructions on reverse $ 0.0 19. Outstanding Debts.............................. Add Line 2+Line 9 in Column B above $ 1500.00 FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period I • ' from 01/01/2017 through 06/30/2017 Page 4 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Mona Lisa Ballesteros for Dublin City Counciil 2018 1382699 DATE FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED,ENTER NAME PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 0.00 Schedule A Summary 'Contributor Codes 1. Amount received this period -itemized monetary contributions. IND-Individual (Include all Schedule A subtotals.) $ 0.00 COM-Recipient Committee ......................................................................................................... (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than $100 ...........................$ 0.00 OTH—Other(l Pa business entity) p rY PTY—Political Party 3. Total monetary contributions received this period. SCC-Small Contributor committee Add Lines 1 and 2. Enter here and on the Summa Page, Column A, Line 1. TOTAL $ 0.00 ( Summary g ) FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Amounts may be rounded SCHEDULE B-PART 1 Schedule B — Part 1 to whole dollars. Statement covers period 0 CALIFORNIA Loans Received from 01/01/2017 FORM SEE INSTRUCTIONS ON REVERSE through 06/30/2017 Page 5 of 6 NAME OF FILER I.D.NUMBER Mona Lisa Ballesteros for Dublin City Counciil 2018 1382699 IF AN INDIVIDUAL,ENTER INTEREST ORIGINAL CUMULATIVE FULL NAME,STREET ADDRESS AND ZIP CODE OUTSTANDING AMOUNT (c) OUTSTANDING OCCUPATION AND EMPLOYER AMOUNT PAID OF LENDER BALANCE RECEIVED THIS BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF SELF-EMPLOYED,ENTER BEGINNING THIS OR FORGIVEN* CLOSE OF THIS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Mona Lisa Ballesteros Human Resourses ❑ PAID CALENDAR YEAR Services District ❑ FORGIVEN RATE PER ELECTION** $ 1500.00 $ 0.00 $ 0 1/01/17 $ 0 7/27/16 $ t IZ IND ❑ COM ❑ OTH [I PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ % $ $ E] FORGIVEN FORGIVEN PER ELECTION*` t❑ IND ❑ COM ❑ OTH [:I PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR E] FORGIVEN FORGIVEN PER ELECTION** t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0.00 $ 0 $ 1500.00 $ 0 (Enter(e)on Schedule B Summary Schedule E,Line 3) 1. Loans received this period....................................................................................................................$ n nn (Total Column (b) plus unitemized loans of less than $100.) tContributor Codes 2. Loans paid or forgiven this period.........................................................................................................$ n on IND—Individual COM-Recipient Committee (Total Column (c) p lus loans under$100 paid or forgiven.) (other than PTY or SCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g.,business entity) PTY—Political Party 3. Net change this period. Subtract Line 2 from Line 1. NET $ 0 00 SCC-Small Contributor Committee Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) *Amounts forgiven or paid by another party also must be reported on Schedule A. FPPC Form 460(Jan/2016) **If required. FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov