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Marie Blankley - Form 410 (2018)Statement of Organization Recipient Committee Statement Type ® Initial Not yet qualified or O Date qualified as committee ❑ Amendment ❑ Termination — See Part b /—/ —W I Date qualified as committee Date of termination rn LVO NOV -2 2017 For oflichi Use Only 1. Committee information I.D. Number ��� J:� a (if applicable) NAME OF COMMITTEE NAME OF TREASURER Marie Blankley for City Council 2018 Paul Vanni STREET ADDRESS (NO P.O. BOX) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 847 -4330 CITY STATE ZIPCODE AREA CODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY Gilroy CA 95020 408 - 842 -4544 Marie Blankley MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) E -MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL) CITY STATE ZIP CODE AREA CODE /PHONE voteblankley @gmail.com Gilroy CA 95020 408 - 842 -4544 COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S) Santa Clara Gilroy, CA STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE /PHONE 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 pe ` uncie;t -he laws of MEASURE PROPONENT Executed on By DATE Executed on DATE OF CONTROLLING MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (October /2017) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME 1 D NUMBER Marie Blankley for City Council 2018 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION I AREA CODE /PHONE BANK ACCOUNT NUMBER Rabobank 408 - 842 -1938 1140653055 ADDRESS CITY STATE ZIP CODE 805 First Street Gilroy CA 95020 ka-t _ "i _�`•�_ - __ i -c �='f ;^_ - +=r��5 - ' s °��. ;c ➢_"vy'7_- eq�s'a. :-; -- ':.�' pia' =':: v:.. �il-5 Y-K� =+.h�3.'r��,.`._' . _- _ `i -� _ ��. ;hs,k -i.� = y_�.� �- -w-i:, �."�.. 4� ° e o „Coimmittee?Co 'I � � :� �' �� _ " :,� ��° � =•` ~ ;� =.� �.:: -•., _ �.- ,,Tylp mp ete` the =ap'ficakile.sectlons. >.- 9- =`� _ =�; - r�:• =, ,�"?; ��e�,i _y;�- : =.s•;r`��,: � _ _ �;' .�, - °:may.- ��,_ �.a'�� >_a.u::t�:.N_Lx ,,.� ...,.., < `Ss ,p. � i ,'s >° - ?,' ��.�,'; r1 - ~,t-�,` - {d` -,.3t ";q ;'�;F t';� *'_. 3,y �:'. �• � -.1�:_ y _ ry vt'.�x'n.1,�yrYi%A`� .L.." _v�tl T._ __ i "_- S_.f�sif�N•, Ct' .. �� � h .t �7 t��Y• ,i �„E ' 'Gi6r `, sfST[�" ��iNj R..'4"- x «.,F�.:iw :'�_ :'s.�_ " =5tl r_'r..- �1�`- .:.- I#.'<L,.�, ,�Ll s.v, j �'1e�`"��y� _ n�.: .� "__i^„v,;:'t,;c�•a�;�.�! -n^ ;�,,'j"j, _S• rs •_ a tti 4^i:,n _ &�i "•€ _ .,_ _�Y+.� ^ro > -:¢4.v ,4d•: >� °•',. _ . 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." Stating "No party preference" is acceptable. • 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 YEAR OF PARTY NAME OF CAN MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION Marie Patane Blankley Gilroy City Council member 2018 Nonpartisan Partisan (list political party below) Nonpartisan Partisan (list political party below) Formed rim r Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE) CHECK ONE T OPPOSE FPPC Form 410'(October /2017) Clear Page Print FPPC Advice: advice @fppc.ca.gov (866/275 -3772) - - - - www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Marie Blankley for City Council 2018 Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ❑ CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party /Central Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS NO AND STREET Date qualified CITY GROUP OR AFFILIATION OF SPONSOR Page 3 STATE ZIP CODE AREA CODE /PHONE 5 °<Terminaifon r;� f� �. =.b s - .�.,�_ F , n ®. e u cements' a ,si the veilflcatfon the treasurer; ess slant nd% kl ate, officetio)der; on ial orieiit`certf t that ell of ttie foUnwtn coed i= Q . _.., ��_?� Y gr! _• ,'� 1 treasLrer a h or cari8 a ihotis liav'e tieeii m" Y.r ,rte< .,.z ..__ .-'0- .��.__N_, —: r -- _-?',._P „�_ �_. • 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. Clear Pagel Print_ FPPC Form 410 (October/2017) t FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy, CA NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE /PHONE 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 cent penalty of pe ` ;r�t��e;t -he laws of PROPONENT Executed on By DATE Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(October /2017) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME I.D. NUMBER Marie Blankley for City Council 2018 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Rabobank ADDRESS AREA CODE /PHONE 408 - 842 -1938 CITY BANK ACCOUNT NUMBER 140653055 STATE ZIP CODE 805 First Street Gilroy CA 95020 Partisan (list political party below) 4. iyiw of Comlmi# tee Complete the applicable sect! a z � Nonpartisan Partisan (list political party below) • 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." Stating "No party preference" is acceptable. • 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 YEAR OF PARTY NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE Marie Patane Blankley Gilroy City Council member 2018 Nonpartisan ✓ Partisan (list political party below) Nonpartisan Partisan (list political party below) Formed Primarily Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATES) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME. CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(5) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE OPPOSE FPPC Form 410 (October /2017) Clear Page Print FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 I.D. NUMBER Marie Blankley for City Council 2018 I. 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 ❑ Political Party /Central Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY • • List additional sponsors on an attachment. NAME OF SPONSOR (INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE AREA CODE /PHONE Small Contributor Committee Date quaifled S.TermlttaitionReqvlmments eyslgmng the vofttioo , the trea3uuM "assts rtEtressurerand/"orcandidite,gf oidlder.orPrOP alt certify that aliofthefDOOWk *coodidons have bmnaft • 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 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 (October /2017) Clear Page; Print FPPC Advice: advice@fppc.ca.gov (866 /275 -3772) www.fppc.ca.gov