Marie Blankley - Form 410 (2018) - AmendmentStatement of Organization ffl) 5 , .
Recipient Committee .
Statement Type ❑ initial Amendment ❑ Termination — See Part 5 NO V 212017 for OMMclal Use Only
Q Not yet qualified
or 11 20 2017
Q Date qualified as committee --/ —..1 - --.1 y'
Date qualified as committee Date of termination
1. Committee Information I.D. Number 1400066 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE
Marie Blankley for City Council 2018
STREET ADDRESS IND P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy
MAILING ADDRESS IIF DIFFERENT)
E MAIL ADDRESS IREDUIRED) / FAX (OPTIONAL)
voteblankley @gmail.com
CA 95020 408 -842 -4544
COUNTY Of DOMICILE IU RISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara Gilroy, CA
Attach additional information on appropriately labeled continuation sheets.
NAME OF TREASURER
Paul Vanni
STREET ADDRESS (NO PO. BOX)
CITY
STATE
ZIP CODE
AREA CODE /PHONE
Gilroy
CA
95020
408-847 -4330
NAME OF ASSISTANT TREASURER, IF ANY
Marie Blankley
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE / PHONF
Gilroy
CA
95020
408 - 842 -4544
NAMF OF PRINCIPAL OFFICERS)
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PNONE
3. Verification
I have used all reasonable diligence
Executed on
Executed on
Executed on BY
DATE 51GNAT URI Of CONTROLLING OFFICEHOLDER, CANOIDATE, 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 NUMBER
Marie Blankley for City Council 2018 11400066
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION I AREA COOE /PHONE I BANK ACCOUNT NUMBER
Rabobank 408 - 842 -1938 140653055
ADDRESS CITY STATE 7IP CODE
805 First Street Gilroy CA 95020
4. Type of Committee Complete the applicable sections.
• 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)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE($) NAME OR MEASURES) FULL TITLE (INCLUDE BALLOT NO. OR LETTER( CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION
IF A RECALL, STATE - RECALL' IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
T OPPOSE
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 CALIFORNIA Ij
Recipient Committee e „
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I D NUMBER
Marie Blankley for City Council 2018 11400066
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 ❑ Political Party /Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STRE IT AODRI SS NO ANUSTREIT CITY STATE lip (111)1 AREACODF /PHONE
Small Contributor Committee , 13 if
Dale qualified
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;
• 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.
Clear Page Print FPPC Form 410 (October /2017)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
Statement Type D Initial ® Amendment
Q Not yet qualified
or 11 20 2017
0 Date qualified as committee ---/ /
Date qualified as committee
❑ Termination —See PjRiie
Date of termination
Date Stamp
'ED AND FILEC
of the Secretary of State
State of California
NOV 2 7 2017
I.D. Number
1. Committee Information (if applicable) 1400066 2 Treasure'r and Other Principal Officers
NAME OF COMMITTEE
Marie Blankley for City Council 2018
STREET ADDRESS (NO P.O. BOX)
CITY
STATE ZIP CODE AREA CODE /PHONE
Gilroy
CA 95020 408 - 842 -4544
MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
voteblankley @gmail.com
COUNTY OF DOMICILE
JURISDICTION WHERE COMMITTEE IS ACTIVE
Santa Clara
Gilroy, CA
I
OF TREASURER
Paul Vanni
For Official Use Only
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 408 - 847 -4330
NAME OF ASSISTANT TREASURER, IF ANY
Marie Blankley
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 408 - 842 -4544
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
3. ,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 perjury unde the laws of
DATE
Executed on
DATE
By
SIGNATURE OF
OR STATE MEASURE PROPONENT
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 1400066
• 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
Raboban k 408 - 842 -1938 1140653055
ADDRESS CITY STATE ZIP CODE
805 First Street Gilroy CA 95020
4. Type of Committee Complete the applicable sections.
• 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 SOUGHTOR HELD YEAR OF PARTY
NAME OF CAN DIDATE/ OFFICEHOLDER /STATEMEASU REPROPONENT (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)
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATES) NAME OR MEASURES) 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 MEASURES) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
i OPPOSE
OPPOSE
FPPC Form 410 (October /2017)
Clear Page Print FPPCAdvice: advice @fppc.ca.gov (866 1275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
_ Page 3
COMMITTEE NAME -
I.D. NUMBER
Marie Blankley for City Council 2018 11400066
General Purpose Committee 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
rnuvwt —It V W-LKIP I JUN OF ACT MTV
List additional sponsors on an attachment.
NAMt OF SPONSOR
.Intti .... t�n NO. AND STREET
CITY
GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE AREA CODE /PHONE
Small Contributor Committee 11
Date qualified
S. Termination Requirements y g g �. y:- 1.
e sI nIn the verification; the treasurer, assistant tress Ter arAd s ty t dte iff e�0 b {i otlGnt ifs a li!Af $hP folloMr)ng ondlt1A 13 ha 1 e �
ray
• 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.
Clear Page Print FPPC Form 410 (October /2017)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov