Tom Fischer - Form 410 Amendment (2018)Statement of Organization
Recipient Committee
Statement Type l] Initial
Not yet qualified ❑ or
® Amendment
List LD. number.
#'1366034
Dat�It1E)�mmlttee Date qualified mittee
(If applicable)
❑ Termination — See Part S in the
List I.D. number:
n
--/ --/
Date of Termination
Date Stamp
ED pND FILED
of the Secretary 01 Slate
St* of cayornla
JAN 13 2017
For official Use Only
NAME OF COMMITTEE
NAME OF TREASURER
Tom, Fischer for City Council 2018
Tom Fischer
STREET ADDRESS (NO P.D.BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
STREET ADDRESS (NO P.O: BOX)
Gilroy CA 95020 (408)847 -4716
CITY - STATE ZIP CODE
AREACODE /PHONE NAME OF ASSISTANT TREASURER, IF ANY
Gilroy CA 95020
(408)847 -47 -16
-
STREET ADDRESS (NO P.O. BOX) .
MAILING ADDRESS (IF DIFFERENT)
CITY - STATE ZIP CODE AREACODE /PHONE
_
FAX /-E•MAILADDRESS
-
to m Qto mfo rg i l roy. co m
COUNTY OF DOMICILE IUBIIUIL I1ON wM"n i
Santa Clara Gilroy, CA
Attach additional information on• appropriately labeled continuation sheets.
NAME OF PRINCIPAL OFFICER($)
Tom Fischer
STREET ADDRESS•(NO:P.O. BOX)
CITY STATE ZIP CODE AREA CODE /PHONE
Gilroy CA 95020 (408)847-471'6
have used all reasonable dilig n�ce,ln pari g•this state an 1�1� Kf f - Yy e the information
p men and to the bes f' ge the contained herein is true and complete. [certity.uncler
penalty of perjury under the laws of the State
TREASURER
EXecuted:Dn DATE By SIGNATURE OF fl I
FFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT -
Executed on By
' DATE - SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE _ - SIGNATURE OF CONTROLLING OFFICEHOLDER, CAN OR STATE MEASURE PROPONENT -
FPPC Form 4i6 (Jan /2016)
FPPC Advice: advice @fppc:ca.gov (866/275 -3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee -
INSTRUCTIONS ON REVERSE PI6e 2
I.D. NUMBER
COMMITTEE NAME
Tom Fischer for City Council 2018 1366034
• All committees must list the financial Institution where the campaign bank account is located.
NAME of FINANCIAL INSTITUTION
Pinnacle Bank
ADDRESS
7597 Monterey Street
AREA CODE /PHONE
(408)848 -7210
Gilroy ,
BANK ACCOUNT NUMBER
101002566
STATE ZIP C
CA 95020
• 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.
ELECTIVE OFFICE SOUGHT OR HELD
NAME'OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBEXIF APPLICABLE) YEAR OF ELECTION PARTY
Tom; Fischer
Citv Council Member
18
Primarily'formed to support or oppose specific candidates or measures in a single election. List below;
CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
Nonpartisan
Nonpartisan
ONE
FPPC Form 430 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov
i
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
for City Council 2018
MIME Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee 0 COUNTY Committee 0 STATE Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
List additional sponsors on an attachment.
ADDRESS NO.
GROUP OR AFFILIAIIUN OF
21P CODE
PBge 3
1366034
Date qualified .
-z; vi-
"M
5 TerminationRe uirements Byslent}g the verlficat�on, theltreasurar, asststantitreasur and/ r$ n ffl propo ent cert(fy that all;of the falloWincawn� h , _ 4 _, �c
• 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'ihas no !intention or ability, to discharge. all debts, loans received, and" other obligations;
• This,committee has no surplusfunds; 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 (Jan /2016)
FPPC Advice: advice@fppc.ca.gov (866/275 -3772)
www.fppc.ca.gov