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Tom Fischer - Form 410 Amendment (2020)Statement of Organization Recipient Committee Statement Type ❑ Initial © Amendment Notyetqualified ❑ or List I.D. number: # 1366034 Date Star''; CALIFORNIA FORM 410 AND FILd ❑ Termination — See Part 5 ir, the office of th§ Sectetary of'Stat For o 9 1 4� List I.D. number: of the StPatA of (>alifornia JAI 17 2019 a 1) Date qualified as committee Date qualified as committee Date of Termination N (If applicable) r 1. Committee Information - - 2. Treasurer and Other Principal Officers d NAME OF COMMITTEE , NAME OF TREASURER Tom Fischer for City Council 2020 Tom Fischer STREET ADDRESS (NO P.O. BOX) ete. I certifv under FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee . M 410 INSTRUCTIONS ON REVERSE Page 2 COMMITTEE NAME Tom Fischer for City Council 2020 I.D. NUMBER 1366034 • All committees must list the financial institution where the campaign bank account is located NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Pinnacle Bank 1(408)848-7210 ADDRESS CITY STATE ZIP CODE 7597 Monterey 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." • 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 NUMBER IF APPLICABLE) YEAR OF ELECTION Tom Fischer City Council Member 2020 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 (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY 21 Nonpartisan ❑ Nonpartisan CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE El El FPPC Form 410(Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee FORM INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME Tom Fischer for City Council 2020 D.NUMBER 1366034 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 List additional sponsors on an attachment. NAME OF SPONSOR I INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Date qualified 5. 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. FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or COPY © Amendment ❑ Termination — See Part 5 List I.D. number: List I.D. number: # 1366034 # Date qualified as committee Date qualified as committee Date of Termination (If applicable) 'rCiftlD JAN 5 2079 RCE c��cr�R�s 1. Committee Information w� 2. Treasurer and Other Pr.in NAME OF COMMITTEE NAME OF TREASURER Tom Fischer for City Council 2020 Tom Fischer STREET ADDRESS (NO P.D. BOX) 3. Verification - I have used all reasonable diligence in preparing this statement and to the best of my nowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the TREASURER Executed on By DATE SIGNATURE al` 6G TROLLING OFFICEHOLDER, 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, CANDIDATE, OR STATE MEASURE PROPONENT 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 COMMITTEE NAME Tom Fischer for City Council 2020 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION Pinnacle Bank ADDRESS AREA CODE/PHONE (408)848-7210 CITY BANK ACCOUNT NUMBER STATE ZIP CODE CALIFORNIA •- 410 Page 2 I.D. NUMBER 1366034 7597 Monterey Street Gilroy CA 95020 4. Type of Committee Complete the applicable'sectons. ����u�uilla•��•iuuu3�ku:� • 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 NUMBER IF APPLICABLE) YEAR OF ELECTION Tom Fischer City Council Member 2020 ■.��.��+ia�.1•.,na.rt.iPrimarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULLTITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY 21 Nonpartisan ❑ Nonpartisan CHECK ONE SUPPORT OPPOSE SUPPORT OPPOSE El El 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 COMMITTEE NAME Tom Fischer for City Council 2020 I— CALIFORNIA •- 410. Page 3 I.D. NUMBER 1366034 4. Type of Committee (Continued) 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 PROVIDE BRIEF DESCRIPTION OF ACTIVITY ����,.,,17.1.4.r•1•l+++uthka:a List additional sponsors on an attachment. NAME OF SPONSOR (INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE Date qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that 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. FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov