Fisher, Tom - Form 410 Amendment (City Council 2022)Statement of Organi z ation
Recipient Committee
Statement Type □Initial
Not yet qualifie d D or
---l---1
Da te qual ifi ed as comm itt ee
NAME OF COMMITTEE
Tom Fischer for City Council 2022
STREET ADDRESS (NO P.O . BOX)
MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX)
FAX/ E-MA IL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE
JURISD ICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICE R(S )
Santa Clara Gilroy , CA Tom Fischer
STREET ADDRESS (NO P.O. BOX)
~--Ve rifi cation ·. .. -
I have used all rea sonable diligen ce in
and correct.
Executed on B -/ e.. -20 Z (j
DATE
Executed on By
DATE OF CO NTR OL LI NG OFFICEHOLD ER , CA NDIDATE, OR STAT E MEASUR E PROPONENT
Executed o n By
DATE SIGNATURE OF CON TROLLING OFF ICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER , CANDIDATE, OR STAT E MEASURE PROPONEN T
FPPC Form 410 (Jan/2016)
FPPC Advice : advice@fppc.ca .gov (866/275-3772)
www.fppc.ca.gov
tatement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
COMMITTEE NAME
Tom Fischer for City Council 2022 -
CALIFORNIA 410
FORM
1.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 (408)848-7210
ADDRESS CITY STATE ZIP CODE
7597 Monterey Street Gilroy CA 95020
Controlled Committee
• 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 .
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT
ELECTIVE OFFICE SOUGHT OR HELD
(INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION
Tom Fischer City Council Member 2022
Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE($) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER)
CANDIDATE($) OFFICE SOUGHT OR HELD OR MEASURE($) JURISDICTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
PARTY
IZJ Nonpartisan
0 Nonpartisan
FPPC Form 410 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
IN STRU CTI ONS O N RE VER SE
COMMITTEE NAM E
Tom Fischer for City Council 2022
CALIFORNIA 410
FORM
1.D . N UM BER
1366034
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election . Check only one box :
0 CITY Committee O COUNTY Committee O STATE Committee
PROV I D E BRIE F DESCRIPTI ON OF AC TI VITY
Sponsored Committee Li st additional sponsors on an attachment.
N AME OF SPONSOR I N DU STRY GRO U P OR A FFILI AT IO N OF SPO N SOR
STR EET A D DR ESS NO. AND STREE T CITY STATE ZI P COD E
Small Contributor Committee □--1--1--
Date qua lified
?· T.~rr:ni ation .Requirements qSS ista ot treasurer aJ1_!JL'or ca pdldate, officeholder, or pm one □t ~ertif tt@t all of the following co. dlti JlS ha e been met :
• This committee ha s ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditu res in the future ;
• This committee has eliminated or has no intention or ability to di scharge all debts, loan s received, and other obligations;
• Thi s committee ha s no surplus fund s; and
• Thi s committee has fil ed all campaign statements required by the Political Reform Act di sclo sing all reportable tran sactions .
There are re strictions on the disposition of surplu s campaign funds held by elected officers who are leaving office and by defeated candidates . Refe r to Government
Code Section 89519 .
Leftover funds of ballot measure committees may be used for political, legi slative or governmental purposes under Government Code Sections 89511 -89518 , and are
subject to Election s 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