Fischer, Tom - Form 410 (City Council 2022 - termination)Statement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment ® Termination — See Part 5
Not yet qualified ❑ or List I.D. number: List I.D. number:
# #1366034
12 /28 2020
Date qualified as committee Date qualified as committee Date of Termination
(If applicable)
1: Committee Information f,,
NAME OF COMMITTEE
Tom Fischer for City Council 2022
STREETADDRESS (NO P.O. BOX)
JURISDICTION WHERE COMMITTEE IS ACTIVE
Gilroy, CA
Attach additional information on appropriately labeled continuation sheets.
/,` v DateStam\
For Official Use Only
Treasurer and Other Prirrc�parfficers t� x { .ram mat,
NAME OF TREASURER
Tom Fischer
STREET ADDRESS (NO P.O. BOX)
NAME OF ASSISTANT TREASURER, IF ANY
STREET ADDRESS (NO P.O. BOX)
CITY
NAME OF PRINCIPAL OFFICER(S)
Tom Fischer
STREET ADDRESS (NO P.O. BOX)
3. Verification
I have used all reasonable diligence in preparing this statement and t e st of knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State
TREASURER
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
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 2022
• An committees must list the tinanclai Institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE
Pinnacle Bank 1(408)848-7210
ADDRESS CITY
7597 Monterey Street Gilroy
4. Type of Committee Complete the applicable sections.
BANK ACCOUNT NUMBER
STATE ZIP CODE
CA 95020
CALIFORNIA •-
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Page 2
I.D. NUMBER
• 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 2022
• 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
® Nonpartisan
❑ Nonpartisan
CHECK ONE
SUPPORT
OPPOSE
SUPPORT
OPPOSE
El
H
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 2022
4. Type of Committee (Continued)
General• • 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
NAME OF SPONSOR
ki9:\f11/J11-11M j.9
List additional sponsors on an attachment.
I�Na\�U7.�i773i
Small Contributor Committee
Date qualified
CITY
(INDUSTRY GROUP OR AFFILIATION OF SPONSOR
STATE ZIP CODE
CALIFORNIA •-
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Page 3
I.D. NUMBER
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