Loading...
HomeMy WebLinkAboutTom Fischer - 2014 - Form 410 Initial1_\t) Statement of Organization Recipient Committee Statement Type ❑Initial Not yet qualified © or Date qualified as committee b � REC IVED MOVILED in the offi e of the Secretary of State oft e State of California ❑ Amendment ❑ Termination — See Part 5 p List I.D. number: List I.D. number: APR 14 2014 DEBRA BOWEN Se rptary of State; Date qualified as committee Date of Termination (IfaPPlicable) ' � Only i -- 1. Committee Information 2. Treasurer and Other Principal Officers NAME OF COMMITTEE NAME OF TREASURER Tom Fischer for City Council 2014 Marie P Blankley STREET ADDRESS (NO P.O. BOX) STREET ADDRESS (NO P.O. BOX) 745 Dawn Way 2290 Coral Bell Ct. CITY STATE ZIPCODE AREA CODE /PHONE CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 Gilroy CA 95020 (408)842 -4544 MAILING ADDRESS (IF DIFFERENT) NAME OF ASSISTANT TREASURER, IF ANY FAX / E-MAIL ADDRESS STREET ADDRESS (NO P.O. BOX) COUNTY OF DOMICILE I URISD ICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE /PHONE Santa Clara Gilroy, CA NAME OF PRINCIPAL OFFICER(S) Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOX) 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 under the laws of the State of California that th foregoing is true and correct. Executed on _ ^ l By DATE 51 N TUR TREASUREROR ASSISTANT TREASURER /� [/ Executed on ✓ 7 A) T Bye DATE SIG T OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIG *LW& OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012) 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 Tom Fischer for City Council 2014 • 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 101002566 STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 4. Type. of Comrnittee, 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Tom Fischer City Council Member 2014 m Nonpartisan SUfn ❑ Nonpartisan Primarily Formed Committee I Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEW 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) rHFCK ONF FPPC Form 410 (Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT 0 E OPPOSE SUfn O FPPC Form 410 (Dec /2012) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified m or Date qualified as committee 1. Committee Information NAME OF COMMITTEE Tom Fischer for City Council 2014 ❑ Amendment List I.D. number: Date qualified as committee (Itapplicable) ❑ Termination —See Part 5 List I.D. number: Date of Termination STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 MAILING ADDRESS (IF DIFFERENT) FAX / E -MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy, CA Attach additional information on appropriately labeled continuation sheets. nn Date Stamp For Official Use Only 2. Treasurer and Other Principal Officers NAME OF TREASURER Marie P Blankley STREET ADDRESS (NO P.O. BOX) 2290 Coral Bell Ct. CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)842 -4544 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) STREET ADDRESS (NO P.O. BOX) 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_ under the laws of the State of California that Pe foregoin g is rue and correct. Executed on By 1 GATE L/ �A�7TREASURER OR ASSISTANT TREASURER Executed on / By ✓ DATE SIGNAT E OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012) 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 Tom Fischer for City Council 2014 • 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 101002566 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Tom Fischer City Council Member 2014 m Nonpartisan SUM ❑ Nonpartisan Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT ❑ OPPOSE ❑ SUM OPn FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization CALIFORNIA Recipient Committee ; „ INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER Tom Fischer for City Council 2014 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 Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor Committee Date 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. FPPC Form 410(Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization Recipient Committee Statement Type ❑ Initial ® Amendment Not yet qualified ❑ or List I.D. number: „1366034 1 06 ./ 1_ —/ 2014 Date qualified as committee Date qualified as committee (It appl -ble) ❑ Termination — See Part 5 List I.D. number: Date of Termination 1. Committee Information NAME OF COMMITTEE Tom Fischer for City Council 2014 STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 MAILING ADDRESS (IF DIFFERENT) FAX / E-MAIL ADDRESS Santa Clara I Gilroy, CA Attach additional information on appropriately labeled continuation sheets. / abate Stamp . A OHICWI Use Only L� CU z.n 2. Treasurer and Other Principal Officers NAME OF TREASURER Marie P Blankley STREET ADDRESS(NO PO. BOX) 2290 Coral Bell Ct. CITY STAFF ZIPCODI AREACODE /PHONE Gilroy CA 95020 (408)842 -4544 NAME OF ASSISTANT TREASURER, IF ANY Tom Fischer STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 NAME OF PRINCIPAL OFFICERS) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE /PHONE 3. Verification 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 Lin er th laws of the State of California that the for oin i rue an car ect. Executed on w By -1A ` E U OF TREASU7 ASSISTANT TREASURER Executed on / 3 By DATE �.....,.� ,., . Executed on GATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 IDec /2012) 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 110. NUMBER Tom Fischer for City Council 2014 11366034 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE I BANK ACCOUNT NUMBER Pinnacle Bank (408)848 -7210 101002566 ADDRESS CITY STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 4�Tyoe:Of Committee Complete the appheable 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. NAME OF CANDIDATE /OFFICEHOLDER /STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Tom Fischer City Council Member 2014 ® Nonpartisan SUM ❑ Nonpartisan 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 ORMEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT M OPPOSE El SUM OPPOSE FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization cALIFORNIA- Recipient Committee FORK. INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME 1.0. NUMBER Tom Fischer for City Council 2014 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 STREET ADDRESS NO. AND STREET CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE Date qualifled S.:Terminatlon Requirements ByAningoe verificatiok& treasurer, assistant treasurerand /or candidate, officeholder onproponent certify that all 6f the:followlnk conditions Have been met! - J • 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 Cade 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 (Dec /2012) 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 Date qualified as committee 0 Amendment List I.D. number: # 1366034 06 /13 /2014 Date qualified as committee (If applicable) ❑ Termination — See Part 5 List I.D. number: Date of Termination 1. Committee Information NAME OF COMMITTEE Tom Fischer for City Council 2014 STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 MAILING ADDRESS (IF DIFFERENT) FAX / E -MAIL ADDRESS COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara I Gilroy, CA Attach additional information on appropriately labeled continuation sheets. Date Stamp Kr- t :WED AND FILED in th office of the Secretary of Stets Of %e State of California JUN 16 2014 For Official Use Only 2. Treasurer and Other Principal Officers _ NAME OF TREASURER Marie P Blankley STREET ADDRESS (NO P.O. BOX) 2290 Coral Bell Ct. CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)842 -4544 NAME OF ASSISTANT TREASURER, IF ANY Tom Fischer STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 NAME OF PRINCIPAL OFFICERS) STREET ADDRESS (NO P.O. BOX) 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 under the laws of the Stat of California that e fore cling is; r and correct. Executed on 6 40 By DATE SIGNATURE 7F TREASURER OR ASSISTANT TREASURER Executed on DATE Executed on DATE Executed on DATE By By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Statement of Organization ® Recipient Committee ® 1Z il Iljl � INSTRUCTIONS ON REVERSE ,Page 2 COMMITTEE NAME I'.0. NUMBER Tom Fischer for City Council 2014 1366034 • All committees, must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREACODE /PHONE BANK ACCOUNT NUMBER Pinnacle Bank 1(408)848-7210 1101002566 ADDRESS CITY STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 ..�. -_ _.-. _., �. .w .. _ . z ♦:. .�_ tnt- r :r... - - - a.,, 'z ✓` h = v �„ - 3a_ ,.tl s �• �_ ,+� � T .�.'?- �". ¢H t 5 • 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 CAN MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY Tom Fischer City Council Member 2014 m Nonpartisan SUPPORT ❑'Nonpartisan • 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) CANDIDATES) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO.. CITY OR COUNTY. AS APPLICABLE)' r"Frr nNc FPPGForm 410 (Dec /2012) FPPC Advice: advice@fppCca.gov (866 /M- 3772)' vrwwfppc.ca.gov i� SUPPORT OPPOSE SUPPORT OPPOSE FPPGForm 410 (Dec /2012) FPPC Advice: advice@fppCca.gov (866 /M- 3772)' vrwwfppc.ca.gov i� Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Tom Fischer for City Council 2014 MRS. 13RIP-M • 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 - (INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREETADDRESS NO. AND STREET CITY STATE ZIP CODE Page 3 I.D. NUMBER 1366034 Date qua -lifted __ .. - _,....... ..�.. ., ,... - _ __. :s •�i %.s - -:r -st ^--"` d'- - Z- .'�`•1= = J'- '4�..� t=i?s;� u2'.. xx' _ >- �. ..., r-.s at.a.:+'s ..an. -5+3 .:mq . -....- '3E ..'�.' %t`s- r:.•,. `?.`7 -`i. ,- tlA- J'xc.. �?iee }:r._Ir!:..l+.v..Yrft;+.A.'z'"� }..'ice. _.. z`rFb'°:� t? T. 1. - �° <y ` . � • ' � ; -��'° - �`�'�,-"' "�`` °_ ! `- � .candidate�officehD �eroP :o o'he1Tt•�e; _: hatall- dfalhe.fbllowin :contliflans,h'ave:been;metk ;':'`�;�. SiTerrni.nafionfRe u�rements,�,�,- �sy�igni ,gs�ie v rlficatTDn •the•ttea�ure�.asslsCanE�treasu erandjo p ,__ , „_ - (�.. �p�P a _ - �fW g, �?' • 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 ballotimeasure 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 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov