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HomeMy WebLinkAboutTom Fischer - 2014 - Form 410 AmendmentStatement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or hl Amendment List I.D. number: #1366034 ❑ Termination — See Part 5 List I.D. number: # Date qualified as committee Date qualified as committee Date of Termination (Ifapplicable) - ... Date Stamp For Official Use Only RECEIVED AND FILE in I ie office of the Secretary of Siial nf thn C'tRta of f 00nmia DEC 1 17 2-014 NAME OF COMMITTEE NAME OF TREASURER Torn Fischer for City Council 2016 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 AREACODE /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 _ - Tom Fischer FAX / E -MAIL ADDRESS STREET ADDRESS (NO P.O. BOX) - - 745. Dawn Way COUNTY OF DOMICILE IURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE /PHONE Santa Clara Gilroy, CA - Gilroy CA 95020 (408)847 -4716 NAME OF PRINCIPALOFFICER(S) STREET ADDRESS (NO P.O. BOX) Attach additional information on appropriately labeled continuation sheets. CITY STATE ZIP CODE AREA CODE /PHONE I have used all reasonable diligence in preparing penalty of perjury under the laws of the State of Executed on By JD E / Executed on �" ./ —/ - By DATE Executed on DATE By statement and to the best of my knowledge the information contained herein is true and complete. ('certify under rnia that the r is tr a d correct. IGNATURE OF REASURER OR ASSISTANT TREASURER ' SIGNATURE CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT _. SIGNATLrRE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT - - .- Executed on By DATE SIGNATURE OF CONTROLLINGOFFICEHOLOER, 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 e - INSTRUCTIONS ON REVERSE Page 2 COMMITTEE, NAME I.D..NUMBER Tom Fischer for City Council 2016 1366034 • 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 St. Gilroy CA 95020 4.xT ��.f e O_iCO�t ltte� omplete the�p _�ICabl •secttoi s>� _��.,�, .� _,� _ _ .� �,�,,. ��. _,. -� ..�:r. �� � �:��� � :. , �. _� �`�. x _ -_ i ,4.: "�)�1'-__t;.:ss s:,,.sfi+'a..'-NN�_ -� ���,�� ���- �,�,�� �es�rw -. * =. ��...�'�'�.�]� � ..�:a•.,>T.a�_� «�'En -��sx .n.�.. 4;ss.�.��':,��...,a ��3v._a.... • 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 Torn Fischer City Council Member 2016 m Nonpartisan - SUPPO0.T ❑ 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) CHFCK ONF FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SUPPORT OPPOSE El- - SUPPO0.T oci 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 Tom Fischer for City Council 2016 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 1 a 0 • . a List add itiona1.sponsors on an attachment. NAME OF SPONSOR OR AFFILIATION OF SPONSOR STREET ADDRESS NO: AND STREET CITY STATE ZIP CODE Page 3 1366034 r a a a ❑ Date qualified �,.:�. �-.T .- . F. eew- � .=. -% ar:: :i �i , tn.�a- ...t.�l :<©x_er._>, � _ ���q, u„�C -;, � -. � M, . w,e.. �n .. t., vs- '���"� . ; �$. ..�.: �.-...s., as�3v.i��;�.�,eg � . fi � , rn_...g - a.. : ; ISe`- �_g''*V s� �@:> f =rlaI.:�G�:s3 .. . e . O .wzC._I.. � ; :: t � e-s-. 2 - x t;t „ �.� ..�:� 8ilu5 » u.s:r.r.�.rs� y 3 .� s= .5 {.I S ,.4�t r8 ._. - nn..t ;;. .a ._r ,e .. �B�- . T..J,ar.e.__ rw��� d ' �.d :� ,O_. �;-: +Q +� a .s hnd: d , � d. d �..�t •-�;. E ,l�. , � i : . �C!.2 � .,�.B.'�r,`$�Y; p 3r Q ,i. p�.1b-... �.h, -r e. .t� . l rc4�`1$ ;�� !.. �'.�th. e � .��r_�O.,,. � f:�lth ;•�.,i�i :�, � i �,*��':GO.:� .{' ,mf, Lt 1;a0.. : :1T.5 , �- .V � � ,�� 2t1��- t �= .y �+sr • 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 18.680 and FPPC Regulation 18521.5. FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov