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Home My WebLink AboutTom Fischer - Form 460 - 2014/10/29 - 2014/12/12Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200- 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Statement covers period from 10/29/2014 through 12/12/2014 Date of election If appll (Month, Day, Year) 11/04/2014 COVER PAGE Date Starnp , ti 4qM FORM •rq►, lkzo Page 1 of a YC �IS For Official Use Only 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 2. Type of Statement: �° Z f�V4 s' IZI Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee Semi - annual Statement � ❑ Special Odd -Year Report Q Recall Q Controlled ❑ Termination Statement ❑ Supplemental Preelection (Also Complete Part 5) O Sponsored (Also file a Form 410 Termination) Statement -Attach Form 495 lso Complete Pad 6) ❑ General Purpose Committee (A ❑ Amendment (Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party /Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1366034 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO 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) NO. AND STREET OR P.O. BOX Treasurer(s) NAME OF TREASURER Marie P Blankley MAILING ADDRESS 2290 Coral Bell Court CITY STATE ZIP CODE AREA CODEIPHONE Gilroy CA 95020 408 - 842 -4544 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY OPTIONAL: FAX / E -MAIL ADDRESS OPTIONAL: FAX / E -MAIL ADDRESS ZIP CODE AREA CODE /PHONE 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury un er Il laws of the State of California that the foregoing is true and correct. i i Executed on By Dale r T ror Assistant rer Executed on z/J By Dale Signature of Corfirollt . CJ�didkite. State Measunkl1iroporent or Responsible Officer of Sponsor Executed an Date By Executed on By Date Sgnature of Corxrdling Officeholder, Candidate. State Measure Proponent FPPC Forth 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772) State of California Type or print in Ink. COVERPAGE -PART2 Recipient Committee . RNIA Campaign Statement FOR M 461f Cover Page — Part 2 S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Tom Fischer OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member, City of Gilroy - RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 745 Dawn Way Gilroy, CA 95020 Related Committees Not Included in this Statement: List any committees not Included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ YES ❑ NO Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I E] SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE Attach continuation sheets if necessary NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661276.1772) State of Califomta Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Statement covers period ® - Amounts may be rounded Summary Page to whole dollars. 10/29/2014 s - from through 12/12/2014 Page 3 of 4 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Tom Fischer for City Council 2014 1366034 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD ATTACHED CALENDAR YEAR TOTALTODATE Running in Both the State Primary and (FROM SCHEDULES) General Elections 1. Monetary Contributions ............ ............................... schedule A, Line 3 $ 0.00 $ 11999.00 500.00 1000.00 1/1 through 6130 7/1 to Date 2. Loans Received ....................... ............................... schedule e, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ................ I......... Add Lines 1 + 2 $ - 6500.00 $ 12999.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... schedule c, tine 3 50.05 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ••.•......•••.•.....••..... Add tines 3 +4 $ - 6500.00 $ 13049.05 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... schedule E, Line 4 $ 0.00 $ 11559.05 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 0.00 11559.05 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ $ (H Subject to Voluntary Expenditure Limit( 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 Date of Election Total to Date 10. Nonmonetary Adjustment .......................................... schedule C. Line 3 50.05 (mm /dd /yy) 11. TOTAL EXPENDITURES MADE . ............................... Add Lines e + s + 10 $ 0.00 $ 11609.10 J $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 7939.95 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A. Line 3 above -6500.00 amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1. Line 4 from Column B of your last reported in Column B. 15. Cash Payments ................... ............................... Column A. Line a above report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 1439.95 figures that should be subtracted from previous N this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... schedule B, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Equivalents and Outstanding Debts Cash E q 9 any). 18. Cash Equivalents ......... ............................... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column a above $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/276 -3772) SCHEDULEB -PART1 5chedule B — Part 1 "" "' '- " "- "' "'_' Amounts may be rounded Statement covers period P . Loans Received to whole dollars. 10/29/2014 � from 12/12/2014 4 4 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Tom Fischer for City Council 2014 1366034 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE AMOUNT (c) AMOUNT PAID OUTSTA DING BALANCEAT e) INTEREST ORIGINAL g CUMULATIVE OF LENDER OFSELF•EMPLOYED.ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD PERIOD PERIOD LOAN TO DATE Tom Fischer Candidate ® PAID CALENDARYEAR 745 Dawn Way a 6500.00 s 1000.00 0 x a 7500.00 a 7500.00 E] FORGIVEN PER ELECTION" Gilroy, CA 95020 RATE a 7500.00 s s s 08/28/14 a 7500.00 t6 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATEDUE DATE INCURRED - ❑ PAID CALENDAR YEAR s a x s $ ❑FORGIVEN PER ELECTION" RATE S 3 a $ $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR $ It x a $ ❑ FORGIVEN PER ELECTION" RATE tEl IND ❑ COM El OTH [I PTY El SCC S a a $ DATE DUE DATEINCURRED SUBTOTALS $ $ 6500.00 $ 1000.00 $ Schedule B Summary 1. Loans received this period ..................................................................................... ............................... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period .......................................................................... ............................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 6500.00 3. Net change this period. Subtract Line 2 from Line 1. - 6500.00 9 P ( ) ................................ ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. (May be anegahren °rnb°° 'Amounts forgiven or paid by another party also must be reported on Schedule A. (Enter (e)on _ Schedule E. Line 3) r tContributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee " If required. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)