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HomeMy WebLinkAboutTom Fischer - Form 410 Amendment (2015)Statement of Organization . Rd ipien't Committee Statement Type ❑ Initial Amendment ❑ Termination — See Part 5 Not yet qualified ❑ or List ID. number: List I.D. number: #1366034 a Dale qualified as committee Date qualified as committee Date of Termination (II applicable) NAME OF COMMITTEE Tom Fischer for City Council 2016 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 tom4gilroy@outlook.com COUNTY OF DOMICILE - JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy, CA Attach additional information on appropriately labeled continuation sheets. I have used all reasonable diligence in preparing penalty of perjury under the laws of the and correct. OR ASSISTANT TREASURER By [/ DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT DATE By is true and complete. I certify under SIGNATURE OF CONTROLLING OFFICEHOLDER; CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410(Dec/2012) FPPC Advice:. advlceLtDfppc.ca.gov (866/275 -3772) www.fppc.ca.gov StatemeEd of Organization Recipient Committee INSTRUCTIONS,ON REVERSE COMMITTEE ,NAME _ Tame Fischer for City Council 2016 Page 2 I.D, NUI 1 'A R • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE /PHONE BANK ACCOUNT NUMBER j Pinnacle Bank (408)848 -7210 ADDRESS CITY STATE ZIP CODE 7597 Mnntwrav Strraat riirnv r A am ,2n • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective ofjfice 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 PARTY 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) �ucry nuc t SUPPORT tak Nonpartisan Tom Fischer City Council Member 2016 In 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) �ucry nuc FPPC Form 410 (Dec /2012) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov t SUPPORT OPPOSE .. E SO In 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 3 Tom Fischer for City Council 2016 Gen Not formed to support or oppose specific candidates or measures in a single election. Check only one box: [I CITY Committee Q COUNTY Committee Q STATE Committee i PROVIDE BRIEF DESCRIPTION OF ACTIVITY I List additional sponsors on an attachment. NAME OF SPONSOR STREET ADDRESS - NO. AND STREET Date quallfled CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE • 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 Section] 89511- 89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Dec /2012) FPPC Advice: advic4fppc.ca.gov (8661275 -3772) www.fppc.ca.gov i I I I Statement of Organization Recipient Committee Statement Type ❑ Initial Not yet qualified ❑ or Date qualified as committee 1. Committee Information NAME OF COMMITTEE Tom Fischer for City Council 2016 STREET ADDRESS (NO PO. BOX) © Amendment List I.D. number: #1366034 Datqualified as committee (If applicable) ❑ Termination — See Part 5 A ` :, List I.D. number: a REP,!' # a DEC 11 2015 cC!TY CLERK'S �' , ca Date of Termination I GiLROY, CA 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 MAILING ADDRESS (IF DIFFERENT) FAX / E-MAIL ADDRESS tom4gilroy @outlook.com COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE Santa Clara Gilroy, CA Attach additional information on appropriately labeled continuation sheets. 2. Treasurer and 0 NAME OF TREASURER Tom Fischer STREET ADDRESS (NO P.O. BOX) 745 Dawn Way rs For Official Use Only CITY + STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 (408)847 -4716 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE /PHONE NAME OF PRINCIPAL OFFICER(S) d�9uJA-) STREET A DRESS (NO P.O. BOX) �; /RL)t/ 61�, �o CITY STATE ZIP CODE AREA CODE /PHONE 3. Verification I have used all reasonable diligence in preparing this statement 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 TREASURER OR ASSISTANT 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 DATE 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 e - Recipient Committee r.U.BER INSTRUCTIONS ON REVERSE COMMITTEE NAME 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 AREA CODE /PHONE BANK ACCOUNT NUMBER Pinnacle Bank 1(408)848-7210 ADDRESS CITY STATE ZIP CODE 7597 Monterey Street Gilroy CA 95020 • 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 PARTY Tom Fischer City Council Member 2016 ® Nonpartisan SUPPORT ❑ Nonpartisan • Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION CANDIDATE(S) NAME OR MEASURE(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 SUPPORT OPPOSE 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 3 COMMITTEE NAME I.D. NUMBER Tom Fischer for City Council 2016 11366034 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 STREET ADDRESS NO. AND STREET Small Contributor Comrrottee; _ � Date qualifiecli CITY GROUP OR AFFILIATION OF SPONSOR STATE ZIP CODE r,- ? e u � f1t5>'� *: r -„ sB 'si ni �heverification�the'trea ° fir* -ass s r�nf`treasUrpr an .bnDan date'�ofticeholder��or, ro onent.certi thetall of�the«follow n �coisdifions;have� eerrmElt s „,,;,,.4�; -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 Code Section 89519. -- Leftover funds of ballot measure committees maybe 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