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Home My WebLink AboutTom Fischer - Form 460 - 2016/01/01 - 2016/06/30Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/2016 through 6/30/2016 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also CornotePads) 0 Sponsored ❑ General Purpose Committee (Also Complete Part B) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (AlsoCWA*f* Pad 7) 3. Committee Information I.D. NUMBER 1366034 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO 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) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/ E -MAIL ADDRESS COVER PAGE Date Stamp JUL 6 2016 i ro Page ___L_ of 5 Date of election if appllcAtr (Month, Day, Year) yt� For Official Use Only d 11/8/2016 99 b E Z 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement W Semi - annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Tom Fischer MAILING ADDRESS 745 Dawn Way CITY STATE ZIP CODE AREA CODERHONE Gilroy CA 95020 408 - 847 -4716 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge thSloWrination contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing Treasurer Executed on By Onto Signature of VoHing Officeholder, en—didate, State Measure Proponent or Responsible Ofter of Sponsor Executed on By Date Signature of Controlling Officeholder, andWate, State Measure Proponent Executed on Date By Signature of Controlling Officeholder, Candidate, Stale Measure Proponent FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Tom Fischer OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Council Member, City of Gilroy RESIDENTIHL/BUSINENS 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. NAME I.D. NUMBER STREETADDRESS (NO P.O. BOX) ❑ YES ❑ NO CITY STATE ZIP CODE AREA CODE /PHONE COMMITTEE NAME NAME I.D. NUMBER ❑ YES ❑ NO CITY STATE ZIP CODE AREACODEIPHONE COVER PAGE - PART 2 Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ 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 offlcehoider(s) or candidate(s) for which this committee Is primarily formed. 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 Attach continuation sheets if necessary FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER z /-w Contributions Received 1. Monetary Contributions .................... ............................... Schedule A, Line 3 $ 2. Loans Received ................................. ............................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ 4. Nonmonetary Contributions ............. ............................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........ ............................Add Lines 3 +4 $ Statement covers period from 1/1/2016 through Column A Column B TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE 0.00 $ 0.00 0.00 $ 0.00 Expenditures Made 6. Payments Made ................................. ............................... Schedule E, Line 4 $ 50.00 $ 7. Loans Made ........................................ ............................... schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ........... ............................... Add Lines 6 + 7 $ $ 9. Accrued Expenses (Unpaid Bills) ........... ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................... ............................... schedule c, Line 3 11. TOTAL EXPENDITURES MADE ......... ............................... Add Lines 6 + 9 + 10 $ 50.00 $ 50.00 50.00 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1535.95 To calculate Column B, 13. Cash Receipts ............................ ............................... Column A, Line 3 above add amounts in Column A to the corresponding 14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line 4 amounts from Column B 15. Cash Payments .......................... ............................... column A, Line 6 above 50. 00 of your last report. Some 1485.95 amounts in Column A may 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED . ............................... Schedule B, Part 2 $ filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ................. ............................... See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 6/30/2016 SUMMARY PAGE Page 3 of 5 1366034 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6 /30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (M Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd /yy) Amounts In this section may be different from amounts reported in Column B. FPPC Form 460 (Jan /2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. �vM Statement covers period • , Loans Received 1/1/2016 , • ' from SEE INSTRUCTIONS ON REVERSE through 6/30/2016 Pof 5 NAME OF FILER �- �' 1366034 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE (IF COMMITTEE, ED TER I.D. NUMBER) (IF SELF - EMPLOYED, ENTER OF BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN BALANCE AT CLOSE OF THIS PAID THIS PERIOD AMOUNT OF LOAN CONTRIBUTIONS TO DATE NAME BUSINESS) PERIOD THIS PERIOD' PERIOD Tom Fischer Candidate ❑ PAID CALENDAR YEAR 745 Dawn Way $ 1.000.00 % $ 7.500.00 $ Gilroy, CA 95020 $ RATE ❑ FORGIVEN PER ELECTION" $ 1,000.00 $ $ $ 8128/14 $ 1 ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ % $ $ PER ELECTION" C3 FORGIVEN RATE S $ $ $ DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR [:1 FORGIVEN FORGIVEN PER ELECTION'M $ $ $ $ $ DATE DUE t ❑ IND [3 COM ❑ OTH El PTY El SCC DATE INCURRED SUBTOTALS $ $ $ $ 777 Schedule B Summary 1. Loans received this period ...................................................................................... ..............................$ n nn (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.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............................... ............................... NET $ n_nn Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) 'Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. Itmer del on Schedule E. Line 3) 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 FPPC Form 460 (Jan /2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. SCHEDULE E Statement covers period CALIFORNIA 1/1/2016 FORM , ' from through 6/30/2016 Page 5 of 5 I.D. NUMBER 1366034 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)` OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundralsing events POL polling and survey research TRS staff /spouse travel, lodging, and meals IND Independent expenditure supporting /opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB Information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Secretary Of State 150011 th Street Rm. 495 Sacramento, CA 95814 CODE OR " Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary Filing Fee DESCRIPTION OF PAYMENT SUBTOTAL$ 1. Itemized payments made this period. (Include all Schedule E subtotals.) .............................................................................. ............................... $ 2. Unitemized payments made this period of under $ 100 ........................................................................................................... ............................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column ( e).) .............................................. ............................... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ AMOUNT PAID 50.00 50.00 50.00 50.00 FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov