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HomeMy WebLinkAboutTom Fischer - Form 460 - 2016/10/23 - 2016/11/01Recipient Committee A-1911, 'y COVER PAGE Campaign Statement °` Date Stamp • 1 Cover Page NOV 2 2016 1 4 Statement covers period Date of election If applicable: of 10/23/16 (Month, Day, ear) ' " Official Use Only from �d SEE INSTRUCTIONS ON REVERSE through 11/1/16 e 11/8/2016 c'� it 0i. 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement: 91 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement O State Candidate Election Committee Committee ❑ Semi - annual Statement ❑ Special Odd -Year Report O Recall O Controlled ❑ Termination Statement (AW ConaWe Pert 5) O Sponsored (Also file a Form 410 Termination) El General Purpose Committee (Also Complete Pet 6J ❑ Amendment (Explain below) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party /Central Committee Aso Cemplete Pod 7) 3. Committee Information I.D. NUMBER 413Qnr%13 , Treasurer(s) Tom Fischer for City Council 2016 STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREACODE/PHONE Gilroy CA 95020 408 - 847 -4716 MAILIN ADDR SS (IF DIFFERENT) NO. AND STREET OR P.O. OX CITY STATE ZIP CODE AR ODE/P NE OPTIONAL: FA /E- MAILADDRESS NAME OF TREASURER Tom Fischer MAILING ADDRESS 745 Dawn Way CITY STATE ZIP D AREA OD E Gilroy CA 95020 408 - 847 -4716 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE 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 knowledg formation contained erein 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 is t ^,e n�.� ^e.^°.:..T Executed on Date Executed on Date Executed on Date Executed on Date By By or By Signature ofContralling Officeholder, Candidate, Slate Measure Proponent By ignaturo of Controlling Officeho der, Candidate, State 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) City Council. Member, City of Gilroy RESIDENT AUBUSINESS ADDRESS (N0. AN STREET) CITY STATE 2 P 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. CITY STATE ZJP CODE AREA CODE/PHONE COVER PAGE PART 2 Page 2 of 4 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I [j SUPPORT ❑ OPPOSE Identify the controlling, officeholder, candidate, or state measure proponent, R any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT DISTRICT NO. IF 7. Primarily Formed Candidate /Officeholder Committee Llstnames.or officeholder(s) or candldate(a) 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 CITY STATE ZIP CODE AREA CODEIPHONE 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 Summary Page to whole dollars. Statement covers:perlod CALIFORNIA , from 10/23116 FORM ON REVERSE NAME OF FILER Tom Fischer 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 Unes 3 + 4 $ Column A TOTALTHI6 PERIOD (FROM ATTACHED eCHEDULPA 0.00 through 11/1116 Column B CALENDAR YEAR TOTAL TO DATE $ 8,055.00 $ 0.00 $ 8,055.00 144.92 $ 0.00 $ 8,199.92 Expenditures Made 6. Payments Made ............................. ............................... Schedule E, Line 4 $ 0100 7. Loans Made ........................................ ............................... Schedule H, Una 3 8. SUBTOTAL CASH PAYMENTS ........... ............................... Add UrW a +7 $ 0.00 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F Line 10. Nonmonetary Adjustment .......................... ............................... schedule C, Line 3 11. TOTAL EXPENDITURES MADE ......... ............................... Add Lines a + e + to $ 0.00 $ 8,545.89 $ 8,545.89 $ 8,545.89 Current Cash Statement 12, Beginning Cash Balance Previous Summary Page, Line 1e ........................'1" ...................... 13. Cash Receipts ........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line 4 $ 1045.06 0.00 To calculate Column B, add amounts In Column Ato -the corresponding amounts from. Column B 15, Cash Payments .......................... ............................... Column A, Una a above 16: ENDING CASH ;BALANCE ..................Add Una 12 + 13 + 14, then subtract Line 16 $ 0.00 1,045.06 of yourlest report. Some amounts In Column may be negative figures that If this is a termination statement, Line 18 must be. should be subtracted from previous - period amounts. If this Is the first, report being 17. LOAN GUARANTEES RECEIVED ...................... " ' ..... schedule e,; Pert 2 $ filed fonthis calendar year, only carry over the amounts from, Lines 2, 7, and 9 (if any). Cash Equivalents and Outstanding Debts 1'8: Cash Equivalents ................................................ see instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Una 9 In Column B above $ Page 3 of 4 11366034 Calendar Year Summary forCandidates Running In Both the State Primary and General Elections 1/1 through 6130 711 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* Ih Subject to votumary Expenditure Limn) Date of Election Total to Date (mm/dd/yy) I $ I $ *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 Amounts may he rounded SCHEDULE 81- PART 1 schedule B — Part 1 to wncle donate. Statement covers period Loans Received 10/23/16 ' • '� from SEE INSTRUCTIONS ON REVERSE through 11/1/16 page 4 of 4 NAME OF FILER I.D. NUMBER Tom Fischer 1366034 FULL NAME, STREETADDRESS AND ZIP CODE IF OCCUPATION AND L, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT (N AMOUNT PAID OUTSTANDING e INTEREST III ORIGINAL CUMULATIVE OF LENDER OF COMMITTEE, ALSO ENTER I.D: NUMBER) (IF SELF- EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN ` BALANCE AT CLOPERIOD THIS PAID THIS AMOUNT OF CONTRIBUTIONS NAME OF BUSINESS) PERIOD THISPERIOD PERIOD LOAN TO DATE Tom Fischer Candidate ❑ PAID CALENDAR YEAR 745 Dawn Way a $ 1.000:00 : 7500.00 a Gilroy, CA 95020 y ❑ FORGIVEN RATE PER ELECTION~ a 1,000.00 t ❑ IND F-1 COM [I OTH ❑ PTY [I SCC a a a DATE INCURRED a DATE DUE ❑ PAID CALENDAR YEAR $ $ % a a ❑ FORGIVEN RATE PER ELECTION~ t ❑ IND ❑ COM C1 OTH [I PTY [I SCC a a a a DATE INCURRED a DATE DUE ❑ PAID CALENDAR YEAR a a % a a PER ELECTION" ❑ FORGIVEN RATE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC a a a a DATE INCURRED DATE DUE SUBTOTALS $ $ $ $ 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.) 3. Netchange this period. (Subtract Line 2 from Line 1.) .............................. ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. If required. (May be a negMWe nurteer) (Enter (e) on Schedule E, Line 3) 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