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Home My WebLink AboutTom Fischer - Form 460 - 2016/11/02 - 2016/12/31Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 11/2/16 through 12/31/16 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee Q Recall 0 Controlled (asocompletsPrl5) O Sponsored (Also Complete Par16) ❑ General Purpose Committee • Sponsored ❑ Primarily Formed Candidate/ • Small Contributor Committee Officeholder Committee • Political Party /Central Committee (ARoCormWePad7) 3. Committee Information I.D. NUMBER 1366034 Tom Fischer for City Council 2016 STREETADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREACODE/PHONE Gilroy CA 95020 408 - 847 -4716 NG ADDRESS (1F -D FFERENT) NO. AND STREET OR P.O. BOX CITY STATI ZIP CODE AREA COD&—PrNE- OPTIONAL: FAX/ E -MAIL ADDRESS Date of election H applicabi . 1 JAN - 9 2017 (Month, Day, Year) 11 /8/2016 I \e\ 2. Type of Statement: ❑ Preelection Statement m Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVER PAGE of ❑ Quarterly Statement ❑ Special Odd -Year Report Treasurer(s) NAME OF TREASURER Tom Fischer MAILINGADDRESS 745 Dawn Way STATE P CODE A CODE/P ONE Gilroy CA 95020 408 - 8474716 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 knowledge informal n 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 is true an Executed on / to / BY lure of Tressuor Ir Assistant Treasurer Executed on Date By Signature of Controlling Ofteholder, is te, M4 to measure roponant or Responsible r o Sponsor Executed on Date By Signature of Controlling 0 holder. Candidate, State Measure Proponent Executed on to By Signature of Controlling Officeholder, Candidate, State Measure Proporvant 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 RESIDENTIALIBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP 745 Dawn Way Gilroy, CA 95020 Related Committees Not Included in this Statement: Listanycommlttess 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 ZIP CODE AREA CODEIPHONE NAME OF NAME I I.D. NUMBER ADDRESS (NO P.O. ❑ YES ❑ NO CITY STATE ZIP 'CODE AREACODE/PHONE 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 NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee List names of officeholder(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 continuatiomsheets ifneceseary FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca- gov(866 /275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Amato w may of rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Tom Fischer Contributions Received 1. Monetary Contributions .................... ............................... Schedule A, Una 3 $ 2. Loans Received ................................. ............................... Schedule e, Una 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Una$ 1 + 2 $ 4. Nonmonetary Contributions ............. ............................... Schedule C. Una 3 5, TOTAL CONTRIBUTIONS RECEIVED ....... ............................Add Lines 3 +4 $ SUMMARY PAGE Statement covers period CALIFORNIA r from 11/2116 FOR- - - 4 4 through 12/31/16 Page 3 or 5 Column A Column B TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE 0.00 8,055.00 $ Schedule F, Una 3 0.00 .8,055.00 $ Lines a +e +10 $ 0.00 $ 8,545.89 144.92 0.00 $ 8,199.92 Expenditures Made Expenditure Limit Summary for State 6. Payments Made ................................. ............................... Schedule E, Una 4 $ 0.00 7. Loans Made ........................................ ............................... Schedule H, Una 3 8. SUBTOTAL CASH PAYMENTS ........... ............................... Add Lines s + 7 $ 0.00 9. Accrued Expenses (Unpaid Bills) ................... ....................... Schedule F, Una 3 10. Nonmonetary Adjustment .......................... ............................... Schedule C, Una 3 11. TOTAL EXPENDITURES MADE ............ ............................Add Lines a +e +10 $ 0.00 Current Cash Statement 12. Beginning Cash Balance .... :....................... Previous Summary Page, Una 1e $ 13. Cash Receipts ............................ ............................... Column A, Una 3 above 14. Miscellaneous Increases to Cash ... ............................... Schedule 1, Una 4 15. Cash Payments .......................... ............................... Column A, Una s above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + t4, then subtract Une l5 $ If this Is a termination statement, Line 16 must be zero. 17. LOAN' GUARANTEES RECEIVED . ............................... Schedule e, Part 2 $ Cash Equivalents and Outstanding Debts 18, Cash Equivalents ................. ............................... See insbuctions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 1045.06 0.00 106.00 0.00 1.1'50.06 11366034 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 0/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State $ 8,545.89 Candidates 22• Cumulative Expenditures Made* 8545.89 $ , IK subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd /yy) $ 8,545.89 -�- F $ $ To calculate Column B, add amounts In Column A to the corresponding *Amounts In this section may be different from amounts amounts from Column B reported in Column S. of your lastreport. Some amounts imCo►umn kmay be negative figuresrthat should be subtracted from previous period amounts. if this Is the first report being filed, for this calendar year, only,carry over the amounts from Unes 2, 7, and 9 (if any). FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov SCHEDULE'B PART 1 — Part 1 hma roununu may hole doolf Schedule B t period Statement covers. Nod p wlars. w • ®' 1 Loans Received from 11/2/16 • through 12/3111 A page 4 of S SEE INSTRUCTIONS ON REVERSE NAME OF FILER LD..NUMBER Tom Fischer 1366034 FULL NAME, STREET ADDRESS AND ZIP CODE WAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE AMOUNT t l AMOUNT PAID OUTSTANDING BALANCEAT e INTEREST THIS ORIGINAL AMOUNT OF CUMULATIVE CONTRIBUTIONS OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN! THIS PERIOD CLOSE OF THIS PAID PERIOD LOAN TO DATE PERIOD PERIOD ❑ PAID CALENDAR YEAR Tom Fischer Candidate ' 1,000.00 ` s 745 Dawn Way $ Gilroy, CA 95020 ❑ FORGIVEN RATE PER ELECTION 1,000.00 s $ 8/28/14 s t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s DATE INCURRED s. DATE DUE ❑ PAID CALENDAR YEAR $ ❑ FORGIVEN PER ELECTION" RATE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ $CC 5 t i 5 i DATE DUE DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION' RATE t [:1 IND ❑ COM ❑ OTH [I PTY [j SCC $ t DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ 7 Schedule B Summary 1. Loans received this period ...................................................................................... ..............................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ........................................................................... ..............................$ ('Tota[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 $ 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 negative number) (Enter (e) an 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 (866/278 -3772) www.fppc.ca.gov 9cha yule I Amounts may he rounded SCHEDULE I Miscellaneous Increases to Cash to whole dollars. Statement covers period from 11/2/16 .. I .® Ii ® ' through 12/31/16 Page 5 of 5 SEE INSTRUCTIO NS ON REVERSE NAME OF FILER I.D. NUMBER Tom Fischer 1366034 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMrrreE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH 12/19/2016 City of Gilroy 7351 Rosanna St. Refund of overpayment for ballot statement printing. 105.00 Gilroy, CA 95020 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 105.00 Schedule I Summary 1. Itemized increases to cash this period ............................................................................................. ..............................$ 2. Unitemized increases to cash of under $100 this period .................................................................... ..............................$ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ......... ..............................$ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.) .............................................................................................. ............................... TOTAL $ 105.00 105.00 FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov