0001209191-12-006115.txt : 20120130
0001209191-12-006115.hdr.sgml : 20120130
20120130170547
ACCESSION NUMBER: 0001209191-12-006115
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111231
FILED AS OF DATE: 20120130
DATE AS OF CHANGE: 20120130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gates Douglas J
CENTRAL INDEX KEY: 0001308959
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-25980
FILM NUMBER: 12556360
MAIL ADDRESS:
STREET 1: 100 E WATER STREET
CITY: SANDUSKY
STATE: OH
ZIP: 44870
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: FIRST CITIZENS BANC CORP /OH
CENTRAL INDEX KEY: 0000944745
STANDARD INDUSTRIAL CLASSIFICATION: STATE COMMERCIAL BANKS [6022]
IRS NUMBER: 341558688
STATE OF INCORPORATION: OH
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
BUSINESS PHONE: 4196254121
MAIL ADDRESS:
STREET 1: 100 EAST WATER ST
STREET 2: P O BOX 5016
CITY: SANDUSKY
STATE: OH
ZIP: 44870
5
1
doc5.xml
FORM 5 SUBMISSION
X0304
5
2011-12-31
1
0
0
0000944745
FIRST CITIZENS BANC CORP /OH
FCZA
0001308959
Gates Douglas J
15 ROSEDALE BOULEVARD
NORWALK
OH
44857
0
1
0
0
Sr Vice President
Common
3643
D
Common
950
D
Common
799
I
Spouse
This person has not been an Insider since he retired on April 15, 2011. Reporting this retirement was overlooked.
/s/Douglas J Gates
2012-01-30