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