0001209191-12-010437.txt : 20120215 0001209191-12-010437.hdr.sgml : 20120215 20120215152854 ACCESSION NUMBER: 0001209191-12-010437 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111231 FILED AS OF DATE: 20120215 DATE AS OF CHANGE: 20120215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WURM GERALD B CENTRAL INDEX KEY: 0001193469 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25980 FILM NUMBER: 12615835 MAIL ADDRESS: STREET 1: 100 EAST 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 0 0 0 0000944745 FIRST CITIZENS BANC CORP /OH FCZA 0001193469 WURM GERALD B 4905 ALBAUGH ROAD NEW WASHINGTON OH 44854 1 0 0 0 Common 34569 D Common 2706.7594 D Common 970.2278 I Daughter #1's Trust Common 564 I Daughter #2's Trust Common 550 I Grandson #1 Common 550 I Grandson #2 Catch up filing of DRIP shares acquired as of 12/31/2009 /s/Gerald B Wurm 2012-02-15