0001209191-12-041617.txt : 20120814 0001209191-12-041617.hdr.sgml : 20120814 20120814164006 ACCESSION NUMBER: 0001209191-12-041617 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120813 FILED AS OF DATE: 20120814 DATE AS OF CHANGE: 20120814 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: WURM GERALD B CENTRAL INDEX KEY: 0001193469 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25980 FILM NUMBER: 121033632 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-08-13 0 0000944745 FIRST CITIZENS BANC CORP /OH FCZA 0001193469 WURM GERALD B 4905 ALBAUGH ROAD NEW WASHINGTON OH 44854 1 0 0 0 Common 2012-08-13 4 P 0 611 5.77 A 39380 D Common 2735.4438 D Common 980.5107 I Daughter #1's Trust Common 564 I Daughter #2's Trust Common 550 I Grandson #1 Common 550 I Grandson #2 /s/Garld B Wurm 2012-08-14