0001209191-13-009373.txt : 20130219 0001209191-13-009373.hdr.sgml : 20130219 20130215160248 ACCESSION NUMBER: 0001209191-13-009373 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130215 DATE AS OF CHANGE: 20130215 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: NICKLES ALLEN R CENTRAL INDEX KEY: 0001265669 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-25980 FILM NUMBER: 13619707 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 X0306 5 2012-12-31 0 0 0 0000944745 FIRST CITIZENS BANC CORP /OH FCZA 0001265669 NICKLES ALLEN R 3308 E BEVERLY DRIVE SANDUSKY OH 44870 1 0 0 0 Common 2012-12-31 5 Z 0 200 D 1200 I Benefit IRA Common 2012-12-31 5 Z 0 200 A 1300 I Spouse Common 725 I Daughter Common 68700 I SEP IRA 200 shares transferred to Diane Nickles (Spouse) from Allen R Nickles Benefit IRA /s/Allen R Nickles 2013-02-15