HomeMy WebLinkAboutSHIPMAN 460 TERMINATION1
Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Statement covers period
from 10/17/2010
through
1/6/2011
1. Type of Recipient Committee: AN Committees -Complete Parts 1, 2, s, and 4.
® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
Q State Candidate Election Committee Committee
O Recall Q Controlled
(Also Complete Fart S) Q Sponsored
(AW CWrOete FBrt0)
❑ General Purpose Committee
Q Sponsored ❑ Primarily Formed Candidate/
Q Small Contributor Committee Officeholder Committee
Q Political Party/Central Committee (Also Complete Part n
3. Committee Information 1 I.D. NUMBER
1329144
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
SHIPMAN FOR COUNCIL 2010
STREET ADDRESS (NO P.O. BOX)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY
STATE
ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
Date of election if applicable:
(Month, Day, Year)
11/2/2010
Daft stamp
2011 J N31{i 1
11J. 3 P.ge or official Use only
2. Type of Statement:
❑ Preelection Statement
❑ Semi-annual Statement
® Termination Statement
(Also file a Form 410 Termination)
❑ Amendment (Explain below)
❑ Quarterly Statement
❑ Special Odd-Year Report
❑ Supplemental Preelection
Statement -Attach Form 495
Treasurer(s)
NAME OF TREASURER
BERNARD ANTHONY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
4. Verification
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my k
under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Executed on
uab
Executed on
e
Executed on
Dab
Executed on
Dab
BY
BY
schedules is true and complete. 1 certify
V Sig MhM orCor*oarg OM Wh0kJer. Canddab, stale Measure Proparart
SW eWre dCo *dkg Ollicelwlder, Car ddab, Stet Meemm Propmgrt FPPC Form 460 (Janwry106)
FPPC Toil-Free Helpline: 11IMASK-FPPC (66612753772)
State of CaBfomis
Type or print in ink. COVER PAGE -PART2
Recipient Commit e
CALIFORNIA
Campaign Statement . 460
Cover Page - Part 2
Page 2 of 8
5. Officeholder or Candidate Controlled Committee
NAME OF OFFICEHOLDER OR CANDIDATE
JERRY M. SHIPMAN
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
WARD Q CITY COUNCIL MEMBER
RESIDENTIAL/BUSINESS ADDRESS (NO. AND
Related Committees Not Included in this Statement: ust any committees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behalf of your candidacy.
COMMITTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEENAME I.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
❑ YES ❑ NO
COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX)
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT
❑ OPPOSE
Identity the controlling officeholder, candidate, or state measure proponent, N any.
NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT
OFFICE SOUGHT OR HELD
DISTRICT NO. IF ANY
7. Primarily Formed Candidate/Officeholder Committee List names of
otllceholdWs) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE
OFFICE SOUGHT OR HELD
❑ SUPPORT
❑ OPPOSE
CITY STATE ZIP CODE AREA CODEIPHONE Attach continuation sheets if necessary
FPPC Fomn 460 (Je uary/05)
FPPC Toll-Free Helpline: 866/ASK4FPPC (8661275-3772)
State of cautomia
Campaign Disclosure Statement
Type or print in ink.
SUMMARY PAGE
Summary Page
Amounts may be rounded
to whole dollars.
Statement coven period
, -10
CALIFORNIA
•
from
10/17/2010 FORM
SEE INSTRUCTIONS ON REVERSE
through
1/6/2011 Page 3 of 8
NAME OF FILER
I.D. NUMBER
JERRY M. SHIPMAN
1329144
Contributions Received
Column A
Column B
Calendar Year Summary for Candidates
TTH OD
(FROMATTACACHEDSCHDSCMEDULES7
ALTO TE
CALENDAR
TOTALTODATE
Running in Both the State Primary and
9 ry
General Elections
1. Monetary Contributions Schedule A, Line 3
$
775.00
$ 5174.
2. Loans Received schedule e. Line 3
4114.
1/1 through 6W 7/1 to Date
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines i + 2
$
775.00
$ 9288.
20. Contributions 9288
Received $ $
4. Nonmonetary Contributions Schedule C, Line 3
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED AddLines 3+4
$
775.00
9288.
$
Made $ $ 9288
Expenditures Made
Expenditure Limit Summary for State
6. Payments Made Schedule E, Line 4
$
5183.19
$ 9288.
Candidates
7. Loans Made Schedule H, Line 3
8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7
$
5183.19
9288
$
22. Cumulative Expenditures Made*
(WSW*@&to vohmbry EM-u lk- U-M
9. Accrued Expenses (Unpaid Bills) Schedule F Line 3
Date of Election Total to Date
10. Nonmonetary Adjustment
Schedule C. Line 3
(mm/dd/yy)
11. TOTAL EXPENDITURES MADE Add Lines 6 + s + 10
$
5183.19
$ 9288.
$
Current Cash Statement
$
12. Beginning Cash Balance Previous Summary Page, Line 16
$
4408.19
To calculate Column e, add
13. Cash Receipts Column A, Line 3 above
775.
amounts in Column A to the
14. Miscellaneous Increases to Cash Schedule 1, Line 4
corresponding amounts
from Column B of your last
*Amounts in this section may be different from amounts
reported in Column B.
15. Cash Payments Column A, Line s above
5183.19
report. Some amounts in
Column A may be negative
16. E WM CASH BALANCE Add Lines 12 + 13 + 14, (hen subtract Line 15
$
figures that should be
subtracted from previous
if this is a termination statement, Line 16 must be zero,
period amounts. If this is
the first report being filed
17. LOAN GUARANTEES RECEIVED Schedule B, Pan 2
$
for this calendar year, only
carry over the amounts
Cash Equivalents and Outstanding Debts
from ones 2, 7, and 9 (if
y)
18. Cash Equivalents see instructions on reverse
$
19. Outstanding Debts Add Line 2 + tine 9 in Column a above
$
FPPC Form 460 (January/05)
FPPC Toll-Free Heiplins: 868/ASK-FPPC (8661275-3772)
Schedule A Type or print in ink.
Monetary Contributions Received Amounts may rounded
to whole doof llars.
Statement covers period
from 10/17/2010
SCHEDULE A
SEE INSTRUCTIONS ON REVERSE through 1/6/2011 Page 4 of 8
NAME OF FILER I.D. NUMBER
JERRY M. SHIPMAN 1329144
DATE
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
DE O
CONTRIBUTOR
IF AN INDIVIDUAL, ENTER
AMOUNT
CUMULATIVE TO DATE
PER ELECTION
RECEIVED
ALSO ENTER NUMBER)
CODE *
OCCUPATION AND EMPLOYER
RECEIVED THIS
CALENDAR YEAR
TO DATE
OF SELF-EMPLOYED, ENTER NAME
PERIOD
(JAN. 1 - DEC. 31)
(IF REQUIRED)
OF BUSINESS)
10-25-2010
CU CURTIS FLOYD
❑COM
ATTORNEY
500
00
500
00
❑ OTH
.
.
El PTY
❑SCC
MIND
MICHAEL REED
C
OOM
❑
10-22-2010
O
❑
100.00
100.00
❑ PTY
❑ SCC
❑IND
11/4/2010
CHARLIE STOWELL
❑
OM
C
RETIRED CDC
100
00
100
00
❑
O
.
.
M PTY
❑ SCC
MIND
❑COM
❑ OTH
M PTY
❑ SCC
❑IND
❑COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL $ 700.
Schedule A Summary
1. Amount received this period - itemized monetary contributions.
(Include all Schedule A subtotals.) $
2. Amount received this period - unitemized monetary contributions of less than $100 $
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) TOTAL $
700.00
75.00
775
"Contributor Codes
IND - Individual
COM-Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC-Small Contributor Committee
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)
SCHEDULEB-PART1
Schedule B - Part 1 Amoun~ '"ts'"'ma"y""tI'e"'rounded..._.
Statement covers period
Loans Received to whole dollars.
10/17/2010
CALIFORNIA
• 1
from
FORM
1/6/2011
8
5
SEE INSTRUCTIONS ON REVERSE
through
of
Page
NAME OF FILER
I.D. NUMBER
JERRY M. SHIPMAN
1329144
FULL NAME, STREET ADDRESS AND ZIP CODE
IF AN INDIVIDUAL, ENTER
OUTSTANDING
AMOUNT
tN
A AID
OUTS ANDING
INTEREST
ORIGINAL
III)
CUMULATIVE
OF LENDER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER
BALANCE
BEGINNING THIS
RECEIVED THIS
OR R FORGIVEN
BALANCEAT
CLOSE OF THIS
PAID THIS
AMOUNT OF
CONTRIBUTIONS
(IF COMMITTEE, ALSO ENTER t.D.NUMBER)
NAME OF BUSINESS)
EERIOD
PERIOD
THIS PERIOD;
RI
PERIOD
LOAN
TO DATE
_
JERRY M. SHIPMAN
® PAID
CALENDAR YEAR
$ 1750.56
s 0
4114.
11
® FORGIVEN
RATE
PER ELECTION-
$ 4114.
$ 0.
S 2363.44
$
s
t® IND ❑ COM ❑ OTH p PTY ❑ SCC
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
S
S
%
S
S
❑ FORGIVEN
RATE
PER ELECTION"
$
S
f
$
S
t❑ IND ❑ COM E] OTH C] PTY SCC
DATE DUE
DATE INCURRED
❑ PAID
CALENDAR YEAR
S
i
%
S
S
❑ FORGIVEN
RATE
PER ELECTION"
S
:
S
S
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
DATE DUE
DATE INCURRED
SUBTOTALS $ $ 4114.00 $ 0 $ 0
Schedule B Summary
1. Loans received this period $
(Total Column (b) plus unitemized loans of less than $100.)
2. Loans paid or forgiven this period $
(Total Column (c) plus loans under $100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
3. Net change this period. (Subtract Line 2 from Line 1.)
Enter the net here and on the Summary Page, Column A, Line 2.
"Amounts forgiven or paid by another party also must be reported on Schedule A.
- If required.
(Enter (B) on
Sdie" E, Lne 3)
0
4114.00
tContributor Codes
IND - Individual
COM -Recipient Committee
(other than PTY or SCC)
OTH - Other (e.g., business entity)
PTY - Political Party
SCC - Small Contributor Committee
NET $ 0
(May be a negative m-bo
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 86WASK-FPPC (866/275-3772)
Schedule E
Payments Made
SEE INSTRUCTIONS ON REVERSE
Type or print in ink.
Amounts may be rounded
to whole dollars.
NAME OF FILER
JERRY M. SHIPMAN
Statement covers period
from 10/17/2010
through 1/6/2011
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
Page 6 of 8
1329144
CNP
campaign paraphemalia/misc.
MBR
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nnonmonetary)*
OFC
office expenses
SAL
campaign workers' salaries
CVC
civic donations
PET
petition circulating
T&
t.v. or cable airtime and production costs
FIL
candidate fifing/ballot flees
PHO
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff/spouse travel, lodging, and meals
I ND
independent expenditure supporting/opposing others (explain)*
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate/sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
voter registration
Lrr
campaign literature and mailings
PRT
print ads
VVEB
information technology costs (intemet, e-mail)
NAME AND ADDRESS OF PAYEE
OF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNTPAID
611 HOME BUYERS
OFFICE SPACE, OFFICE EQUIPMENT,TELEPONE
MEDIA PLACE
500.00
ALBERTSON MARKET
VOLUNTEERS-PHONE BANK
MEALS AND REFRESHMENT
75.03
A TEAM PRODUCTION
PRODUCTION OF VIDEO AND AUDIO
TEL
250.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS 825.03
Schedule E Summary
1. Itemized payments made this period. Include all Schedule E subtotals. $ 5045.19
2. Unitemized payments made this period of under $100 $ 138.00
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) $
4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summa Page, Column A, Line 6. TOTAL $ 5183.19
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 8661ASK-FPPC (86612753772)
Schedule E
(Continuation Sheet)
Payments Made
REVERSE
NAME OF FILER
JERRY M. SHIPMAN
type or print in ink.
Amounts may be rounded
to whole dollars.
SCHEDULE E (CONT.)
Statement covers period CALIFORNIA
10/17/2010 FORM s
from
through 1/6/2011 Page 7 of 8
I.D. NUMBER
1329144
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CW
campaign paraphernalia/misc.
NW
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
CTB
contribution (explain nonmonetary)*
OFC
office expenses
SAL
campaign workers' salaries
CVC
civic donations
PET
petition circulating
TEL
t.v. or cable airtime and production costs
FIL
candidate filing/ballot fees
PHO
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff/spouse travel, lodging, and meals
IND
independent expenditure supporting/opposing others (explain)*
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate/sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
voter registration
LIT
campaign literature and mailings
PIT
print ads
WEB
information technology costs (internal, e-mail)
NAME AND ADDRESS OF PAYEE
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
AMERICAN GENERAL MEDIA
AUDIO BROADCAST
RAD
399.50
KBFX
VIDEO BROADCAST
TEL
382.00
KGET
VIDEO BROADCAST
TEL
413.10
KERO
VIDEO BROADCAST
TEL
476.00
KBAK
VIDEO BROADCAST
459.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2129.60
FPPC Form 460 (January/05)
FPPC Toll-Free Helplins: 866/ASK-FPPC (066/275-3772)
Schedule E
(Continuation Sheet)
Payments Made
ON
NAME OF FILER
JERRY M. SHIPMAN
Type or print in Ink.
Amounts may be rounded
to whole dollars.
Statement covers period
SCHEDULE E (CONT.)
from 10/17/2010
through 1/6/2011
Page 8 of 8
I.D. NUMBER
1329144
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise,
describe the payment.
CLIP
campaign paraphemalia/misc.
NBR
member communications
RAD
radio airtime and production costs
CNS
campaign consultants
MTG
meetings and appearances
RFD
returned contributions
'
CTB
contribution (explain nonmonetary)'
OFC
office expenses
SAL
salaries
campaign workers
CVC
civic donations
PET
petition circulating
TEL
t.v. or cable airtime and production costs
FL
candidate filing/ballot fees
PHO
phone banks
TRC
candidate travel, lodging, and meals
FND
fundraising events
POL
polling and survey research
TRS
staff /spouse travel, lodging, and meals
IPD
independent expenditure supporting/opposing others (explain)'
POS
postage, delivery and messenger services
TSF
transfer between committees of the same candidate/sponsor
LEG
legal defense
PRO
professional services (legal, accounting)
VOT
voter registration
LIT
camoaian literature and mailings
PRT
print ads
VVEB
information technology costs (intemet, e-mail)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
BUCKLEY RADIO
RAD
AUDIO BROADCASTING
340.00
JERRY M. SHIPMAN
RFD
REFUND LOAN PARTIALLY
1750.56
" Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2090.56
FPPC Form 460 (January/05)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)