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HomeMy WebLinkAboutSHIPMAN PREELECT10(2)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if applicable: from 10/1/2010 (Month, Day, Year) through 10/16/2010 1 11/2/2010 1. Type of Recipient Committee: AN Committees - Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Forted Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also C-PWePart 5) 0 Sponsored ❑ General Purpose Committee (asoConplefePart 6) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (A/so Compkqe Part 7) 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 COVER PAGE Date Stamp Page 1 of 6 LOt 1 Q OCT 20 11 2' W al Use Only 2. Type of Statement: ® Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also Me 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 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 knowledge formation contai herein and in the attached schedules is true and complete. I certify under penalty of perjury under glaws f the State of California that the foregoing is true and Executed on BY © Sign Assistant Treasurer Executed on BY ~7 S' C Measure Proponent or ResponableOfllcerof Sponsor Executed on By - y i DeOe Sigr>atue of CantrWNng OfAmtakler, Candidate, Stale Measure Proponent Executed on Date By SOvitwe of Controlling OfScetwkler, Candidate, Stele Measure Proponent FPPC Form 460 (January/06) FPPC Toll-Free Helpline: 8661ASK-FPPC (866!275-3772) State of California RecipientCommitbee Type or print in ink. COVER PAGE -PART 2 CALIFORNIA Campaign Statement • 1 FORM Cover Page - Part 2 Page 2 of 6 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 1 CITY COUNCIL MEMBER RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP , Related Committees Not Included in this Statement: List 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. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) 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 v.. , .~n~ ~~r ~.VUC I1RV~ {..VUUrI"IVIYC Attach continuation sheets if necessary FPPC Form 460 (JanuaryMS) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661276-3772) State of califomia BALLOT NO. OR LETTER I JURISDICTION I El SUPPORT ❑ OPPOSE Campaign Disclosure Statement Type or print in ink. d d SUMMARY PAGE P e Amounts may be roun l Statem ent covers period CALIFORNIA 1 age Summary ars. to whole dol 10/1/2010 FORM from through 10/16/2010 paw 3 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER JERRY M. SHIPMAN 1329144 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR T DATE Running in Both the State Primary and g (FROMATTACHED SCHEDULES) TOTAL O General Elections ib ns 1 M t C t ti Line 3 Schedule A $ 2050. $ 4399 . one ary on r u o , t/1 through 6/30 7/1 to Date 4114. 2. Loans Received Schedule B, Line 3 SUBTOTAL CASH CONTRIBUTIONS 3 Add Lines t + 2 $ 2050. $ 8513 20. Contributions 8513 . Received $ $ Contributions 4 N m r t Line 3 schedule C di . on one y a , tures 21. Expen 81 4104 TOTAL CONTRIBUTIONS RECEIVED 5 AddLines3+4 2050. $ $ 8613 . Made $ $ . Expenditures Made 6. Payments Made schedule E, Line 4 $ 7. Loans Made Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F Line 3 10. Nonmonetary Adjustment schedule C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines s + s + 10 $ 409.17 $ 409.17 $ 100.00 309.17 $ 4204.81 4204.81 100.00 4104.81 Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash schedule 1, Line 4 15. Cash Payments Column A, Line b above 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement; Line 16 must be zero. 2767.36 2050. 409.17 4408.19 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). 17. LOAN GUARANTEES RECEIVED Schedule e, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents see instructions on reverse $ 4408.19 19. Outstanding Debts Add Line 2 + Line 9 in Column B above $ 4114.00 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subjed to vuwuwry ExpwwNW a umR1 Date of Election Total to Date (mm/dd/yy) $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772) Q..tinrln ale A Type or print in ink. SCHEDULE A w§.v....... - Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA • 0 10/1/2010 from through 10/16/2010 Page 4 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER JERRY M. SHIPMAN 1329144 DATE CODE OF CONTRIBUTOR FULL NAME, STREET ADDRESS AND ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND DARREL AHRENS [3Com MINISTER 1000 1000. 10/5/10 ❑OTH . ❑ PTY [3 SCC O IND RONNIE CLAIBORNE ❑COM MD 500 500. 10/12/10 ❑OTH . ❑ PTY ❑ SCC ® IND CHARLES YONKE ❑COM AERO 500 500. 10/12/10 ❑OTH . ❑ PTY ❑ SCC ❑ IND ❑ COM [3 OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 2000. Schedule A Summary 1. Amount received this period - itemized monetary contributions. 2000. (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 $ 50 *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 2050. FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772) - Tvoe or crint in ink. $ - % VII Wvuti v Amounts may be rounded Nonmionetary Contributions Received to whole dollars. Statement covers period ' CALIFORNIA 10/1/2010 - from 10/16/2010 5 6 through of Page SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER 1329144 JERRY M. SHIPMAN 7 6 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE DATE RECEIVED ZIP CODE OF CONTRIBUTOR NUMBER CODE * (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) (IF REQUIRED) ) (IF COMMITTEE, ALSO ENTER I.D. NAME OF BUSINESS) ❑IND NSF CHECK RETURNED pCOM 100.00 100.00 FROM BANK pOTH El PTY ❑SCC pIND ❑COM ❑OTH p PTY ❑SCC pIND pCOM pOTH El PTY ❑SCIC pIND pCOM pOTH E-] PTY ❑SCC nr+-,.), -4,4iifinnmr infnrmatinn nn anmmnriatP1V laha/ed continuation sheets. SUBTOTAL $ 100. Schedule C Summary 1. Amount received this period - itemized nonmonetary contributions. (include all Schedule C subtotals.) $ 2. Amount received this period - unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) TOTAL $ 100. SCHEDULE C '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: 866/ASK-FPPC (866/2753772) . f a - 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 10/1/2010 through 10/16/2010 Page 6 of 6 I.D. NUMBER 1329144 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP 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 nonmonetary)* OFC office expenses SAL salaries campaign workers CVC civic donations PEF 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 i TRS TSF staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor M independent expenditure supporting/opposing others (explain) POS ces postage, delivery and messenger serv LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE OF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID HOME DEPOT POST, SIGNAGE EQUIPMENT, TAGS 409.17 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 409.17 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 2. Unitemized payments made this period of under $100 $ 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 Summary Page, Column A, Line 6.) TOTAL $ 409.17 409.17 FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 8661ASK-FPPC (8661275-3772)