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HomeMy WebLinkAboutSHIPMAN 410 1/6/11 tERMStatement of Organization STATEMENT OF ORGANIZATION Recipient Committee Typeorprintinink Detestamp Statement Type Initial Not yet qualified 0 or Date quaified as committee Amendment List I.D. number. Dale qudW as committee (s appic") 1. Committee Information 2• NAME OF COMMITTEE SHIPMAN FOR COUNCIL 2010 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) OP'nONAL• FAX / E-MAIL ADDRESS COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE KERN Afi' d- adalMbna/ irAwmadlon on appropride0y ial*led oontiasr ibn sheets. 01r I' O.A f f p v -&o t b o-j e ?-I I I Treasurer an Other Principal Officers NAME OF TREASURER BERNARD ANTHONY STREET ADDRESS CRY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE MAILING ADDRESS CRY STATE ZIP CODE AREA CODE/PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information n he Is mplete. I certify under penalty of oop I? ! perjury under the laws of the State of California that the foregoing is true and correct. ~.~C~ss il.~ Executed on EV - " - SIGNIOURE gt OR ASEPPANT TREASURER Executed on Ev (I jF D F CO OFF Executed on By ZM27 NP150-' DER, CANDID/t<E, OR STATE MEASURE PROPONENT DATE SIGNI4URE OF CONTROLLING OFFICEHOLDER. CANDID/GE, OR SDATE MEASURE PROPONENT Executed On Bjl DATE SIGFLCIJRE OF CONTROLLING OFFICEHOLDER, . ® Termination - See Part 5 List I.D. number: # 1329144 use 1/ a'_ 6 1 11 Date ofTemtination FPPC Form 410 (Jan/01) FPPC Toll-Free Heloline: UNASK-FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE SHIPMAN FOR COUNCIL 2010 4. Type of Committee Complete the applicable sections. • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non-partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDA'E/OFFICEHOLDERISTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY JERRY M. SHIPMAN CITY COUNCIL WARD 1 2010 Non-Partisan Non-13arrtsan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) ADDRESS CITY STATE ZIP CODE Primarily formed tosupport or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE Pap• 2 1329144 NAME OF FINANCIAL INSTITUTION AREA CODEIPHONE BANK ACCOUNT NUMBER CHASE 10871294914 FPPC Form 410 (JarM ) FPPC Toll-Free Heipline: SWASK-FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE SHIPMAN FOR COUNCIL 2010 4. Type of Committee (continued) s 1329144 • Not forrrled to support or oppose specific candidates or measures in a single election. Check only one box: © CITY Committee E]COUNTYCommittee C]STATECommittee PROVIDE BRIEF DESCRIPTION OF ACTIVITY CAMPAIGN FOR CITY COUNCIL SEAT List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE • • ❑ Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a small Date qualified contributor committee on January 1, 2001, enter 1/1101. 5. Termination Requirements By signing the verification,thetreasurer,assistant treasurer and/or candidate, officeholder, orproponentcertifydwtalofthefoNowingconditiomhavebeenmet: • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. Additional filing obligations will be incurred if, after terminating, the committee receives or spends any funds, or receives the forgiveness of a loan, repayments of loans made to others, or any other receipts. FPPC Form 410 (Jan/01) FPPC Toll-Free Helpline: 866/ASK-FP1PC