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Home My WebLink AboutSHIPMAN 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)