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HomeMy WebLinkAboutSHIPMAN 410 1/06/11Staterlment ,of Organization Recipient Committee Statement Type 0 Initial / Not yet qualified 0 or -J~ Date qualified as committee 1. Committee Information Type or print in ink El Amendment List I.D. number. Date qualified as committee (if eppl-be) in © Termination - See Part 5 List I.D. number. # 1329144 1/ 1 6 1 11 Date of Termination NAME OF COMMITTEE SHIPMAN FOR COUNCIL 2010 STREET ADDRESS (NO PO. BOX) CITY STATE ZIP CODE AREA CODERHONE MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX / E-MAIL ADDRESS COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE KERN Attach additional information on appropriately labeled continuation sheets. Ov-lvcly AND Office of the Secretary D a r'f the State Ot Ca!if0ml 2o j l(~0a EBRA'rJ6WE Icretary Of State, ORGANIZATION 15 AM 00 VED: 2. Treasurer and Other Principal Officers NAME OF TREASURER BERNARD ANTHONY STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE AREA CODEIPHONE NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE MAILING ADDRESS CITY 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 her . is omplete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on BY A SIGN/Al1RE RER OR AS ANT TREASURER Executed on DY ° D ZIG7F CON G OFF DER, CANDIDATE, OR STATE MEASURE PROPONENT Executed On 131 DATE smujsn IDG nc rnu nl i imr. nFFICEH01 nFD reunlnere - mreTC &A-1 IOC DDnDnk1FNT Executed on By DATE SIC4-UMRE OF O L IN OF I R A U PR FPPC Form 410 (Jan/01) FPPC Toll-Free Heloline: 6661ASK-FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE GUMMm ILL NAMt - - I.D. NUMBER SHIPMAN FOR COUNCIL 2010 1329144 4. Type of Committee Complete the applicable sections. Controlled Committee • 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. NAME OF CANDIDArE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT HELD (INCLUDE DISTRICT NUMBER IF AP APPLICABLE) YEAR OF ELECTION PARTY JERRY M. SHIPMAN CITY COUNCIL WARD 1 2010 g] Non-Partisan E] Non-Partisan • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER CHASE ADDRESS CRY STATE ZIP CODE • - • . Primarily formed to support 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 OPPOSE FPPC Form 410 (Jan/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER SHIPMAN FOR COUNCIL 2010 1329144 4. Type of Committee (Continued) General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITYCommittee 0 COUNTY Committee n sTATECommittee PROVIDE BRIEF DESCRIPTION OF ACTIVITY CAMPAIGN FOR CITY COUNCIL SEAT Sponsored List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE Small Contributor El 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, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all ofthe following conditions have been met: • 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-FPPC