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Jensen 460Recipient t Co r�lttee COVER PAGE Camp State m e M Ty r ti nt in ink yp p ..,:;F ......Date.Stam P Cover Y rt (Government Code Sections 84204 84216.5 e Statement covers period Date of election if applicable g e� O P LJ Day, e Month Da Year) F Official Use Only from INSTRUCTIONS REVERSE 1' A I p SEE ON through Type o f Reci Commi All Committees Complete Parts 'l; 2; 3, a nd 4. 2. Type o f.Sta te ment: officeholder, Candidate Controlled Committee Primaril .F r r y o ed Measure Preelection State Quarterly Statement 0 State Candidate Election Committee Committee E Semi- annual Statement Special Odd -Year Report Recall (Also Complete Part 5) 0 Controlled Sponsored Termination Statement Supplemental Preelection PP (Also Complete Part 6) Als fle a Form 410 Termination) Statement Attach Form 495 General Purpose Committee Amendment (Explain below) Spflnsvred Primarily Formed Candidat el 0 .Small Contributor. Committee Officeholder Committee Political Party /Central Committee (Afso Complete Part 7) 3. Committee Information D. NUMBER T reasure r (s) COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURE 4 t MAILING ADDRESS S TR E ET ADDRESS.(N0 P.O, BOX) CITY STATE ZIP CODE REA CDDEJPHON A 6vvv. CITY STATE ZIP CODE .AREA .CODEJPHO E NAME OF ASSISTANT TREASURER;. IF ANY 6 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.D. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE CITY STATE ZIP CODE AREA CODE/PHONE Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January105) FPPG Toll- Free Helpline: 866 /ASK -FPPC (85fi1275- 3772) State Of California ii O `CALF RN IA FORM 4 P age of 4 6. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF. OFFICEHOLDER OR .CANDIDATE NAME OF BALLOT MEASURE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION SUPPORT r] OPPOSE RESIDENTIALIBU NESS ADDRESS (NO. AND STREET) CITY STATE ZIP c q Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT Related Cormmi ,Not I n c Iuued. in this .Statement:. List any committees .not. inciuded. in this.: statement that are controlled ,by you or are primarily farmed to receive OFFICE SOUGHT OR HELD DISTRICT NO, IF ANY contributions '.3rmake:.experl[, itures: on. behalf Uf. ur candidacy. COM MITTEE NAME D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7. Primarily Fo Candidatelofficeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily forayed. Kin NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT OPPOSE NAME OF 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 FPPG Form 460 Wanuaryl45) FPPC Toll -Free Helpline: 866 FPP.0 (86.612 75 -3772) Sate oUCalifornia Campai Disclosure Statement T or print in ink. Amounts ma be rounded Statement covers period Summar Pa to whole dollars. f rom 0, r7, i SEE INSTRUCTIONS ON REVERSE through lo NAME OF FILER Contributions Received (if Subject to Voluntar Column A Column B Total to Date (mm/dd/ TOTAL TH I S PER I OD CALENDAR YEAR F ROM ATTACHED SCHEDULES TOTAL TO DATE 1. Monetar Contributions Schedule A, Line 3 Z.2 2. Loans Received Schedule B, Line 3 1 SUBTOTAL CASH CONTRIBUTIONS Add Lines I 2 4. Nonmonetar Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 4 2q SUMMARY PAGE Pa of I.D. NUMBER Calendar Year Summar for Candidates Runnin in Both the State Primar and General Elections 1/1 throu 6130 7/1 to Date 20. Contributions Received 21. Expenditures Made :.-xpenditures Madz 6. Pa Made Schedule E, Lire 4 �3�� 7. Loans Made Schedule H. Line 3 8. SU BTOTAL CAS H PAYM ENTS Add Lures 6+7 9. Accrued Expenses (Unpaid Bills) Schedule F Line 3 10. Nonmonetar Adjustment Schedule C, Line 3 1 1. TOTAL EXPENDITURES MADE Lines 8 9 10 r C 2 Current Cash Statement 12. Be Cash Balance Previous Summar Pa Line 16 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule Line 4 15. Cash Pa Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 12 13 14, then subtract Line 15 -4) If this is a termination statement. Line 16 must be zero. 17 LOAN GUARANTEES RECEIVED- Schedule B, Part 2 Cash E and Outstandin Debts 18. Cash E See instructiorts on reverse 19. Outstandin Debts Add Line 2 Line 9 in Column B above To calculate Column B, add amounts in Column A to the correspondin amounts from Column B of y our last report. Some amounts in Column A ma be negative I fi that should be subtracted from previous period aMOUnts- If this is the first report bein filed for this calendar y ear, onl carr over the amounts from Lines 2, 7., and 9 (if an Expenditure Limit Summar for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntar Expenditure Limit) Date of Election Total to Date (mm/dd/ *Since Januar 1, 2001. Amounts in this section ma be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll-Free Helpfine: 866/ASK-FPPC Schedule A Type or print in ink. SCHEDULE A on etar y Contr Amounts may he rounded Statement covers period to whole dollars. from SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER o DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ALSO ENTER I D (IF COMMITTEE, I. NUMBER} CONTRIBUTOR IF. AN INDIVIDUAL; ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ..CODE (IF SELF ENTER NAME PERIOD (.SAN. 1 DEC. 31) (IF REQUIRED) OF BUSINESS} QIND 0 CtM [DO C PTY /.0 c) [DINE) ❑CDM OTH PTY SCC IND ❑Cam 00TH PTY EISCC IND ❑CoM D OTH F❑ PTY SCC IND 1 7 cOM F❑ OTH PTY 0S CC SUBTOTAL: Schedule A Summary 1: Amount received this period itemized monetary contributions./ 00 (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 an the Summary Page, Column A, Line 1.) TOTAL FP P arm 4fifl; January105 FPPC Toll -Free Helpline: 8661ASK -FPPC: (8661275 -3772) Schedule D Summar of Expenditures Supportin Other Coandidates, Measures and Committees SEE INSTRUCTIONS owREVERSE NAME OF FILER Statement covers period from 1, fo throu SCHEDULED Page m__� W. NUMBER DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION IF REQUIRED) CUMULATIVE TO DATE AMOUNTTHIS CALENDAR YEAR PERIOD JAN, 1 DEC, 31 PER ELECTION TO DATE IF REQUIRED Contribution -2� 10 Contribution 1:1 Independent 1__/1 7 Support Oppose Expenditure Monetar Contribution Nonmonetar Contribution Independent Support Oppose Expenditure E] Monetar Contribution E] Nonmonetar Contribution Independent Support oppose Expenditure SUBTOTAL 1. Contributions and independent expenditures made this period of$1ODor more. (include all Schedule Osubiotaks.) 2. Unitemized contributions and independent expenditures made this period of under $100 3. Total contributions and independent expenditures made this period. Add Lines 1 and 2. Do not enter on the Summar Pa TOTAL Type or nom in ink. Amounts may be rounded to whole dollars. FpPC Form 46o(Junem1) Schedule E Pa Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. NAME OF FILER Statement covers period from through CODES: if one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment SCHEDULE E Page of I.D. NUMBER CMP campaign paraphernalia /misc. MBR member communications RAID 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 F1L candidate filinglballot 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 candidatelsponsor LEO legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings. PRT print ads VVEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (1F COMMITTEE, ALSO ENTER 11", NUMBER) /9 tAeA� S -4-4 c �tf'2�e Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL Schedule E Summary 1. Payments made this period of $100 or more. 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.} .................e........,.. TOTAL FPPC Form 460 (June/0 FPPC Toll Free Helplinee 866IAS -FPP