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Tracy Jensen for School Board 460Recipient Committee Campaign Statement (Government Code Sections 84200-84216.5) Statement covers period from 10/20/2002 through 12/31/2002 1. Type of Recipient Committee: Ill Officeholder, Candidate Controlled Committee D Ballot Measure Committee @ State Candidate Election Committee 0 Primarily Formed 0 Recall 0 Controlled 0 Sponsored D General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information COMMITTEE NAME D Primarily Formed Candidate Officeholder Committee l.D. NUMBER 1247658 Tracy Jensen for School Board STREET ADDRESS (NO P.O. BOX) CITY Alameda STATE ZIP CODE CA 94501 STREET ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX/E-MAILADDRESS I 4. Verification AREA CODE/PHONE (510) 523 1861 AREA CODE/PHONE FEB ... 4 2003 1 of 7 Date of Election if applicaCi {Month, Day, Year) Y Clork' S Off ic A For Official Use Only 11/05/2002 2. Type of Statement: D Pre-election Statement l!I Semi-annual Statement D Termination Statement D Amendment (Explain below) Treasurer{s) NAME OF TREASURER Jill Cabeceiras STREET ADDRESS CITY Alameda NAME OF ASSISTANT TREASURER, IFANY STREET ADDRESS CITY OPTIONAL: FAX/E-MAIL ADDRESS D Quarterly Statement D Special Odd-Year Report D Supplemental Pre-election Statement -Attach Form 495 STATE ZIP CODE AREA CODE/PHONE (510)523 1861 CA 94501 STATE ZIP CODE AREA CODE/PHONE ( ) I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of C · or.nii 'that }t\eJg;ing'is true and correct. Executed on 01/07 /2 0 03 By --------1--- ~,,.,~~=~~~~=~~==-----------DATE Executed on 01i07 i'.2003 By DATE Executed on 01£'.'.07 £'.'.2003 By DATE Executed on 01i07 i'.'.2003 By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT S/CCW -PCAP03030142115 (Rev. 9/99) State of CalHornia Fair Political Practices Commission. Recipient Committee Campaign Statement Cover Page -Part 2 COVER PAGE -PART 2 5. Officeholder or Candidate Controlled Committee 6. Ballot Measure Committee NAME OF OFFICEHOLDER OF CANDIDATE Tracy Jensen OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Board of Education, District RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP CODE Alameda CA 94501 Related Committees Not Included in this Statement: Ustanycommittees not induded in this consolidated statement that are controlled by you or which are primarily formed to receive contributions or to make expenditures on behalf of your candidacy. COMMITTEE NAME 1.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME 1.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION Cl SUPPORT CJ OPPOSE 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 1. Primarily Formed Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD D SUPPORT D OPPOSE Campaign Disclosure Statement Summary Page NAMEOFFILER Tracy Jensen, Tracy Jensen for School Board Contributions Received Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions ..................................... Schedule A, Line 3 $ 6 5 o • O O 2. Loans Received ................................................ Schedule 8, Line 7 0.00 3. SUBTOTAL CASH CONTRIBUTIONS .................. Add Lines 1+2 $ ____ _;6;:..;;5;;....:0"'"'.'""o""o'- 4. Non-monetary Contributions ............................. Schedule C, Line 3 0. 00 5. TOTAL CONTRIBUTIONS RECEIVED ................. Add Lines 3 + 4 $ _____ 6""'5"'"'0:;....:...;. o .... o._ Expenditures Made 6. Cash Payments ................................................ Schedule E, Line 4 $ -----""'-'--"'~:....:..;;""'--3 050.30 7. Loans Made ...................................................... Schedule H, Line 7 0.00 3 050.30 8. SUBTOTAL CASH PAYMENTS ............................ Add Lines 6 + 7 $ ----"'-'-"-'"""'"'-~'- 9. Accrued Expenses (Unpaid Bills) ...................... Schedule F, Line 3 0.00 10. Nonmonetary Adjustment ................................ Schedule C, Line 3 0.00 3 050.30 11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ ----"'-'-"-'""""'-:...;;;;...;'- Current Cash Statement 2 400.30 12. Beginning Cash Balance .......... Previous Summary Page, Line 16 $ ---~....w::~:...:...;;;:..:.:.... 13. Cash Receipts ......................................... Column A, Line 3 above 650.00 14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 0.00 15. Cash Payments ....................................... Column A, Line 8 above 3 050.30 0.00 16. ENDING CASH BALM'<Uhes 12 + 13 + 14, then subtract Line 15 $ --------"'-'-'"-"- If this is a Termination Statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVEDSchedule B, Part 1, Column (b) $ ------"Oo:...·:..:0::....:0"- Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................................................ .$. _____ ___.o"-':..;0""'0"-- 19. Outstanding Debts .......... Add Line 2 + Line 9 in Column C above $ _____ __,o"-.:..;o""'o"- SICCW -PCAP03030142115 (Rev. 9(99) SUMMARY PAGE Statement covers period CAl.IFOR'ilA 460 FORM from 10/20/2002 through 12/31/2002 Page 3 of '/ ColumnB CALENDAR YEAR TOTAL TO DATE $ 3 084.00 0.00 $ ___ _..3~0~8~4~·~0~0~ 2 412. 86 3 084.00 0.00 3 0 84. 0 0 0.00 2 412.86 5 496. 86 l.D. NUMBER 1247658 Calendar Year summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 7/1 to Date 20. Contributions Received .... .,...$ ___ __,.,O 21. Expenditures 3 . 0 8 0 Made .......... $,,... _ __......._.. ......... Expenditure Limit summary for State Candidates 22. Cumulative Exenditure Made* (H Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) Schedule A Monetary Contributions Received NAME OF FILER Tracy Jensen, Tracy Jensen for School Board IF AN INDIVIDUAL, ENTER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED (IF COMMITTEE, ALSO ENTER l.D. NUMBER) CODE• (IF SELF-EMPLOYED ENTER NAME 10/22/2002 California Teachers Assn. for Better Citizenship Burlingame, CA 94010 11/04/2002 Lorraine Ingeman Alameda, CA 94502 10/22/2002 Susanne Lindsey Alameda, CA 94501 Monetary Contributions Summary 1. Amount received this period -contributions of $100 or more. D IND Iii COM D OTH D PTY D sec Iii IND D COM D OTH D PTY D sec Iii IND D COM D OTH D PTY D sec D IND D COM D OTH D PTY D sec D IND D COM D OTH D PTY D sec OF BUSINESS) ID# 741941 Homemaker Realtor Gallagher & U ndsey SUBTOTAL $ Statement covers period from 10/20/2002 through 17./31/7.002 SCHEDULE A CALIFOR'\IA 460 FORM Page 4 of 7 l.D. NUMBER 1247658 AMOUNT RECEIVED CUMULATIVE TO DATE PER ELECTION TO DATE THIS PERIOD CALENDAR YEAR (JAN 1 -DEC 31) 400.00 400.00 100.00 100.00 100.00 100.00 600.00 (IF REQUIRED) (Include all Schedule A subtotals.) .................................................................................................. $ -----"'-6-"'-0-"'0-'."""'o""'o'-- 2. Amount received this period -contributions of less than $100. (Do not itemize.).............................................................................................................................. $ ------"'5-"'0_,,.-"'o'-"'o'-- 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) .............. TOTAL $ 650.00 Schedule E Payments Made NAMEOFFILER Tracy Jensen, Tracy Jensen for School Board Statement covers period from 10/20/2002 through 12/31/2002 SCHEDULE E CALIFOR"llA 460 FORl\I Page 5 of 7 l.D. NUMBER 1247658 CODES: If one of the following codes accurately describes the payment, you may enter the code. otherwise, describe the payment. CMP campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* eve civic donations FIL candidate filing/ballot fees FND fundraising events IND independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITIEE, ALSO ENTER l.D. NUMBER Jill Cabeceiras Alameda, CA 94501 Exit Strategies Alameda, CA 94501 John Hulihan Alameda, CA 94501 Schedule E Summary MBR member communications MTG meetings and appearances OFC office expenses PET pet~ion circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) PRT print ads CODE OR PRO LIT 534.00 CMP 719.86 POS 62.10 FND RAD radio airtime and production costs RFD returned contributions SAL campaign workers salaries TEL t. v. or cable airtime and production costs TRC candidate travel, lodging and meals (explain) TRS staff/spouse travel, lodging and meals (explain) TSF transfer between committees of the same candidate/spar VOT voter registration WEB information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 300.00 1,315.96 14 0. 00 SUBTOTAL $ 1,755.96 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ......................................................................... .. $ 3 010.30 2. Unitemized payments made this period of under $100 ................................................................................................................... . $ 40.00 3. Total interest paid this period on outstanding loans. (Enter amount from Schedule B, Part 2, Column(d).) ................................... . $ 0.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .... TOTAL $ 3 050.30 Schedule E (Continuation Sheet) Payments Made NAME OF FILER Tiacy Jensen, Tiacy Jensen foI School Boaid Statement covers period from 10/20/2002 through 12/31/2002 SCHEDULE E (CONT.) CAIJFOR:\IA 460 FORM Page 6 of 7 1.D. NUMBER 1247658 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events CMP CNS CTB eve FIL FND IND LEG LIT independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITIEE, ALSO ENTER l.D. NUMBER Pinnacle Piinting Systems Alameda, CA 94502 7081 Tiacy Jensen Alameda, CA 94501 ' MBR MTG OFC PET PHO POL POS PRO PAT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR LIT CMP 321.81 OFC 312.58 RAD RFD SAL TEL TRC TRS TSF VOT WEB DESCRIPTION OF PAYMENT radio airtime and production costs returned contributions campaign workers salaries t. v. or cable airtime and production costs candidate travel, lodging and meals (explain) staff/spouse travel, lodging and meals (explain) transfer between committees of the same candidate/spon voter registration information technology costs (internet, e-mail) AMOUNT PAID 61 g. gc:, 634.39 ' SUBTOTAL $ 1,254.34 Schedule G Payments Made by an Agent or Independent Contractor (on Behatf of an Officeholder pr Candidate NAME OF FILER Tiacy Jensen, Tiacy Jensen foI School Boaid NAME OF AGENT OR INDEPENDENT CONIRACTOR: Exit Stiategies Statement covers period from 10/20/2002 through 12/31/2002 SCHEDULEG CALIFORXIA 460 FORM Page 7 of 7 l.D. NUMBER 1247658 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB eve FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE OR CREDITOR {IF COMMITIEE, ALSO ENTER l.D. NUMBER Belaiie Displays, Inc Emeiyville, CA 94608 MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR CMP RAD radio airtime and production costs RFD returned contributions SAL campaign workers salaries TEL t. v. or cable airtime and production costs TRC candidate travel, lodging and meals (explain) TRS staff/spouse travel, lodging and meals (explain) TSF transfer between committees of the same candidate/spar VOT voter registration WEB information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 719.86 SUBTOTAL $ 719.86