Jensen 460M m
Keelplent Commiftee
Campai Statement
CoverPa
(Government Code Sections 84200-84216.51
SEE INSTRUCTIONS ON REVERSE
Statement covers period f'Date of election if applica
(Month, Da Year)
f ro m
2=11
1. T of Reziplient Committee.' All Committees Complete Parts 1, 2, 3, and 4,
Candidate Controlled Committee
E:] Ballot Measure Committee
'.1 .0---Officeholder"
0 State Candidate Election Committee
0 Primaril Formed
0 Recall
0 Controlled
(Also Complete Part 5
0 Sponsored
El General Purpose C ommittee
Also Cbmplete Part
0 Sponsored
Primaril Formed Candidate/
0 Small Contributor Committee
Officeholder Committee
0 Political Part /Central Committee
(Also �ornplete Part 7
3. Committee Information I.D NUMBER
1. :�CC C 1 71 00 cl-
COMMITTEE NAME OR CANDIDATE'S NAME IF NO COMMITTEE)
2-1 1
Date Stamp
u 11pa
tp 5
2. T of Statement:
Preelection Statement
Semi-annual Statement
E:] Termination Statement
Amendment Explain below
of
For Official Use Dal
0 Quarterl Statement
El Special Odd-Year Report
mental Preelection
Statement Attach Form 495
Treasurer(s)
NAME OF REASURER
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
T STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX E-MAIL ADDRESS
Executed on Date By
Executed on Date By
CITE STATE ZIP CODE AREA CODE/PHONE
OPTIONAL, FAX E-MAIL ADDRESS
Si of Controllin Officeholder, Candidate. State Measure Proponent
Si of Controllin Officeholder, 'Candidate, State Measure Proponent
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
State of California
WOW 01 ME URI' WO I N-1 I
L
VIM' gpl
110
Pa
I.D. NUMBER
6, Ballot Measure Committee
NAME OF BALLOT MEASURE
BALLOT NO. OR LETTER
SUPPORT
CPPOSE
Identif the controllin officeholder, candidate, or state measure proponent, if an
NAME OF OFFICEHOLDER. CANDIDATE, OR PROPONENT
NAME OF TREASURER CONTROLLED COMMITTEE?
YES NO
COMMITTEE ADDRESS STREET ADDRESS (NO RO. BOX)
CITY STATE ZIP CODE AREA CODEIPHONE
COMMITTEE NAME
Im
DISTRICT NO, IF ANY
7. P r1martl Formed Committee List names of officeholder(s) or candidate(s) for
which this committee is primaril formed.
NAME OF OFFICEHOLDER OR CANDIDAT E OFFICE SOUGHT OR HELD
E] SUPPORT
NAME OF OFFICEHOLDER OR CANDIDATE
CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE
YES NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) I I
CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessar
FPPC Form 460 June/01
FPPC Toll-Free Helpline: 866/ASK-FPPC
State of California
,,)chedule A
Monetar Contributions Received
T or print in ink.
Amounts ma be roundel#`
to whole dollars,
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
DATE FULL NAME, STREET AGGRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(I F COM M ITTEE ALSO ENTE R 1, D N U M B ER
RECEIVED I CODE
61to
Statement covers period
iNNUM,"WE';
from
throu Pa 7 of
T
I.D,NUMBER
IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION
OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE
IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 DEC, 31) (IF REQUIRED)
OF BUSINESS
t 0
'z
El COM
L] OTC
PTY
(V
r-1 SCC
IND
OTH
PTY
El SCC
B IND
EICOM
OT'{
PTY
El SCC
E] IND
EICOM
E]OTH
EIPTY
M SCC
E]]ND
com
F-1 OTH
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SCC
SUBTOTAL
Schedule A Summar
1. Amount received this period contributions of 100 or more,
(include all Schedule A subtotals.)_
�r c,
2. Amount received this period uniternized contributions of less than $100
3. Total monetar contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summar Pa Column A, Line 1.) TOTAL
FPPC Form ►60 Wune/01)
FPPC Toll-Free Helpire: 866/ASK-FPPC
Campai Disclosure StatemeWo-
Summar Pa
SEE INSTRUCTIONS ON REVERSE
T or print in ink,, SUMMARYPAGE
Amounts ma be rounded 101 W
Statement covers period RNIA
to whole dollars. 104', CALMED �1�00
NO
1011-
"I.
from
I
throu Pa of
NAME OF FILER
64
Contributions Received
Column A
Column B
TOTAL THIS PERIOD
CALENDAR YEAR
(FROM ATTACHED SCHEDULES)
TOTAL TO DATE
1. Monetar Contributions Schedule A. Line 3
2. Loans Received Schedule B-. Line 3
3. SUBTOTAL CASH CONTRIBUTIONS Add Lines1+2
4. Nonmonetar Contributions Schedule C. Line 3
5. TOTAL CONTRIBUTIONS RECEIVED Add Lines 3 4
Expenditures Made
6. Pa Schedule E Une 4
c
7. Loans Made. Schedule H. Line 3
8. SUBTOTAL CASH PAYMENTS Add Lines 6 7
9. Accrued Expenses (Unpaid Bills) Schedule F Line 3
10. Nonmone tar y Ad Schedule G�. Line 3
TOTAL E PENDITURES MADE es 8 9 +10
11 X Add Lin
-3
Current Cash tats ment
12, Be Cash Balance Previous Summar Pa Line 16
To calculate Column B, add
13. Cash Receipts Column A, Line 3 above
amounts in Column A to the
correspondin amounts
14. Miscellaneous Increases to Cash Schedule Line 4
from Column B of y our last
15. Cash Payments Column A, Line 8 above
report. Some amount in
s
Column A y be ne
6. ENDING CASH BA
BALANCE Add Lines 12 13 14,, then subtract Line 15
fi tha should be
subtracted from previous
If this is a termination statement, Line 16 must be zero.
period amounts. If this is
22%mmm
the first report bein filed
17. LOAN GUARANTEES RECEIVED Schedule 9, Part 2
for this calendar y ear, onl
carr over the amounts
ients u e
Cash E and Otstandin Dbts
from Lines 2, and 9 (if
an
18. Cash Equivalents see instructions on reverse
19. Outstandin Debts Add Line 2 Line 9 in Column B above
20. Contributions
Received
21 Expenditures
Made
*Since Januar 1. 2001. Amounts in this section ma be
different from amounts reported in Column B,
FPPC Form 460 (June/01)
IPPC Toll-Free Helpfine: 866/ASK-FPPC
Z%chedule E
Pa Madl
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
M
T or print in ink,
Amounts ma be rounded
to whole dollars,
Statement covers period
I from
G
throu
l e i
M
COMES: If one of the followin codes accuratel describes the pa y ou ma enter the code. Otherwise, describe the paymerc
Pa V of
I.D. NUMBER
0a`_7
CIVP
campai paraphernalia/misc.
MBR
member communications
RAD
radio airtime and production costs
CNS
campai consultants
KFG
meetin and appearances
RFD
returned contributions
CTB
contribution explain nonmonetar
OFC
office expenses
SAL
campai workers' salaries
C
civic donations
PET
petition circulatin
TEL
t.v. or cable airtime and production costs
FIL
candidate filin fees
Pal O
phone banks
TRC
candidate travel, lod and meals
FN®
fundraisin events
POL
pollin and surve research
TS
staff /spouse travel, lod and meals
IND
independent expenditure supportin others (explain)*
OS
posta deliver and messen services
TSF
transfer between committees of the same candidate/sponsor
LEG
le defense
PRO
professional services (le accountin
VOT
voter re
LIT
campai literature and mailin
PRT
print ads
�B
information technolo costs (internet, e-mail
1. Pa made this period of $100 or more. (include all Schedule E subtotals)
2. Un itemized payments made this period of under $100 I 1. 1 a x. x. a d. g e
3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)..
4. Total pa made this period, (Add Lines 1, 2, and 3. Enter here and on the Summar Pa Column A, Line 6. TOTAL
FPPC Form 460 June/01
FPPC Toll-Free Helpline: 866/ASK-FPPC