Tracy Lynn Jensen 470Officeholder and Candidate
Campaign Statement -
Short Form
(Government Code Section 84206)
Type or print in ink.
Date of election if applicable: D Amendment (Explain Below}
(Month, Day, Year)
1. Statement Covers Calendar Year 20. 6
Date Stamp
ILE
FEB 2 8 2005
2. Officeholder or Candidate Information 3. Office Sought or Held
NAME OFO~OLDER OR CANDIDATE \,
'. .. STREETADDRt;ac:/ L):(n n "J6'\~<Z/\
) A' . /
ZIP CODE 4450 l
6
OPTIONAL: FAX/E-MAILADDRESS-
~ ~~ i::.~~c.::.::::··i··· -~ ' ': '•. --------------------""'!t·~~-----------------------------,.--------·•M 4. Committee Information ::S'' '!£' ~::-~ ~,Y"''~'1 . · .. · .. ·.. .•. ,. . ' ·<-",,,,. . \_ ·. •. -~··" ..
List all committees of which you have knowledge that are primarily formed to receive contributions @r..fo rtrake expenditures on behalf of your cantl(daejl.')'
COMMITTEE NAME AND 1.0. NUMBER COMMITTEE ADDRESS NAME OF TREASURER
5. Verification
I d.eclare under penalty of perjury that to the best of my knowledge I anticipate that I will receive less than $1,000 and that I will spend less than $1,000 during
the calendar year and that I have used all reasonable diligence in preparing this statement. I certify un er penalty of R ·u under the laws of the State of
California that the foregoing is true and correct.
executec1on___;;~~Z_..;;;...~~'2lt2:;.--.6 ___ _
DATE
FPPC Form 450 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC