Tracy Jensen for School Board 460 (2)Recipient Committee
Campaign Statement
(Government Code Sections 84200 -
Statement covers period
from _ ... o ... 7..,/ ... 0 ... 1 ... / ... 2..,0 ... 0 ... 2,_
through 09/30/2002
1. Type of Recipient Committee:
00 Officeholder, Candidate Controlled Committee 0 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
Tiacy Jensen f oI School Boaid
STREET ADDRESS (NO P.O. BOX)
CITY
Alameda
STATE ZIP CODE
CA 94501
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE
OPTIONAL: FAX/E-MAIL ADDRESS
( l I
4. Verification
AREA CODE/PHONE
(510)523-1861
AREA CODE/PHONE
Date of Election if applicable:
(Month, Day, Year)
11/05/2002
2. Type of Statement:
IE Pre-election Statement
D Semi-annual Statement
D Termination Statement
D Amendment (Explain below)
Treasurer(s}
NAME OF TREASURER
Jill Cabeceiias
MAILING ADDRESS
CITY
Alameda
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY
OPTIONAL FAX/E-MAIL ADDRESS
COVER PAGE-LONG FORM
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. 1 certify under penalty of perjury under the laws of the State Cal11'15rnia that the foregoing is true and correct.
Exectrted on ID J }iT92-By
Executed on _ _,__{ o;;;;;...i/'--(_/-"'1/~02'5.omI DAifE
Executed on -----------DATE
Executed on -----------DATE
S/CCW-PCAB02030122115 (Rev. 9/99)
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
State of California 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: List any committees
not included 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.
COMMITIEE NAME l.D. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITIEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITIEE?
COMMITIEE 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
Cl OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, if any.
NAME OF OFFICEHOLDER, CANDIDATE OR, PROPONENT
OFFICE SOUGHT OR HELD !STRICT NO. IF ANY
7. 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
NAME OF FILER Tracy Jensen, Tracy Jensen for School Board
Contributions Received Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
1. Monetary Contributions ..................................... Schedule A, Line 3 $ 125. 00
2. Loans Received ................................................ Schedule B, Line 7 0.00
3. SUBTOTAL CASH CONTRIBUTIONS .................. Add Lines 1 + 2 $ ______ 1=2.:..:5'-'''-'o"-"o'-
4. Non-monetary Contributions ............................. Schedule C, Line 3 O • O O
5. TOTAL CONTRIBUTIONS RECEIVED ................. Add Lines 3 + 4 $ ------"1=2.:..:5;;...-:...;• 0::..0;;_
Expenditures Made
6. Cash Payments ................................................ Schedule E, Line 4 $ -------'o'-''-'o""'o""""
7. Loans Made ...................................................... Schedule H, Line 7 O. O O
8. SUBTOTAL CASH PAYMENTS ............................ Add Lines 6 + 7 $ ______ o....._. o __ o __
9. Accrued Expenses (Unpaid Bills) ...................... Schedule F, Line 3 O . O O
10. Nonmonetary Adjustment ................................ Schedule C, Line 3 O • O O
11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ _____ ....;o;;...:...;. o;;...;o::...
Current Cash Statement
12. Beginning Cash Balance .......... Previous Summary Page, Line 16 $ -------'O;;...:...;. 0-.0-...
13. Cash Receipts ......................................... Column A, Line 3 above 125. O O
14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 0. 0 0
15. Cash Payments ....................................... Column A, Line 8 above O • O O
16. ENDING CASH BAl.!Ullfmles 12 + 13 + 14, then subtract Line 15 $ ____ __.1""'2"'"5;;;...:.... 0::..0;;;._
If this is a Termination Statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVEDSchedule B, Part 1, Column (b) $ _____ '""'o---. 0;;...;0::...
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................................................ $. _____ --'o"-._o ... o ....
19. Outstanding Debts .......... Add Line 2 + Line 9 in Column C above $ -------'o_._o._.o-..
S/CCW -PCAB02030122115 (Rev. 9/99)
SUMMARY PAGE
Statement covers period CALIFOR:'\IA 460
FORM kom 07/01/2002
through 09 /3 o /2 O 02 Page 3 of 4
ColumnB
CALENDAR YEAR
TOTAL TO DATE
$ 125.00
0.00
$ ______ 1_2_5_.'""'o""o'--
o. o o
$ ____ _.1=2=5"'"'."'"'o;;...;o::...
$ _____ __,:o_._o._.o._
0.00
$ _____ --'o_._o-o"'""
0.00
0.00
l.D. NUMBER
1247658
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1 /1 through 6130 7/1 to Date
20. Contributions Received .... $. ___ _
21. Expenditures 0 Made .......... $;i;-----
Expenditure Limit Summary for State
Candidates
22. Cumulative Exenditure Made*
(If Subject to Voluntary Expenditure Limit)
Date of Election
(mmlddlyy)
Total to Date
Schedule A
Monetary Contributions Received
NAME OF FILER Tracy Jensen, Tracy Jensen for School Board
IF AN INDIVIDUAL, ENTER
DATE FULL NAME, MAILING ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER
RECEIVED (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE* (IF SELF-EMPLOYED ENTER NAME
OF BUSINESS)
09/30/2002 Thomas Holstlaw Iii IND Retired
D COM
Alameda, CA 94501 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
D IND
D COM
D OTH
D PTY
D sec
D IND
D COM
D OTH
D PTY D sec
SUBTOTAL $
Monetary Contributions Summary
1. Amount received this period -contributions of $100 or more.
Statement covers period
from 07/01/2002
through 09/30/2002
SCHEDULE A
CALUOR;\;IA 460 FORM
Page 4 of 4
l.D. NUMBER
1247658
AMOUNT RECEIVED CUMULATIVE TO DATE CUMULATIVE TO DATE
THIS PERIOD CALENDAR YEAR OTHER
(JAN 1 -DEC 31) (IF APPLICABLE)
100.00 100.00
100.00
(Include all Schedule A subtotals.) .................................................................................................. $ ____ 1~0~0~. O~O~
2. Amount received this period -contributions of less than $100.
(Do not itemize.).............................................................................................................................. $ ____ -"'-2""'5-'-.-""o"""o_
3. Total monetary contributions received this period.
(Add Lines 1and2. Enter here and on the Summary Page, Column A, Line 1.) .............. TOTAL $ 125.00