Tracy Jensen for School Board 460 AmendmentCOVER PAGE-LONG FORM
Recipient Committee
Campaign Statement
(Government Code Sections 84200 -84216.5)
Statement covers period
from 10/01/2002
through 10/19/2002
1. Type of Recipient Committee:
00 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
Tracy Jensen for School Board
D Primarily Formed Candidate
Officeholder Committee
1.0. NUMBER
1247658
Date Stamp
1 of
(Month, Day, Year)
11/05/2002
OCI 2 4 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 Cabeceiras
MAILING ADDRESS
1620 Central Ave, Ste A
D Quarterly Statement
D Special Odd-Year Report
D Supplemental Pre-election
Statement -Attach Form 495
5
STREET ADDRESS (NO P.O. BOX)
904 Lincoln Ave
CITY
Alameda
STATE ZIP CODE AREA CODE/PHONE
(510)523 1861
CITY
Alameda
STATE ZIP CODE
CA 94501
AREA CODE/PHONE
(510)523 1861
CA 94 5-01 NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
MAILING ADDRESS
CITY STATE ZIP CODE AREA CODE/PHONE
CITY STATE ZIP CODE AREA CODE/PHONE
OPTIONAL: FAX/E-MAIL ADDRESS
< I OPTIONAL: FAX/E-MAIL ADDRESS
4. Verification
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 St~ of Galifornia that the foregoing i ue and correct.
( ;
. )~.::;_ _____________ _
DATE
Executed on 1ol'.23l'.2002 By
DATE
Executed on Jol'.23l'.2002 By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
Executed on Hll23L7.002 By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
S/CCW-PCAP03030142115 (Rev. 9/99) 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 ~NCLUDE 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.
COMMITTEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. SOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME 1.0. 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 D SUPPORT
a OPPOSE
Identify the controlling officeholder, candidate, or state measure proponent, H any.
NAME OF OFFICEHOLDER, CANDIDATE OR, PROPONENT
OFFICE SOUGHT OR HELD DISTRICT 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 $ 1 3 09 . 0 0
2. Loans Received ................................................ Schedule 8, Line 7 o.oo
3. SUBTOTAL CASH CONTRIBUTIONS .................. Add Lines 1 + 2 $ -----"1'""-"3;;..:0""9....._. o_o;;;...
4. Non-monetary Contributions ............................. Schedule C, Line 3 2 412.86
5. TOTAL CONTRIBUTIONS RECEIVED ................. Add Lines 3 + 4 $ ----"'3'-'-"7_.2'-'1'"".'-'8"-'6"--)
Expenditures Made
0.00 6. Cash Payments ................................................ Schedule E, Line 4 $ --------'"-'-'"-"-
7. Loans Made ...................................................... Schedule H, Line 7 0.00
0.00 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 2 412.86
2 412.86 11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ ----""-'-""'~~'-
Current Cash Statement
1 091.30 12. Beginning Cash Balance .......... Previous Summary Page, Line 16 $ ___ ......: .......... ~:....:....~
13. Cash Receipts ......................................... Column A, Line 3 above 1 3 OCJ. 00
14. Miscellaneous Increases to Cash ..................... Schedule I, Line 4 () . () 0
15. Cash Payments ....................................... Column A, Line 8 above 0.00
2 400.30 16. ENDING CASH BAl4it«rubes 12 + 13 + 14, then subtract Line 15 $ -----=-'-L-2~'-!..:"-"
lf this is a Termination Statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVEDSchedule B, Part 1, Column (b) $ _____ -'C"-J "-'' O"-'O"--
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................................................ $. _____ ___,o"-"-'. O"-C""-l
19. Outstanding Debts .......... Add Line 2 + Line 9 in Column C above $ _____ ___,("'-) "-'' O:.:..<"'--l
S/CCW-PCAP03030142115 {Rev. 9/99)
SUMMARY PAGE
Statement covers period
from 10/01/2002
through 10/19/2002 Page 3 of
ColumnB
CALENDAR YEAR
TOTAL TO DATE
2 434.00
0.00
2 434.00
2 412.86
4 846.86
33.70
0.00
33.70
0.00
2 412.86
2 446.56
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 .... $.'------"'-
21. Expenditures 3 0 Made .......... $'ii-----'-"'
Expenditure Limit Summary for State
Candidates
22. Cumulative Exenditure Made* (If Subject to Voluntary Expend~ure Limit)
Date of Election
(mm/dd/yy)
Total to Date
Schedule A
Monetary Contributions Received
NAMEOFFILER 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 COMMITTSE, ALSO ENTER l.D. NUMBER) CODE* (IF SELF-EMPLOYED ENTER NAME
OF BUSINESS)
10/04/2002 Charles Cline lil IND Attorney
D COM
l\lameda, CA 94501 D OTH Self
0 PTY
D sec
10/04/2002 Karen Nelson Larson, D.D.S D IND
2cl20 Webb Ave D COM
Alameda, CA 94501 ii OTH
D PTY
0 sec
10/04/2002 Dana Nelson ii IND Teacher
1170A Park Avenue 0 COM
Alameda, CA 94501 0 OTH AUSD
0 PTY
D sec
10/02/2002 Dale Reno lil IND Garbage Man
3315 Willis Lane 0 COM
Alameda, CA 94502 0 OTH Waste Management
0 PTY
0 sec
10/02/2002 Dianne Steed lil IND Homemaker
1616 San Antonio Ave 0 COM
,l'\lameda, CA 94501 0 OTH
0 PTY
0 sec
SUBTOTAL $
Monetary Contributions Summary
I. Amount received this period -contributions of $100 or more.
Statement covers period
from 10/01/2002
through l O / 1 9 / 2 O O 2
SCHEDULE A
;, ~ALIFOR:SlA 4' 6'0 JiORM
Page 4 of
1.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. 00 100. 00
100.00 100. (]()
100.00 100.00
100.00 100.00
500.00
(Include all Schedule A sublotals.) .................................................................................................. $ ____ ... s""o"-o"'-'-. -.o""o_
2. Amount received this period -contributions of less than $100.
(Do not itemize.).............................................................................................................................. $ ____ _,8"""("-)9"-'--. "'"o-"'o-
3. Total monetary contributions received this period.
(Add Lines I and 2. Enter here and on the Swmnary Page, Column A, Line 1.) .............. TOTAL $ 1 309.00
SCHEDULE C
Schedule C Statement covers period
Non-Monetary Contributions Received from 10/Dl/;'.002
through 10/19/2002 Page 5 of 5
NAMEOFFILER Tracy Jensen, Tracy Jensen for School Board l.D. NUMBER
124 '/ 658
DATE
RECEIVED
FULL NAME, MAILING ADDRESS AND
ZIP CODE OF CONTRIBUTOR
IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER DESCRIPTION OF FAIR MARKET
VALUE
CUMULATIVE TO DATE CUMULATIVE TO DATE
(IF COMMITTEE, ALSO ENTER 1.D, NUMBER) CODE • (IF SELF-EMPLOYED ENTER GOODS OR SERVICES
NAME OF BUSINESS)
CALENDAR YEAR OTHER
(JAN 1 ·DEC 31) (IF APPLICABLE)
10/17/2002 The Perata Committee
Alameda, CA 94501
D IND ID# 983343 Postage 2,412.86 3,412.86
[iJ COM Absentee
D OTH Mailer
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 $ 2,412.86
Non~ etary Contributions Summary
1. Amount received this period -non-monetary contributions of $100 or more.
(Include all Schedule C subtotals.) . .......... ............ ...... ............ ...... ...... ............ .......... .......... .......... .... $ _____ 2.....__4 ... 1...,2._.. __ 8._.6'--
2. Amount received this period -non-monetary contributions of less than $100.
(Do not itemize.) .............................................................................................................................. $ _____ ...;;o""'.""'o'"'o'--
3. Total non-monetary contributions received this period.
(Add Lines 1and2. Enter here and on the Summary Page, Colutnn A, Line 4.) .............. TOTAL $ 2 412.86
ncludes
Monetary
Cc:ntr :Lbut.i.cm (s