Tracy Jensen for School Board 460Recipient Committee
Campaign Statement
(Government Code Sections 84200 -84216.5)
S1Dtement covers period
from __ 0_1 ... f_.o ... 1 ... f.-2 ... 0_.o ... 2,_
through 09/30/2002
1. Type of Recipient Committee:
Ill 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
D Primarily Formed Candidate
Officeholder Committee
0 Political Party/Central Committee
3. Committee Information l.D. NUMBER
1247658
COMMITTEE NAME
Tiacy Jensen foI School Boaid ~1 -1
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
OPTONAL: FAX/E-MAILADDRESS
< I
4. Verification
Executed on -----------DATE
ZIP CODE
By
AREA CODE/PHONE
(510) 523 1861
AREA CODE/PHONE
2. Type of Statement:
11!1 Pre-election Statement
D Semi-annual Statement
D Tennination Statement
•Amendment (Explain belo'<i)
D Quarterly Statement
D Special Odd-Year Report
D Supplemental Pre-election
Statement -Attach Form 495
t\YS~ ~ Aqe6rt ~~ bf-,,3b/&L ~
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
STATE ZIP CODE
CA 94501
STATE ZIP CODE
AREA CODE/PHONE
(510) 523 1861
AREA CODE/PHONE
Executed on -----------DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT
DATE By --------------=---------=----__,.----,........,...,-.,,.-,-=-------------~ SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, STATE MEASURE PROPONENT Executed on -----------
S/CCW -PCA802030122115 (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
Jensen
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
Boaid of Education, Distiict
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 l.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 a SUPPORT
a 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
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
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 $ 1 125. 00
2. Loans Received ................................................ Schedule B, Line 7 0.00
1 125.00 3. SUBTOTAL CASH CONTRIBUTIONS .................. Add Lines 1 + 2 $ -----"'-"-="'-"'-'--"-''-
4. Non-monetary Contributions ............................. Schedule C, Line 3 0.00
1 125.00 5. TOTAL CONTRIBUTIONS RECEIVED ................. Add Lines 3 +4 $----=-~~'-="-
Expenditures Made
33.70 6. Cash Payments ................................................ Schedule E, Line 4 $ ------:::..=:.....:....:.....::-
7. Loans Made ...................................................... Schedule H, Line 7 0.00
33.70 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
33.70 11. TOTAL EXPENDITURES MADE .................. Add Lines 8 + 9 + 10 $ ------""-"'--"""'--''-
Current Cash Statement
0.00 12. Beginning Cash Balance .......... Previous Summary Page, Line 16 $ ------"'-'-..::....:.:-
13. Cash Receipts ......................................... Column A, Line 3 above
14. Miscellaneous Increases to Cash ..................... Schedule/, Line 4
15'. Cash Payments ....................................... Column A, Line 8 above 33.70
16. ENDING CASH BA~rubes 12 + 13 + 14, then subtract Line 15 $ ___ _.l!o..L.,~O .:.9 .;1..:.. ""'3~0:....
If this is a Termination Statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVEDSchedu/e B, Part 1, Column (b) $-------"-'-="-
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................................................ .$. ______ .:;.O..:.·~O:..!:O:....
19. Outstanding Debts .......... Add Line 2 +Line 9 in Column C above $ ______ .;;;.o""".-"0-"0'-
S/CCW-PCAB02030122115 (Rev. 9/99)
Statement covers period
from 07/01/2002
through 09 /3 O /2 o 02
ColumnB
CALENDAR YEAR
TOTAL TO DATE
SUMMARY PAGE
CALffORNIA 460 ItORM
Page 3 of 5
l.D. NUMBER
1247658
$ _____ 1-.......=1=2~5~·~0~0~
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
0.00
$ 1 125.00
0.00
$ . 1 125.00
$ 33.70
0.00
$ 33.70
0.00
0.00
$ 33.70
111 through 6130 7/1 to Date
20. Contributions
Received .... $.·-----"'
21. Expenditures 3 0 Made .......... $.'h-----'-"'-
Expenditure Limit Summary for State
Candidates
22. Cumulative Exenditure Made*
(If Subject to Voluntary Expend~ure Lim~)
Date of Election
(mmlddlyy)
Totalto Date
Schedule A
Monetary Contributions Received
NAMEOFFILER Tiacy Jensen, Tiacy Jensen foI School Boaid
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 lil IND Retiied
D COM
Alameda, CA 94501 D OTH
D PTY
D sec
09/30/2002 The Peiata CommiLtee D IND ID# 983343
lil 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
SUBTOTAL $
Monetary Contributions Summary
1. Amount received this period -contributions of $100 or more.
SCHEDULE A
Statement covers period
kom 07/01/2002
through 09 /3 o /2 O 02 Page 4 of 5
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
1,000.00 1,000.00
1,100.00
(Include all Schedule A subtotals.) .................................................................................................. $ ----"'1-'-"'1-"o-"o'-'.-"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 I and 2. Enter here and on the Summary Page, Column A, Line 1.) .............. TOTAL $ 1 125.00
Schedule E
Payments Made
NAMEOFFILER Tracy Jensen, Tracy Jensen for School Board
Statement covers period
from 07/01/2002
through 09 /3 o /2 o 02
SCHEDULE E
CAUH>RNIA 4·~0
FORM l2f
Page 5 of 5
1.0. 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 COMMITTEE, ALSO ENTER 1.D. NUMBER
Schedule E Summary
MBR member communications
MTG meetings and appearances
OFC office expenses
PET petition 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
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/spons·
VOT voter registration
WEB information technology costs (internet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
SUBTOTAL $ 0.00
1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ......................................................................... .. $ 0.00
2. Unitemized payments made this period of under $100 .................................................................................................................. .. $ 33.70
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 $ 33.70