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Amendment

I

UNITED STATES SENATE FINANCIAL DISCLOSURE REPORT FOR ANNUAL AND TERMINATION REPORTS
First Name and Middle Initial

Last Name

Annual Report
Calendar Year Covered by Report: Senate Office / Agency in Which Employed

Klobuchar
Senate Office Address(Number, Street, City, State, and ZIP Code)

AmyJ.
Senate Office Telephone Number (Include Area Code)

2011
Termination Report
Termination Date (mm/dd/yy):

United States Senator/U.S. Senate
Prior Office / Agency in Which Employed

302 Hart Senate Office Building Washington, D.C. 20510

202-224-3244

AFTER READING THE INSTRUCTIONS - ANSWER EACH OF THESE QUESTIONS AND ATTACH THE RELEVANT PART
YES NO

I

YES

I

NO

IDid any individual or organization make a donation to charity in lieu of paying you for a speech, appearance, or article in the reporting period? If Yes, Complete and Attach PART I. Did you or your spouse have earned income (e.g., salaries or fees) or noniinvestment income of more than $200 from any reportable source in the reporting period? If Yes, Complete and Attach PART II. Did you, your spouse, or dependent child hold any reportable asset worth more than $1,000 at the end of the period, or receive unearned or investment income of more than $200 in the reporting period? If Yes, Complete & Attach PART IliA and/or IIIB. Did you, your spouse, or dependent child purchase, sell, or exchange any reportable asset worth more than $1,000 in the reporting period? If Yes, Complete and Attach PART IV. Old you, your spouse, or dependent child receive any reportable gift in the reporting period (i.e., aggregating more than $350 and not otherwise exempt)? :f Yes, Complete and Attach PART V.

Did you, your spouse, or dependent child receive any reportable travel or reimbursements for travel in the reporting period (i.e., worth more than $350 from one source)? If Yes, Complete and Attach PART VI. Did you, your spouse, or dependent child have any reportable liability (more than $10,000) during the reporting period? If Yes, Complete and Attach PART VII. Did you hold any reportable positions on or before the date of filing in the current calendar year? If Yes, Complete and Attach PART VIII. Do you have any reportable agreement or arrangement entity? If Yes, Complete and Attach PART IX, with an outside

If this is your FIRST Report: Did you receive compensation $5,000 from a single source in the two prior years? If Yes, Complete and Attach PART X,

of more than

Each question

must be answered

and the appropriate

PART attached for each "YES" response.

DD
U.S.
I'TI -of!1

, File this report and any amendments with the Secretary of the Senate, Office of Public Records, Room 232, Hart Senate Office Building, Senate, Washington, DC 20510. $200 Penalty for filing more than 30 days after due date.
This Financial Disclosure Statement is required by the Ethics in Government Act of 1978, as amended. The statement will be made available by the Office of the Secretary of the Senate to any requesting person upon written application and will be reviewed by the Select Committee on Ethics. Any individual who knowingly and willfully falsifies, or who knowingly and willfully fails to file this report may be subject to civil and criminal sanctions. (See 5 USc. app. 4, § 104, and 18 U.S.C, § 1001,)
Certification Signature of Reporting Individual Date (Month, Day, Year) :3:
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FOR OFFICIAL USE ONLY Do Not Write Below this Line

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I CERTIFY that the statements I have made on this form and all attached schedules are true, complete and correct to the best of my knowledge and belief It is the opinion of the reviewer that the statements made in this form are in compliance with Title I of the Ethics in Government Act,

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Name

I 0 Amendment

Page Number

Amy Klobuchar

PART II. EARNED AND NON-INVESTMENT

INCOME

2

Report the source (name and address), type, and amount of earned income to you from any source aggregating $200 or more during the reporting period. For your spouse, report the source (name and address) and type of earned income which aggregate $1,000 or more during the reporting period. No amount needs to be specified for your spouse. (See p.3, CONTENTS OF REPORTS Part B of Instructions.) Do not report income from employment by the U.S. Government for you or your spouse. Individuals not covered by the Honoraria Ban: For you and lor your spouse, report honoraria income received which aggregates $200 or more by exact amount, give the date of, and describe the activity (speech, appearance or article) generating such honoraria payment. Do not include payments in lieu of honoraria reported on Part I. Name of Income Source
Example: JP Computers MCI (Spouse) Wash., DC Arlington, VA

Address (City, State) EXAMPLE EXAMPLE

Type of Income
Salary Salary

Amount
$15,000 Over $1,000

1 2 3 4

State of Maryland (University of Baltimore) (spouse) Georgetown University (spouse)

Baltimore, MD Washington, DC

Salary Salary

Over $1,000 Over $1,000

5
6 7 8 9 10 11 12 13

,

Reporting Individual's Name

~

I D Amendment

Page Number

Amy Klobuchar
BLOCKA

PART iliA.

PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
BLOCK B BLOCK C

3

Identity of Publicly Traded Assets And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, or your dependent child, (See p.3, CONTENTS OF REPORTS Part B of Instructions) for production of income or investment which: (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period. Include on this PART IliA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and pu blicly traded assets of a retirement plan.
Example S, DC, orJ IBM Corp. (stock) (S) Keystone Fund

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*- This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset is/was either held by the filer or jointly held, use the other categories of value,as appropriate.

EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.

D

Reporting Individual's ame N

Page Number

Amy Klobuchar
BLOCKA Identity of Publicly Traded Assets And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, or your dependent child, (See p.3, CONTENTS OF REPORTS Part B of Instructions) for production of income or investment which: (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period. Include on this PART IliA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and publicly traded assets of a retirement plan. Example DC, or J 1 2
3 4
S, IBM Corp. (stock) (S) Keystone Fund

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PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
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4

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D

, Reporting''individual's Name

Page Number

Amy Klobuchar
BLOCKA

PART lilA.

PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
BLOCK B BLOCK C

5

Identity of Publicly Traded Assets And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, or your dependent child, (See p.3, CONTENTS OF REPORTS Part B of Instructions) for production of income or investment which (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period. Include on this PART IliA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and publicly traded assets of a retirement plan.
Example S, DC, orJ IBM Corp. (stock) (S) Keystone Fund

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EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right.
*** This category applies only if the asset islwas held independently by the spouse or dependent child. If the asset is/was either held by the filer or jointly held, use the other categories of value, as appropriate.

D

, Reporting 'I~dividual's Name

Page Number

Amy Klobuchar
BLOCKA Identity of Publicly Traded Assets And Unearned Income Sources Report the complete name of each publicly traded asset held by you, your spouse, or your dependent child, (See p.3, CONTENTS OF REPORTS Part B of Instructions) for production of income or investment which: (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period. Include on this PART IliA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and publicly traded assets of a retirement plan. Example DC, or J
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S, IBM Corp. (stock) (S) Keystone Fund

PART iliA.

PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
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6

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(S) Fidelity Adv Intermediate Bond (K&B /Faecre & Benson(F&B) 401 (k) rollovers) (S) Fidelity Adv Equity Growth (K&B 401 (k) rollover) United States Senate Federal Credit Union (IRA certificate) (S) United States Senate Federal Credit Union (IRA certificate)

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EXEMPTION TEST (see instructions before marking box): If you omittedany assetbecauseit meetsthe three-part test for exemptiondescribedin the instructions, leasecheck boxto the right. p This categoryappliesonlyif the assetis/washeld independentlybythe spouseor dependentchild. If the assetis/waseither held bythe filer or jointty held,usethe other categoriesof value, as appropriate.

D

'Reporting individual's Name

Page Number

Amy Klobuchar
BLOCKA

PART iliA.

PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
BLOCK B BLOCK C

7

Identity of Publicly Traded Assets And Unearned Income Sources
Report the complete name of each publicly traded asset held by you, your spouse, or your dependent child, (See p.s,

Valuation of Assets
At the close of reporting period, If None, or less than $1,001, Check the first column.

Type and Amount of Income
If "None (or less than $201)" is Checked, no other entry is needed in Block C for that item, This includes income received or accrued to the benefit of the individual.

Type of Income

Amount of Income

CONTENTS OF REPORTS Part B of Instructions) for production of income or
investment which: (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period, Include on this PART IliA a complete identification of each public bond, mutual fund, publicly traded partnership interest, excepted investment funds, bank accounts, excepted and qualified blind trusts, and publicly traded assets of a retirement plan, Example: DC, orJ 1 2 3 4
S, IBM Corp, (stock) (S) Keystone Fund

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9 10 EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right. This category applies only if the asset islwas held independently by the spouse or dependent child, If the asset is/was either held by the filer or jointly held, use the other categories of value, as appropriate,

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D

Reporting Individual's Name

I

0 Amendment
PART IIIB. NON-PUBLICLY TRADED ASSETS AND UNEARNED INCOME SOURCES
BLOCK C Type and Amount of Income

Page Number

Amy Klobuchar
BLOCKA Identity of Non-Publicly Traded Assets and Unearned Income Sources Report the name, address (city, state and description) of each interest held by you, your spouse, or your dependent child (See p.3, CONTENTS OF REPORTS Part B of Instructions) for the production of income or investment in a non-public trade or business which: (1) had a value exceeding $1,000 at the close of the reporting period; and/or (2) generated over $200 in "unearned" income during the reporting period. Include the above report for each underlying asset, which is not incidental to the trade or business. Publicly traded assets held by non-public entity may be listed on Part IliA. S, Example DC, or J
JP Computer, Wash DC Undeveloped Software Design, land, Dubuque, Iowa

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BLOCK B Valuation of Assets At the close of reporting period. If None, or less than $1,001, Check the first column. Type of Income

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10 EXEMPTION TEST (see instructions before marking box): If you omittedany asset becauseit meetsthe three-parttest for exemptiondescribedin the instructions,pleasecheckboxto the right. ••• Thiscategoryappliesonly if the asset is/washeldindependentlyby the spouseor dependentchild. If the assetis/waseither heldbythe filer or jointly held, usethe other categoriesof value, as appropriate.

D

"

Reporting Individual's Name

I 0 Amendment

Page Number

Amy Klobuchar

PART IV. TRANSACTIONS
Amount of Transaction (x)

9

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(S) IRA Certificate (United States Senate Federal Credit Union)

(S) Minnesota College Savings Plan (Managed Allocation Age 15-17) (allocation listed elsewhere on form) (S) Minnesota College Savings Plan (Managed Allocation Age 15-17) (allocation 4 listed elsewhere on form) (misc. contributions from 1/18/11 - 12/27/11)
5 (S) Selected Bond (MSA) (sub-account 6 (S) High Yield Bond (MSA) (sub-account 7

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of Northwestern of Northwestern

Mutual Life ins. policies) Mutual Life ins. policies) Retirement Plan Retirement Plan

(S) Vanguard SmCap Growth Index Inst. contributions in 2011 to 401(k) Plan (S) Vanguard SmCap Growth Index Inst. 8 contributions in 2011 to 457(b) Plan (S) Univ Sys. of MD Optional - TC Lfcycle 9 switched these funds to TC Lfcycle 2025 (S) Univ. Sys. of MD Optional - TC Lfcycle 10 substituted this fund for TC Lfcycle 2025 -

MD Supplemental MD Supplemental

2025 - Rtmt (the plan administrator Prm (see next line) 2025 - Prm (the plan administrator Rtmt) (see prior line)

11 (S) Univ. Sys. of MD Optional - TC Lfcycle 2025 - Prm 12

***

EXEMPTION TEST (see instructions before marking box): If you omitted any asset because it meets the three-part test for exemption described in the instructions, please check box to the right. This category applies only if the asset is/was held independently by the spouse or dependent child. If the asset is/was either held by the filer or jointly held. use the other categories of value, as appropriate.

D

Amy Klobuchar

Page 10

UNITED STATES SENATE FINANCIAL DISCLOSURE REPORT FOR ANNUAL AND TERMINATION REPORTS SUPPLEMENT AL ATT ACHMENTS TO THE REPORT OF U.S. SENATOR AMY KLOBUCHAR APPENDIX A Dates of individual contributions to (S) Minnesota College Savings Plan (Managed Allocation Age 15-17) (Beneficiary: DC) in 2011 that did not exceed $1,000 individually (but which, collectively, fall within the $1,001-$15,000 range): 1118111 1/20/11 1/25111 211111 2115/11 2/22/11 3115111 3/21111 3/24/11 4115111 4/20/11 5/3111 5/16111 5/20111 6115/11 6/20/11 7115/11 7/20111 8/15/11 8/22/11 9/15111 9/20/11 10/14/11 10/17111 10/20/11 1113111 11115111 11121111 12/13111 12/15/11 12/20/11 12/27111

Amy Klobuchar

Page 11

APPENDIXB Dates of individual contributions to (S) Vanguard SmCap Growth Index Inst. - MD Supplemental Retirement Plan (401(k) Plan) in 2011 that fall within the $1,001-$15,000 range individually (and which, collectively, fall within the $15,001-$50,000 range): 1112111 1126111 2/9111 2/23111

Amy Klobuchar

Page 12

APPENDIXC Dates of individual contributions to (S) Vanguard SmCap Growth Index Inst. - MD Supplemental Retirement Plan (457(b) Plan) in 2011 that do not exceed $1,000 individually (but which, collectively, fall within the $1,001-$15,000 range):

3/9111 3/23111 4/6111 4/20111 5/4111 5118111 6/1111 6115/11 7113111

Amy Klobuchar

Page 13

APPENDIXD Dates of individual contributions to (S) Univ. Sys. of MD Optional - TC Lfcycle 2025 Prm in 2011 that do not exceed $1,000 individually (but which, collectively, fall within the $1,001-$15,000 range): 9/14111 9/28/11 10112111 10/26111 1119/11 11122111
1217111

12/21111