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<br />CITY OF ROSEVILLE <br />CAMPAIGN CONTRIBUTION REPORT <br /> <br />A candidate for office must file with the City Clerk. <br /> <br />Within the previous year no individual, committee or organization has made <br />one or more contributions that in the aggregate are greater than $50; or <br /> <br />X Within the previous year the following individual(s), committee(s) or <br />organization( s) has (have) made one or more contributions that in the aggregate is <br />(are) greater than $50. <br /> <br />Date of Amount Name of individual, Address Employer or occupation <br />contribution committee or organization if self employed <br /> I J <br /> J-r: eN- 1/r.-;- <br /> ,y-v <br /> ./ , 0/ <br /> ,r _ xv <br /> '""/ <br /> <br />(Use additional sheets, if needed.) <br /> <br />Name of Candidate Ja. yY) m \1 Pv.s t- <br />Name of Person filing report ~. r,' /5 P:;e-r ~ <br />Address of Person filing report g, ~ fi-( . 'll uJC)ori Au; ~ <br />~~/'Il-e-l MI\1 ~5 (I 3 <br /> <br />Signature ~~~/ . _ <br /> <br />Period of time covered by this report: From 10 ls. I / (j "i to 10 13 l (f '):" <br /> <br />All information in this report is public information. <br /> <br />(Over) <br />