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<br />STATEMENT OF RECEIPTS AND EXPENDITURES
<br />pursuant to the Minnesota Fair Campaign Practices Act, Minn. Stat. ~210A.27, Subd. 1
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<br />This STATEMENT OF RECEIPTS AND EXPENDITURES is to be used by candidates, committees, and corpora-
<br />tions required by Minn. Stat. Ch. 210A to file such a report. These include candidates and committees in elections
<br />for county office; municipal office in municipalities over 20,000 population; individuals, political committees,
<br />associations, or corporations for ballot questions; and corporations spending more than $100 on certain activities to
<br />encourage participation in precinct caucuses, voter registration, or voting. (For supplemental information, see page
<br />four.) Candidates and committees for state constitutional office, state legislature, supreme court, district court,
<br />county court, and committees for state constitutional amendments are not included; candidates and committees for
<br />U.S. senate and U.S. representative in congress may file copies of their federally-required disclosures in lieu of this
<br />statement.
<br />
<br />This statement is to be filed with the filing officer designated in Minn. Stat. ~ ~210A.26, Subds. 2-4, and 210A.34,
<br />Subd. 8; questions about completing and filing this statement may be directed to that filing officer.
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<br />Name of candidate, committee, or corporation (U.... , ^'
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<br />Office sought by candidate ~_IIA.1 l..t c.. Mh-'" District
<br />(if appl icable)
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<br />Identification of ballot question
<br />(if applicable)
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<br />Type of report 1 Candidate report
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<br />_Party committee report
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<br />_ Personal campaign committee report
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<br />_Association or corporation report
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<br />_ Political committee report
<br />Period of time covered by report: from ,,~r ,~ . 19r?to (JL7 2. ?, ,~f 1
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<br />SUMMARY STATEMENT TO DATE
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<br />TOTAL FOR
<br />THIS REPORT
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<br />TOTAL FROM
<br />PREVIOUS REPORT
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<br />TOTAL
<br />TO DATE
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<br />o RECEIPTS (Exhibit A)
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<br />PROMISES OR PLEDGES
<br />RECEIVABLE (Exhibit B)
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<br />EXPENDITURES ACTUALLY
<br />MADE (Exhibit C)
<br />
<br />OBLIGATIONS INCURRED
<br />BUT NOT PAID (Exhibit D)
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<br />I do swear (or affirm) that I am a candidate for public office or an officer of the
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<br />committee or corporation and that this report is a full
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<br />and true statement pursuant to Minnesota Statutes Ch. 210A.
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<br />Committee or corporate office held
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<br />, NOT,0, a'i"'; If A' (~OU,,\"!,'-, ',:,"
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<br />ii';:', My Comnws5lon, ,~a~~..J.9IH
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<br />Address
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<br />Subscribed and sworn to before me this
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<br />~ ~Notary Public
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<br />SC 00069-03
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