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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: C+�"iz�v1 S ��Y" s'e-l�'�--{�-�-CZ'' <br />Office sought or held by candidate <br />or purpose of political committee:_ C��'�/ �oUh�i �� <br />Type of Organization: _ ►� C:andidate Cornmittee <br />Type of report: <br />_ Initial report <br />c� Pre-primary <br />Pre-general <br />oteYi' u2.. �(1(? <br />D ���� u � a <br />AUG � � 1ia12 <br />R�.;r�S��� �c�� ���i� <br />��.i.�� r���� <br />Political (Action) Committee <br />Post-general <br />Year-end (January) report <br />_, Fllla� C2pOft (closes committee account — <br />see M.S Ch 211A 03 for requirements) <br />Period of time covered by report: From � 1 ��' to ��9 /� __ <br />SUMMARY STATEMENT TO DATE <br />MAJOR CONTRIBUTORS <br />ALL OTHER CUNTRIBUTIONS RECEIVED <br />EXPENDITURES <br />Total For This <br />Report <br />3oa <br />Total From <br />Previous Report <br />+ a = <br />Total To <br />Date <br />3 00 <br />o + � = O <br />a"'- o—�-- + _ b = �'-° —l-- <br />SUMMARY OF EXPENDITURES AND CONTRIBUTIONS FOR THIS PERIOD <br />Itemize all contributions made during the previous 365 days by an individual or committee that are greater than $50 in the <br />aggregate on a separate sheet Itemization must provide amount, date, name, address, employer or occupation if self- <br />employed for all contributors, <br />An itemized list of all expenditures must also be provided. This must include date, purpose, and amount for each <br />expenditure. <br />Contributions less than/equal to $50 _ O <br />Contributions between $51 and $300 .3 DC� __ Check here if within the previous year <br />no individual, committee or organization has made one or more contributions that in the aggregate are greater than $50 <br />Expenditures � a-- � 9 <br />Current Balance <br />List the name and address of all depositories <br />holding this committee's deposits � Ir'�Y1��1� �al <br />����o <br />� �v- ,4. <br />� os 2v i IiC.a., VYl f7 5 5! I <br />.�i rcc �— — <br />Committee treasurer <br />� �" (,4> • G� . 1Q d, t� �— � <br />S 9 I �-- <br />Date <br />Email (note if you want it redacted before form becomes public): ��1r��I%� S('i�1�7 �r ��'DS�Vi %�E. C6�yj <br />