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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: '/nlw�n-�-e-�V s -�,r- �'Vl.c `s'��e-�-- <br />Office sought or held by candidate <br />or purpose of pofitica) committee: �s�v � � ��- e"-�' C��,,,� �-^- l <br />Type af Organization: ✓ Candidate Committee _ Political (Action) Committee <br />Type of report: ✓ Initial report _ Post-general <br />Pre-primary _Year-end (January) report <br />Pre-general Flnal I'epOYt (closescommitteeaccount- <br />see M.S. Ch. 211A.03 for requirements) <br />Period of time covered by report: From _ to _ <br />SUMMARY STATEMENT TO DATE <br />Total For This Total From Total To <br />Report Previous Report Date <br />MAJOR C�NTRIBUT�RS <br />ALL OTHER CONTRIBUTIONS RECEIVED <br />EXPENDITURES <br />� -+-�'' _ -�-- <br />,� + —� _ --� , <br />;� + —�— _ —� <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 con#ributors. <br />An itemized list of aIl expenditures must also be provided. This must include date, purpose, and amount for each <br />expenditure. <br />Contributions less than/equal to $50 <br />Contributions between $51 and $300 <br />�it�1 _ <br />'2�2u--� <br />Check here if within the previous year no individual, committee or organization has made one or more contributions that in the <br />aggregate are greater than $50. <br />Expenditures <br />Current Account Balance <br />=iiw-k-c� <br />$ `�'t�az�c-L� <br />List the name and address of all depositories • <br />holding this committee's deposits `�2�-� .e��-c�-c� <br />Signature�. �y/�� <br />Date: � ' � �' � `� <br />/� / L <br />Printed Name: �� l�l�`!�1 c/ �� �.-�-Lt �ie- Email: -�GLt�LL �°-. 72L.� �i ��C� �--. 1 � <br />Address: �12t.i �( o..�ss �u,� �c�seu� l�e �`��U Phone: � 5 l ��f 5"- Z4 � 3 <br />Revised 6/2013 � 5^�� 3 <br />