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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: ��J� �—t�c_... �--5�� C��� <br />Office sought or held by candidate <br />or purpose of political committee: �''Y�� �1 ��5� ��-�-� ,�� <br />Type of Organization: �/ Candidate Committee <br />Type of report: i� Initial report <br />Political (Action) Committee <br />Post-general <br />� Pre-primary Year-end (January) report <br />Pre-general FIn81 r2pOrt (closes committee account— <br />see M.S. Ch. 211A. 3 for requirements) <br />Period oftime covered by report: From += lLi i���� to � <br />SUMMARY STATEMENT TO DATE <br />�i1_�I�]:Z�L�7►��:�I:�Ijr�l:�� <br />ALL OTHER CONTRIBUTIONS RECEIVED <br />L�3»I►1�]�lll:�Xc.' <br />Total For This <br />Report <br />� <br />� � <br />�� -� <br />Total From Total To <br />Previous Report Date <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 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 �� <br />Contributions between $51 and $300 � <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 $50. <br />Expenditures <br />Current Account Balance <br />List the name and address of all depositories <br />holding this committee'. . e� sit� <br />�;^� /' � � . <br />Signature: <br />Printed Name: <br />� � <br />� <br />$ / � 7, � <br />� <br />mail <br />L� <br />Date: ( <br />r �� i � <br />r�c�c4 �z�sc� �� i 1 I e�, c�►M���`����' <br />Address: �« �j�ti �(` {�}; /2l�'�f Il.l� MIJ ��� Z Phone: �S�- �%- ��5�—' <br />i <br />Revised 6/2013 <br />