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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: J�.� �� �'�� �`L�� L l.: 1.V`.:� <br />Office sought or held by candidate <br />or purpose of political committee: � �-l. �Z'-�2 �-� <br />Type of Organization: � Candidate Committee _ <br />`��'�- ( ' < < < � � � \ � <br />Political (Action) Committee <br />Type of report: Initial report Post-general <br />Pre-primary Year-end (January) report <br />� Pre-general Flnal I'epol't (closescommitteeaccount- <br />see M.S. Ch. 21�A.03 for requirements) <br />Period of time covered by report: From Z (`�" to �t, �� �)� -- <br />SUMMARY STATEMENT TO DATE <br />MAJOR CONTRIBUTORS <br />ALL OTHER CONTRIBUTIONS RECEIVED <br />EXPENDITURES <br />Total For This <br />Report <br />� <br />�� .-� <br />� <br />�..�� � r <br />Total From <br />Previous Report <br />+ � _ <br />+ � _ <br />+ �� _ <br />Total To <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 $600 � <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 greaterthan $50. <br />Expenditures <br />Current Account Balance <br />/ <br />'�, � �l <br />_� , <br />$ /Z s. =- <br />List the name and address of all depositories <br />holding this committee's ep its ;�! �7r� '•- � -'�� ,�v' �iQ.�`j K , � ��:- � rJ. ��` � r J `u �-�'��', �.`� I ��� �"���' <br />��� �� �:t�a/ �_j <br />Signature: <br />Printed Name: �l:v' t' <br />Date: 'E� �' l <br />Email: �L,�=;�''�,����o ��1� �t', L�}bat�y����;/1{�- <br />Address: ��'l,� �\�������� �'I �,� l��l.���i,( I<<< Jl7'� ,__.:-._•�Phone: �,�'. /- ��� 1 - 9� � `� <br />, �� � <br />Revised 7/2014 <br />