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Committee Name: <br />OffiCe sought or heiu uy tar�c�iaate <br />or purpose of politicai committee: <br />CI1'Y OF ROSEVILLE <br />CAA/IpAIGN FINANCE REPORT' FORM <br />� <br />Type of Organization: Candidate Committee Political (Actian) Cammittee <br />iype of report: Initial repart Past-general <br />Pre-primary Year-er�d {lanuary) report <br />Pre-general Fil121 report (closes committee account- <br />see M.5 Gh. 21 .03 for requirements� <br />Period of time covered by report: From � � � ta F �� <br />SUiVIMARY STATEMENT TO �ATE <br />Total For This Total From Totai To <br />Report Previous Report Date <br />MAJOR CONTRIBUTORS <br />ALL OTHER CONTRIBUifOfVS RECEIVE� <br />EXPENDlTURES <br />_ �.�Q�,�� + ���� - �� � <br />�� + ��� � _ �� � � <br />���T + � �� _ � �w �� <br />SIJMNRARY OF EXPENDlTURES AIVD CONTRIBUTBONS FOR THIS PERIOD <br />lYem�ze all contributions made during the previous 365 days by an individual or committee that are greater than $50 in fhe <br />aggregate on a separate sheet. Itemization must provide an�ount, date, name, acldress, employer or occupation if self- <br />employed for all contributors. <br />An iYemized list of atl expenditures must also be provided. This must indude date, purpose, and amount for each <br />expenditure. <br />Contributions less than/equal to $5� <br />Cantributions between $51 and $b00 <br />�� <br />� �.� �� <br />Check here if within che previous year no individual, committee or organization has made one or more contributions that in the <br />aggregate are greater than $50. <br />Expenditures <br />Current Account Satance <br />List the name and adclress of aIl depositories <br />holding this corr��mittee's depasits <br />$ � � �. �'� <br />Signature:,�, - ��"'�° � � Date ' �'"� �� <br />Printed Name: r`°�� � °`��' Email: � ,�' '� � �g���`�• � <br />� �� � �� <br />Address: `�r•�� � � �.�,.�""� �'� Phone: _� ��. a �.� ��� �� < <br />Revised 7/2014 ��� �� �� � � � �� � � � �� <br />