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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: v � `v`'����-�5 �o,T �J� �� �^^��5 <br />Office sought or held by candidate <br />or purpose of political committee: ��� ��� C��� C�'1�� <br />Type of Organization: _� Candidate Committee Political (Action) Committee <br />Type of report: Initial report Post-general <br />Pre-primary Year-end (January) report <br />�,4_ Pre-general Fin21 r2pOtt (closes committee account— <br />/ see M.S. Ch. 211A.03 for requirements) <br />Period of time covered by report: From �(��Z� �`-i to ���Z� � 2°``-1 <br />SUMMARY STATEMENT TO DATE <br />Total For This Tota) From Total To <br />Report Previous Report Date <br />MAJOR CONTRIBUTORS <br />ALL OTHER CONTRIBUTIONS RECEIVED <br />EXPENDITURES <br />52y0 + / SS`/ '�- _ (a�s3�f � <br />+ - <br />�.Ca3.'� �'-{ + -7 �-( l . �-- - Co3�, � <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/equa) to $50 <br />Contributions between $51 and $600 <br />�� <br />��0� <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 $50. <br />Expenditures <br />Current Account Balance <br />List the name and address of all depositories <br />holding this committee's deposits US <br />i� �� � <br />Signature: <br />�C.o33.�r- <br />$ �-( S� . yF <br />r f <br />Printed Name: ���, ���1�.�5 Email: <br />Address: <br />2�t 3Z- '�-�.�^^� ; �..._ �� nE �2o-xy. �Z GKK <br />Revised 7/2014 �j(�� <br />hone: <br />Date: �-� ( Z�{ Z�1 � <br />