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CITY OF ROSEVILLE <br />CAMPAIGN FINANCE REPORT FORM <br />Committee Name: " � \`J`�` ���' ��� w'�1 �5 <br />Office sought or held by candidate ( � ( <br />or purpose of political committee: �5-� `�`�'`- ����., Lrr�✓��✓\ <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 />Pre-general Fin81 repOrt(closescommitteeaccount— <br />see M.S. Ch. 211A.03 for requirements) <br />Period oftime covered by report: From ���z-� �Zv`�f to �"Z-% o`{ I w��( <br />SUMMARY STATEMENT TO DATE <br />Total For This Total From Total To <br />Report Previous Report Date <br />MAJOR CONTRIBUTORS <br />ALL OTHER CONTRIBUTIONS RECEIVED <br />EXPENDITURES <br />"�� �C� + (o�s3�c. � <br />+ - <br />�-( 3�3 ��' + c,3 � s, �- <br />Qt � p`�l. �'� <br />�o, ��� , ss <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 />� <br />3vSv <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 />0 <br />Expenditures �3�� 3� <br />Current Account Balance $ ��3 • �� <br />List the name and address of all depositories <br />holding this committee's deposits �'�c.•� <br />Signature: W <br />Printed Name�c��� �,�%��� �S Email: <br />Address: Z43Z N-o,,�-�.s..,.� i�-r, N�„w,l(,� �. �S�i3 Phone: <br />Revised 7/2014 <br />Date: �Z cx�, I Z��`i <br />