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CITY OF ROSEVILLE <br />CAMPAIGN CONTRIBUTION REPORT <br />candidate for office rust file with. the City Clerk. <br />Within the previous year no individual, committee or organization has mace <br />one or more contributions that in the aggregate are gT atr than $50; or <br />A Within the previous year the following individual(s), committee(s) or <br />organization(s) has (have) made one or more contributions that in the aggregate is <br />(are) greater than $50. <br />Date of Amount Name of individual, Address Employer or occupation <br />contribution committee or organization if self employed <br />(Use additional sheets, if needed.) <br />Name of Candidate <br />Name of Person filing report <br />Address of Person filing report 1t*,L-I <br />Signature <br />Period of time covered by this report: From to 1!2- u L- <br />All in 'onnation in this report is public information. <br />(Over) <br />