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CAMPAIGN FINANCIAL REPORT CERTIFICATION of FILING <br />Eac COUJIty, municipal or school district candidate or treasurer of a c ommittee formed to promote <br />or defeat a ballot question shall certify to the filing officer that all reports required. by Minnes ota Statutes <br />211,4 02 have been submitted to the filing officer or that the candidate or c ommittee has not received <br />contributions or made disbursement exceeding $750 in the calendar y ear. The certification shall b <br />ubmitted to the filing officer not later than seven days after the general or special election. Minn esota <br />Sta tu tes 2 1 1A. 05. Is Itt b di vis io n 1) <br />Name of candidate or committee <br />Office sought b candidate <br />u I <br />if applicabl <br />o r <br />Identificat.i.on of ballot question <br />1b <br />Check the appropriate box belo <br />I do swear (or affirm) that all campaign financial reports required by <br />Minnesota Statutes 211 A.02 have been submitted to the filing officer: <br />a I do swear (or affirm) that campaign contributions or disbursements did not <br />exceed X750 in the calendar year. <br />(Si tore of candidate or committee treasurer) (Date) <br />Office of the Minnesota Secretary of State <br />