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CITY OF ROSEVILLE <br />CAMPAIGN CONTRIBUTION REPORT <br />candidate for office must file with the City Clerk. <br />Within the previous year no individual, committee or organization has mad <br />one or more c that in the aggregate are greater than or <br />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 S50. <br />Date of Amount Name of individual, Address Employer or occupation <br />contribution committee or or anization if self employed <br />J r7 <br />(Use additional sheets, if needed.) <br />Nam of Can di date <br />Ire of Person filing report <br />Address of Person filing report 2 L: <br />Signature <br />Period. of time covered by this report: From o to Zo #v <br />All infor .ation ire this report 1s public infor atio <br />(Over) <br />