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CITY OF ROSEVILLE <br />CAMPAIGN CONTRIBUTION REPORT <br />A candidate for office must file with the City Clerk. <br />Within the previ year n indi comet "ttee or o has made <br />one or more contributions that in the aggregate are greater than 50; or <br />Within the previous year the following individual(s), committee(s) or <br />organization(s) has (have) made o ne or more contributions that in the aggregate is <br />(ar greater than $50- <br />Date of Amount of indivi Address employer or occupation <br />contribution c mmittee or organization if self emnlaved <br />e� <br />Af+a <br />(Use additional sheets, if needed.) <br />Name of Candidate �t° �1��? P1 50 iej <br />Name of Person f ling eport r <br />Address of Person fili g report gldrLelse, <br />se�r�cl�� 5511_ <br />Signature JU4LZ <br />U W__ <br />Period of time covere4 by this report: From �I 4 r to `b 04e. <br />All information in this <br />ort is public information. <br />(over) <br />S t? d 02012E 1 T S9 0 1 1006829 T S9 W O J d 92:21 8002 t72 IDO <br />