HomeMy WebLinkAboutWhiting, Jay Final Campaign Report Campaign Financial Report Form (Printable)
CAMPAIGN FINANCIAL REPORT
w of the hob" troy in uric report is public wbrn,odon)
Name of candici0te,committee or corporation
Office sought or ballot question -5J4A 4'1,?f C 1.r$e COu,�e/ District
Type of Candidate report Period of time covered by report
report Campaign committee report
Association or corporation report from 1 to
it Final report
CONTRIBUTIONS RECEIVED
t Give the total for all cons butions received during the period of time covered bythis repom corrtrbutians should be listed by type(money
or iwbnd)rather than contributor.See note on contribution lints on the back of this form use a separate sheet to itemae all rnmtributions
i from a=%W scree that exceeded Sint)during the calendar year.This itemization must include name,address,employer or occupation if
self-erqlvyed,arnumt and date for these corrafttians.
CASH S /y0• y0 TOTAL CASH-ON-HAND S 0
IN-lUND + S Q
TOTAL AMOUNT RECEIVED = S / 0 0. 00
DISBURSEWMNTS
Include the amount,date and purpose for all disbursements made during the period of time covered by repot.
Attach additional sheets if necessary.
Date Purpose Amount
& Tee
.k- s 9S 0,0
TOTAL / Uv
CORPORATE PROJECT EXPENDITURES
Corporations must list any media project or corporate message project for which contributions)or expenditures)total more
than$200. Submit a separate repot for sub project. Attach additional sheets if necessary.
Project title or description
Dote Purpose Name and Address Expenditure or
of Recipient Contnbvtion
Amount
dv
E
z
TOTAL
O
I certify that this is a full and true statement
v Si re Date
O Primed Name r Telephone fi/l V&O-04l i Email(if available)
Address Slil 3 ��!�✓> E �hs lfi;P.t�• 07,- '�53
Office of the Minnesota Secretary of State—Campaign Manual
78
CORPORATE ACTIVITIES TO ENCOURAGE PARTICIPATION: Corporations may contribute to or conduct public
media projects to encourage individuals to attend precinct caucuses, register or vote if the projects are not
controlled by or operated for the advantage of a candidate,political party or committee.The total amount of
expenditures or contributions for any one project greater than$200,together with the date, purpose and the
names and addresses of the persons receiving the contribution or expenditures must be reported. Reports must be
filed with the Secretary of State,Veterans Services Building, 20 W 12th Street,Suite 210,St. Paul, MN 55155, using
the same schedule as above.
FINAL REPORT:A final report may be filed any time after the candidate,committee or corporation has settled all
debts and disposed of all assets in excess of$100 in the aggregate.Check final report under"type of report".
PROHIBITED TRANSFERS:Candidates for county, municipal,school district or special district offices may not accept
contributions from the principal campaign committees of any candidate for legislative,judicial or state
constitutional office. In addition,a candidate may not make contributions to the principal campaign committee of
any candidate for legislative,judicial or state constitutional office unless the contributions are made from the
candidate's personal funds.
STATE CANDIDATES:Candidates and committees for state constitutional offices,the state legislature,supreme
court,court of appeals,district court and committees for state constitutional amendments are governed by
Minnesota Statutes Chapter 10A.Contact the State Campaign Finance and Public Disclosure Board for further
information at(651)539-1180.
Note:The filing officer must restrict public access to the address of any individual who has made a contribution
that exceeds$100 and who has filed with the filing officer a written statement signed by the individual that
withholding the individual's address from the financial report is required for the safety of the individual or the
individual's family.
Office of the Minnesota Secretary of State—Campaign Manual
77
CAMPAIGN FINANCIAL REPORT CERTIFICATION OF FILING
Instructions
Each county, municipal or school district candidate or treasurer of a committee formed to promote or
defeat a ballot question shall certify to the filing officer that all reports required by Minnesota Statutes
211A.02 have been submitted to the filing officer or that the candidate or committee has not received
contributions or made disbursements exceeding$750 in the calendar year.The certification shall be
submitted to the filing officer not later than seven days after the general or special election. (Minnesota
Statutes 211A.05, subdivision 1).
Campaign Information ----�� /
Name of candidate or committee J� �h i%ii✓J
Office sought by candidate (if applicable) 'SA.1,C�o�t''E' (� TV 694,A/4-i
Identification of ballot question (if applicable)
Certification
Select the appropriate choice below, and sign:
❑ I do swear(or affirm)that all campaign financial reports required to date by Minnesota Statutes
211A.02 have been submitted to the filing officer.
1 do swear(or affirm)that campaign contributions or disbursements did not exceed $750 in the
calendar year.
Signature of candidate or committee treasurer Ax 11
Date \�,i�j
Office of the Minnesota Secretary of State—Campaign Manual
L
79
Office of the Minnesota Secretary of State
Elections Division
Campaign Manual
Updated April 2024