HomeMy WebLinkAboutJay Whiting Office of the Minnesota Secretary of State
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 -4
Office sought by candidate (if applicable) 51)4Ko 100!e CST'!j C0!cn1Qr j
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 by Minnesota Statutes
I� 211A.02 have been submitted to the filing officer.
❑ I do swear(or affirm)that campaign contributions or disbursements did not exceed
$750 in the calendar year.
Signature of candidate or committee treasurer
Date
Office of the Minnesota Secretary of State
63
CAMPAIGN FINANCIAL REPORT
(Ati of the htfonnadon in this report is public information)
Name of candidate,committee or corporation IA!i (A)4 eT,,�,R
Office sought or ballot question 154d6JZo&e e,Ty Coiwvs~ / District
Type of Candidate report Period of time covered by report:
report Campaign committee report
Association or corporation report from G K to ii�2q�5
we" Final report
CONTRIBUTIONS RECEIVED
Give the total for all contributions received during the period of time covered by this report. Contributions should be listed by type
(money or in-kind)rather than contributor. See note on contribution limits on the back of this form.Use a separate sheet to itemize all
contributions from a single source that exceeded$100 during the calendar year.This itemization must include name,address,employer
Qor occupation if self-employed,amount and date for these contributions.
cc CASH $ Z I y (' 13 TOTAL CASH-ON-HAND $ 2 11(e.8 2
IN-KIND + $
TOTAL AMOUNT RECEIVED
EXPENDITURES
Include the amount,date and purpose for all expenditures made during the period of time covered by report.
Attach additional sheets if necessary.
Date Purpose Amount
G/3o 1 S4Lb�t9 A — .i.�t• �'.v�- So,ov
?Z2 is Slu a is tc s
4To Tlwko/t - F•l�w Fed Soa
° 8 c5 P ecJS - A
15CR A136-4a) TOTAL �87�• ��
CORPORATE PROJECT EXPENDITURES
Corporations must list any media project or corporate message project for which contribution(s) or expenditures) total
more than$200. Submit a separate report for each project. Attach additional sheets if necessary.
Project title or description
Date Purpose Name and Address Expenditure or
of Recipient Contribution
Amount
E TOTAL
m
Z
1 certify that this is a full and true statement.
15 Signature Date
Printed Name *1c►\i Telephone 1'52q%_01';1 Email(if available) Ja Y c.?1►T t/Jq •c A01.c&'
_r
Address 52. 3rD AJ'e 6.� '%gkofee. Mr/ S5'373
Office of the Minnesota Secretary of State
61
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