Miller, Jay Initial Campaign Financial ReportFor Office Use Only:
CAMPAIGN FINANCIAL REPORT
(All of the information in this re
Name of candidate, committee or corporation�
Office sought or ballot questionC-.r i l IU,1.CA,- Of
Type of Candidate report
report Campaign committee report
Association or corporation report
Final report
rt is public information)
t
District
Period of time covered by report:
from
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 or occupation if
self-employed, amount and date for these contributions.
CASH $ iJ TOTAL CASH -ON -HAND $ `r
IN-KIND + $
TOTAL AMOUNT RECEIVED = $
DISBURSEMENTS
Include the amount, date and purpose for all disbursements made during the period of time covered by report.
Attach additional sheets if necessary.
Date
Purpose
Name and Address
of Recipient
Amount
Expenditure or
Contribution
Amount
C.--041-4 PAL 41J 3t—` -f'
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CA -t, PD 161.) NiQ- .':'''ll,-).
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TOTAL
TOTAL1,
l 13
CORPORATE PROJECT EXPENDITURES
Corporations must list any media project or corporate message project for which contribution(s) or expenditure(s) 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
of Recipient
Expenditure or
Contribution
Amount
(-------,N\
TOTAL
I certify that this is a full and true statemen
jett
11,
t gnature Date
Printed Name (Vi JV1l i:.l T- ephone Email (if available d Mi
Address �✓1JV
-a.ciz5PrA 4-7c-17,0
Office of the Minnesota Secretary of State — 2016 Campaign Manual
69