Garlock, Neil Campaign Fin Report Certification of FilingOffice 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 /\%/ ` �G rltac
Office sought by candidate (if applicable)
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 211A.02 have been
submitted to the filing officer.
i 1 do swear (or affirm) that all campaign contributions or disbursements did not exceed $750 in the calendar
year.
Signature of candidate or committee treasurer -7
Date
Revised 2/2014
CAMPAIGN FINANCIAL REPORT
(All of the information in this report is public information)
Name of candidate, committee or corporation' / J
Office sought or ballot question /J% �tyc� District /�%�i7�d'7�i /7E/g/� T
Type of
report
Candidate report
Campaign committee report
Association or corporation report
Final report
Period of time covered by report:
fromh�--'7/,eto 11-1.3—le
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
0 or occupation if self-employed, amount and date for these contributions.
Q
Q) CASH $ TOTAL CASH -ON -HAND $
IN-KIND +
TOTAL AMOUNT RECEIVED - (�7:)
DISBURSEMENTS
Include the amount, date and purpose for all disbursements made during the period of time covered by report.
f; Attach additional sheets if necessary.
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v
U
0
a
C]
m
E
z
Date Purpose Amount
TOTAL
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 Expenditure or
of Recipient Contribution
Amount
TOTAL
I certify that this is a full and true statement.
Signature Date
651
Printed Name /VC, '/oc,k Telephone �7�—�F�'jG7 Email (if available)
Address