Petschel-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 Tater than seven days after the general or special election.
(Minnesota Statutes 211A.05, subdivision 1).
Campaign Information
Name of candidate or committee
Office sought by candidate (if applicable)
m�,, >L 4-6 C,P
Identification of ballot question (if applicable)
Certification
Select the appropriate choice below, and sign:
K11 do swear (or affirm) that all campaign financial reports required by Minnesota Statutes
1A.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 „Nap/4
4,ALL
Office of the Minnesota Secretary of State — 2014 Campaign Manual — 9/10/2014 Revised Edition
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