Lorberbaum, Sally - certification of filing 11-15-2022t
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CAMPAIGN FINANCIAL REPORT
(All of the Information In this report is public information)
Name of candidate, committee or corporation Sally Lorberbaum - Sally for Council
Office sought or ballot question Mendota Heights City Council District
Type of X Candidate report Period of time covered by report:
report Campaign committee report
Association or corporation report from 5/11 /2022 to 11 /15/2022
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
or occupation if self-employed, amount and date for these contributions.
CASH $ 5,782.18 TOTAL CASH -ON -HAND $ 0
IN -KIND 316.26
TOTAL AMOUNT RECEIVED
$ 6,098.44
MUM -
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 Amount
See enclosed attachment
TOTAL $5,782.18
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
of Recipient
Expenditure or
Contribution
Amount
TOTAL
I certify that this is a full and true statement.
e Date
Printed Name Mickey Kieffer Telephone 952-831-4000 Email (if available) mkieffer@ameritelinc.net
Address 1830 Rolling Green Curve, Mendota Heights, MN 55118-4230
11 / 15/2022
Office of the Minnesota Secretary of State
CAMPAIGN FINANCIAL REPORT CERTIFICATION OF FILING
1 nstrur_tinnS
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 Sally Lorberbaum
Office sought by candidate (if applicable) Mendota Heights City Council
Identification of ballot question (if applicable)
Cprtificatinn
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.
OI do swear (or affirm) that all campaign contributions or disbursements did not exceed $750 in the calendar
year.
Signature of candidate or commi tee treasurer Mickey Kieffer, Treasurer
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Date November 15, 2022
Revised 212014
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