CAMPAIGN FINANCIAL REPORT
(All of the information in this report is public information)
Name of candidate, committee or corporation _____________________________________________________________
Office sought or ballot question ________________________________________ District __________________________
Type of
report
_______________ Candidate report
_______________ Campaign committee report
_______________ Association or corporation report
_______________ Final report
Period of time covered by report:
from __________ to __________
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
IN-KIND
TOTAL AMOUNT RECEIVED
$ ________________
+
$ ________________
=
$ _______________
TOTAL CASH-ON-HAND $ _______________
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
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
of Recipient
Expenditure or
Contribution
Amount
TOTAL
I certify that this is a full and true statement. ______________________________________________________________
Signature Date
Printed Name ____________________________ Telephone__________________ Email (if available)________________
Address ___________________________________________________________________________________________
For Office Use Only: Name Office Report
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INSTRUCTIONS
(Reference: Minnesota Statutes, Chapters 211A and 211B)
This CAMPAIGN FINANCIAL REPORT is for use by candidates and committees for county, municipal, school district and special
district office who receive contributions or make disbursements of more than $750 in a calendar year; committees or corporations
spending more than $750 for or against a ballot question in a calendar year; and corporations spending more than $200 on
activities to encourage participation in precinct caucuses, voter registration or voting.
Where to file this report:
Hospital Districts
Park Districts
School Districts
Townships
Cities
Soil & Water Conservation Districts
Counties
The municipal (city or town) clerk same place where filed affidavit of candidacy
The county auditor or municipal clerk same place where filed affidavit of candidacy
School district clerk
Town clerk
City clerk
County auditor
County auditor
Candidate or committee report: The initial report must be filed within 14 days after the candidate or committee receives contributions
or makes disbursements of more than $750 in a calendar year. Subsequent reports must be filed.
During an Election Year - An election year is any year in which the candidate’s name or a question appears on the ballot.
In such a year (if an initial report has been filed) reports are required to be filed:
10 days before the primary or special primary
10 days before the general election or special election
30 days after a general election or special election
By January 31 of each year following the year when the initial report was
filed.
During a non-election year - By January 31 of each year following the year when the initial report was filed.
Once a final report* is filed, no further subsequent reports are required to be filed.
CONTRIBUTIONS: Means anything of monetary value that is given or loaned to a candidate or committee for a political purpose.
“Contribution” does not include a service provided without compensation by an individual. Each candidate or committee must list the
total amount of cash-on-hand designated to be used for political purposes as of the close of the reporting period.
CONTRIBUTION LIMITS: Candidates or candidate’s committees for county, municipal, school district offices may not accept aggregate
contributions in excess of $600 in an election year or in excess of $250 in a non-election year made or delivered by an individual or
committee. However, candidates seeking election from districts with a population in excess of 100,000 may not accept aggregate
contributions in excess of $1,000 in an election year and $250 in a non-election year.
BALLOT QUESTIONS: Any political committee, association or corporation that makes a contribution or expenditure to promote or defeat
a ballot question as defined in Minnesota Statutes, section 211A.01
shall file reports with the filing officer responsible for placing the
question on the ballot. Reports must be filed within 14 days of receiving contributions or making disbursements of more than $750 in one
calendar year, using the same schedule as above.
CONGRESSIONAL CANDIDATES: Candidates for election to the United States House of Representatives and Senate and any committee
raising funds exclusively on behalf of any one of those candidates may file copies of the reports required by federal law in lieu of those
required by Minnesota Statutes Chapter 211A.
CORPORATE ACTIVITIES TO ENCOURAGE PARTICIPATION: Corporations may contribute to or conduct public media projects to encourage
individuals to attend precinct caucuses, register or vote if the projects are not controlled by or operated for the advantage of a candidate,
political party or committee. The total amount of expenditures or contributions for any one project greater than $200, together with the
date, purpose and the names and addresses of the persons receiving the contribution or expenditures must be reported. Reports must be
filed with the Secretary of State, 180 State Office Building, St. Paul, MN 55155-1299, using the same schedule as above.
*FINAL REPORT: A final report may be filed any time after the candidate, committee or corporation has settled all debts and disposed of
all assets in excess of $100 in the aggregate. Check final report under “type of report”.
PROHIBITED TRANSFERS: Candidates for county, municipal, school district or special district offices may not accept contributions from
the principal campaign committees of any candidate for legislative, judicial or state constitutional office. In addition, a candidate may not
make contributions to the principal campaign committee of any candidate for legislative, judicial or state constitutional office unless the
contributions are made from the candidate’s personal funds.
STATE CANDIDATES: Candidates and committees for state constitutional offices, the state legislature, supreme court, court of appeals,
district court and committees for state constitutional amendments are governed by Minnesota Statutes Chapter 10A
. Contact the State
Campaign Finance and Public Disclosure Board for further information at (651) 539-1180.
Note: The filing officer must restrict public access to the address of any individual who has made a contribution that exceeds $100 and
who has filed with the filing officer a written statement signed by the individual that withholding the individual’s address from the
financial report is required for the safety of the individual or the individual’s family.
Updated 7/18/2014
Campaign Financial Form Addendum: Campaign Donations:
Date: Name: Employer/Cause: Address: Amount: Type: Number:
6/19/2018 Steve Dennis Dennis Brothers Liquor 7264 Jenner Lane S., Cottage Grove, MN 55016 $140.00 Cash
6/19/2018 Annie Berndt Vintage Touch Weddings 7310 Lamar Ave S., Cottage Grove, MN 55016 $20.00 PayPal
7/2/2018 Steve Dennis Dennis Brothers Liquor 7264 Jenner Lane S., Cottage Grove, MN 55016 $180.00
Cash/Check
7/9/2018 Steve Dennis Dennis Brothers Liquor 7264 Jenner Lane S., Cottage Grove, MN 55016 $125.00 Cash
7/30/2018 Jeff Lennartson Unknown 7526 Ivystone Ave. S., Cottage Grovw, MN 55016 $50.00 Check
8/13/2018 Brian Treber Target Corporation 7250 Hidden Valley Tr. S., Cottage Grove, MN 55016 $250.00 Check
8/13/2018 Fred Luden Jr. Unknown 9920 77th Street S., Cottage Grove, MN 55016 $300.00 Cash
8/14/2018 Mark Cookson Unknown 7294 Jordan Ave S., Cottage Grove, MN 55016 $250.00 PayPal
8/17/2018 Megan Titcomb Healing Garden Hypnosis 8844 67th Street Bay S., Cottage Grove, MN 55016 $50.00 PayPal
PayPal Processing Fees On-Line ($10.15)
7/31/2018 City of Cottage Grove Campaign Filing Fee ($5.00) Cash
Total: $1,349.85