Office of the Minnesota Secretary of State
Revised 2/2014
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
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 2
11A.02 have been
submitted to the filing officer.
I do swear (or affirm) that all campaign contributions or disbursements did not exceed $750 in the calendar
year.
Signature of c
andidate or committee treasurer
Date
Jill Larson-Vito
Elk River City Council Ward 1
11/16/18
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