Candidate Filing Information 2022 - Elections 651-430-6790 14949 62nd Street North Stillwater, MN 55082 - Washington County, MN

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Candidate Filing Information 2022 - Elections 651-430-6790 14949 62nd Street North Stillwater, MN 55082 - Washington County, MN
Candidate Filing
   Information
       2022
Property Records and Taxpayer Services Department
                    Elections
            14949 62nd Street North
             Stillwater, MN 55082
                  651-430-6790
2|Page
2022 Candidate Information

This packet contains selected general information regarding the candidate filing and election process for
 federal, state and county offices. The process is principally governed by Minnesota Statutes, Chapter
            200 through 211B. Please refer to these sources for more complete information.

 If you have any questions pertaining to the election, feel free to call this office at 651-430-6790 or the
                              Secretary of State’s Office at 651-215-1440.

                                        Table of Contents
2022 ELECTION DATES                                                          4
GENERAL INFORMATION & COUNTY MISSION STATEMENT                               5
CURRENT OFFICES                                                              6
WHEN TO FILE                                                                 7
WHERE TO FILE                                                                8
WHO CAN FILE                                                                 10
AFFIDAVIT OF CANDIDACY INFORMATION                                           11
FILING FEE (OR PETITION IN LIEU OF FILING FEE)                               12
PARTISAN/NON-PARTISAN OFFICES                                                12
STATEMENTS OF ECONOMIC INTEREST                                              13
CAMPAIGN FINANCIAL REPORTING                                                 14
CYBERSECURITY MEMO                                                           17
FAIR CAMPAIGN PRACTICES                                                      18
CAMPAIGN SIGNS                                                               18
MINNESOTA DEPARTMENT OF TRANSPORTATION LETTER WASHINGTON                     19
COUNTY DEPARTMENT OF TRANSPORTATION LETTER                                   20

                                         Attachments Enclosed:
                                    Minnesota Affidavit of Candidacy
                                     Statement of Economic Interest
                                       Campaign Financial Report
                                         Affidavit of Withdrawal
                                   Secretary of State Map Order Form
                           Secretary of State Voter Registration List Request
                    Secretary of State Precinct Finder, Table, & Polling Place Request
                        Secretary of State Election Candidate Information Form

                                                                                                    3|Page
Election Dates

June 24th – Aug 8th             Primary Election Absentee Voting
July 19th 2022                  End of pre-registration of voters for primary election
August 6th 2022                 Saturday hours 8am-3pm in-person absentee voting
August 9th 2022                 Primary Election
September 23rd - Nov 7th        General Election Absentee Voting Period
October 18th 2022               End of pre-registration of voters for general election
November 5th 2022               Saturday hours 8am-3pm in-person absentee voting
November 8th 2022               General Election

                               2022 Important Election Filing Dates
Early Filing Period            Filing Opens        Filing Close       Withdrawal Deadline
                                5/17/22               5/31/22               6/2/22

Applicable Offices

    •   Federal Offices
    •   State Offices
    •   Judicial Offices
    •   County Offices
    •   If primary is possible
                     City Offices
                     School District Office

Late Filing Period             Filing Opens        Filing Close       Withdrawal Deadline
                                08/2/22               08/16/22               08/18/22

Applicable Offices
   •    If primary is not possible
   •    City Offices
   •    School District Offices
   •    Township Offices with November elections

                                          Financial Reporting
More than $750 (contribution/disbursements)
Within 14 days                  of receiving or disbursing more than $750 in a calendar year
July 30th, 2022                 Pre-primary election campaign financial reports due
October 29 , 2022
             th
                                Pre-general election campaign financial reports due
November 15 , 2022
                th
                                Certificate of filing due
December 8th, 2022              Post-general election campaign financial reports due
January 31 , 2023
            st
                                Annually until all debts have been settled and all assets in excess of $100 in
                                the aggregate are disposed of, at which a final report is filed.
$750 or less (contribution/disbursements)
November 15th, 2022                Certificate of filing due

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GENERAL INFORMATION

                              COUNTY MISSION STATEMENT

   Providingqualityservicesthrough responsibleleadership,
     innovation,and thecooperation of dedicated people.
Washington County was officially created on October 27, 1849, in the Territory of Minnesota
(Minnesota was admitted to the United States as the 32nd state on May 11, 1858). As one of
Minnesota’s original nine counties, Washington County is located on the eastern edge of the
Twin Cities Metropolitan area and is comprised of 423 square miles of land. Washington County
government has been serving residents since its creation in 1849. The county seat is located in
Stillwater, Minnesota, along the scenic St. Croix River.

Washington County has historically played a diverse role in the region, serving the Twin Cities
with its commercial, industrial, natural, and agricultural resources. The residents of Washington
County take great pride in the rich, historical significance of the area.

Today, Washington County is a place where a prosperous economy grows with vital industries.
The continued economic expansion of the Twin Cities metropolitan area, with its resultant
population growth, has caused a spread of highly developed urban areas in Washington County
in the cities of Woodbury, Cottage Grove and Oakdale. The communities of Stillwater, Bayport,
St. Paul Park, Newport and Forest Lake have each developed economic bases that support a
local labor force.

While much of Washington County has retained its rural atmosphere, today it is considered a
suburban county. However, the county continues to maintain its diverse image - from the corn
fields of Denmark Township to the residential neighborhoods of Woodbury; from the office and
retail complexes along Interstate 94 to the cooling waters of the St. Croix River; from the
lakeshore communities around White Bear Lake and Forest Lake to the pastoral wooded
settings of Scandia and May Township … each area of Washington County possesses a distinct
set of landscapes and resources.

Goals:
To promote the health, safety, and quality of life citizens
To provide accessible, high‐quality services in a timely and respectful manner
To address today’s needs while proactively planning for the future
To maintain public trust through responsible use of public resources, accountability, and
openness of government

Values:
Ethical: to ensure public trust through fairness, consistency, and transparency.
Stewardship: to demonstrate tangible, cost‐effective results and protect public resources.
Quality: to ensure that services delivered to the public are up to the organization’s highest
standards.
Responsive: to deliver services that are accessible, timely, respectful and efficient.
Respectful: to believe in and support the dignity and value of all members of this community.
Leadership: to actively advocate for and guide the County toward a higher quality of life

                                                                                      5|Page
In 2022 Washington County citizens will vote for the following
                        Federal, State and County offices:

 Federal Offices                                                  Term

 United States Representative District 2                          Two Years
 United States Representative District 4                          Two Years
 United States Representative District 8                          Two Years
 State Offices                                                    Term
 Governor and Lieutenant Governor                                 Four Years
 Secretary of State                                               Four Years
 State Auditor                                                    Four Years
 Attorney General                                                 Four Years
 State Senator District 33                                        Four Years
 State Senator District 36                                        Four Years
 State Senator District 41                                        Four Years
 State Senator District 44                                        Four Years
 State Senator District 47                                        Four Years
 State Senator District 53                                        Four Years
 State Representative District 33A                                Two Years
 State Representative District 33B                                Two Years
 State Representative District 36B                                Two Years
 State Representative District 41A                                Two Years
 State Representative District 41B                                Two Years
 State Representative District 44B                                Two Years
 State Representative District 47A                                Two Years
 State Representative District 47B                                Two Years
 State Representative District 53B                                Two Years
 County Offices                                                   Term
 County Commissioner District 2                                   Four Years
 County Commissioner District 4                                   Four Years
 County Commissioner District 5                                   Four Years
 County Sheriff                                                   Four Years
 County Attorney                                                  Four Years
 Soil & Water Conservation District Supervisor District 2         Four Years
 Soil & Water Conservation District Supervisor District 4         Four Years
 Soil & Water Conservation District Supervisor District 5         Four Years
 Judicial Offices                                                 # of seats
                                                                  open
 Supreme Court Associate Justice                                  2
 Court of Appeals Judge                                           10
 District Court Judge                                             12

In addition to the federal, state, county, and judicial offices, some municipal and, school
                                                                                 6|Page
districts will be on the ballot.

                                   7|Page
Filing for Office

When to File:

                         Federal, State, & County Offices

Filing for federal, state and county offices opens Tuesday, May 17, 2022, and ends at
5:00 p.m. on Tuesday, May 31, 2022. Because May 30th, 2022, is a state holiday on
which unnecessary public business is prohibited by law, neither affidavits of candidacy
nor nominating petitions will be accepted for filing and will not be processed on May
30th, 2022, at the Property Records & Taxpayer Services Department, 14949 62nd
Street N, Stillwater MN and the Office of the Minnesota Secretary of State.

                                        MAY 2022

                Sun       Mon     Tue      Wed     Thu     Fri     Sat
                1         2       3        4       5       6       7
                8         9       10       11      12      13      14
                15        16      17       18      19      20      21
                22        23      24       25      26      27      28
                29        30      31       1       2       3       4

Candidates for federal, state or county office may withdraw from candidacy until 5:00
p.m. June 2, 2022. Filing fees are not refundable.

                    Municipal Offices/ School District Offices
                     (For municipalities and School Districts without a
                       municipal or School District primary election)

Filing for city, township and school district offices opens Tuesday, August 2, 2022, and
ends at 5:00 p.m. on Tuesday, August 16th, 2022. Filings are submitted to the city, or
township clerk. Contact your local municipal clerk for filing packets and information.

Candidates for municipal offices may withdraw from candidacy until 5:00 p.m. August
18th, 2022. Contact your local clerk regarding municipal candidacy withdrawals. Filing
fees are not refundable.

                                                                               8|Page
Where to File:

Filing with the Minnesota Secretary of State, 100 Constitution Ave., 180 State Office
Building, St. Paul, MN 55115, telephone number 651- 215-1440 for these federal
and state offices:

United States Representative Congressional District 2
United States Representative Congressional District 4
United States Representative Congressional District 8

Filing with Washington County or the Minnesota Secretary of State: Candidates
filing for the State Offices, Supreme Court, Court of Appeals, 10th Judicial Judge offices
may file with Washington County Elections if they reside in Washington County, or they
may file with the Office of the Minnesota Secretary of State.

Governor and Lieutenant Governor
State Senate
Secretary of State
State Auditor
Attorney General
Supreme Court Chief Justice
Supreme Court Associate Justices
Court of Appeals Judges
10th Judicial Court Judges

Filing with Washington County or the Minnesota Secretary of State: Candidates
filing for the State Representative offices may file with Washington County Elections if
they reside in Washington County or they may file with the Office of the Minnesota
Secretary of State.

State Representative District 33A, 33B, 36B, 41A, 41B, 44B,47A, 47B, 53B

Filing with Washington County: Washington County Elections at: 14949 62nd Street
North, Stillwater, MN 55082, telephone number 651-430-6790 for these state and
county offices.

County Commissioner -Districts 2,4,5
County Sheriff
County Attorney
Soil & Water Conservation District Supervisor Districts 2,4,5

                                                                                9|Page
Municipal & School District Filings: Filing at the City Hall or Town Hall: Filings will
take place with the municipal clerks.

Mayor
Council Member
Council Member Special
Council Member at Large
Town Supervisor
Town Clerk

SCHOOL DISTRICT OFFICES

Filing with the School District Clerk: Filings will take place with the school district office

School Board Members
School Board Special

                                                                                    10 | P a g e
Who Can File:

Age, residency, and other requirements are governed by Minnesota Statute 204B.06
and local ordinances and vary according to office. Contact your city, township or school
district clerk filing officer for specific eligibility information regarding city, township, or
school district offices.

All Candidates
   •   must be eligible to vote in Minnesota
   •   must have not filed for another office at the upcoming primary or general election
   •   must be 21 years of age or more upon assuming office
   •   must have maintained residence in their district* for at least 30 days before the
       general election

*Note: Candidates for federal office are exempt; see Additional Qualifications for
Specific Offices below.

Major Party Candidates
Must have participated in the party's most recent precinct caucuses, or intend to vote for
a majority of the party's candidates at the next general election

Additional Qualifications for Specific Offices
UNITED STATES SENATOR
  • must be an inhabitant of Minnesota when elected
  • must be at least 30 years old upon assuming office
  • must be a citizen of the United States for at least nine years upon assuming
       office
UNITED STATES REPRESENTATIVE
  • must be an inhabitant of Minnesota when elected
  • must be at least 25 years old upon assuming office
  • must be a citizen of the United States at least seven years upon assuming office
GOVERNOR OR LIEUTENANT GOVERNOR
  • must be at least 25 years old upon assuming office
  • must be a resident of Minnesota for at least one year before the general election
STATE JUDICIAL OFFICERS
  • must be licensed to practice law in Minnesota
STATE SENATOR OR REPRESENTATIVE
  • must be a resident of Minnesota for at least one year before the general election
  • must be a resident of their district for at least six months before the general
       election
COUNTY SHERIFF
  • must be licensed as a peace officer in Minnesota
SCHOOL BOARD MEMBER
  • must have not been convicted of an offense for which they are required to
       register as a predatory offender under Minnesota Statutes 243.166

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AFFIDAVIT OF CANDIDACY

All candidates, including those filing by petition, must file affidavits stating, in part,

   •   the name of the office sought
   •   that the candidate is an eligible voter
   •   the candidate has no other affidavit on file for any other office for the election
   •   that the candidate meets the qualifications for the office; and
   •   that the name listed on the affidavit is the candidate’s true name or name by
       which the candidate is commonly known in the community.
   •   telephone number of the candidate

The affidavit of a candidate who seeks the nomination of a major political party must
state that the candidate participated in the party’s most recent precinct caucus or that
the candidate intends to vote for a majority of the party’s candidates at the next state
general election. (MS 204B.06)

Affidavits of Candidacy for federal, state, and county offices may be executed starting
60 days before and during the filing period. The properly completed affidavit, filing fee,
and petition (if required) must be received by the filing officer during the filing period and
no later than 5:00 p.m. on the last day of filing. (MS 204B.09)

Affidavits of candidacy for municipal and school district candidates must be filed during
the applicable filing period. The affidavit must be signed in the presence of a notarial
officer. (Or a designated employee of the County, School District & Municipality, if the
filing occurs in that office). The candidate should be prepared to supply satisfactory
evidence of identification.

A candidate for a federal, state, or county office who will be out of the state during the
filing period may file an Affidavit of Candidacy and any required filing fee or petition
during the seven days immediately preceding the candidate’s absence from the state.

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Filing Fee (or Petition in Lieu of Filing Fee)

   •   United States Senator: $400.00 (or petition of 2000 signatures)
   •   United States Representative: $300.00 (or petition of 1000 signatures)
   •   Governor, Lt. Governor, Attorney General, State Auditor, Secretary of State:
       $300 (or petition of 2000 signatures)
   •   State Senator or State Representative: $100.00 (or petition of 500 signatures)
   •   Judicial Officer: $300.00 (or petition of 500 signatures)
   •   County Commissioner: $50.00 (or petition of 500 signatures)
   •   County Sheriff: $50.00 (or petition of 500 signatures)
   •   County Attorney: $50.00 (or petition of 500 signatures)
   •   Soil & Water Conservation Supervisor: $20.00 (or petition of 500 signatures)

Contact your local filing official to ask about filing fees for other offices.

A filing fee must be paid at the time of filing the Affidavit of Candidacy. A petition may be
filed in lieu of the filing fee. Sample forms and information about the number of
signatures required on a petition in lieu of filing fee are available from the filing officer.

A candidate who provides the filing fee by a check or other instrument for which
sufficient funds are not available will have his or her name removed from the ballot and
is liable for all costs incurred by election officials in removing the name from the ballot.
(MS 204B.11)

Partisan/ Non-Partisan Offices:

State offices are partisan. Candidates for partisan office who do not seek the
nomination of a major political party must be nominated by petition. The petition may
nominate only one candidate, except for a petition jointly nominating a team for
President & Vice President.

Sample forms for nominating petitions are available from the Secretary of State.

Each page of the petition must include:
   • the candidate’s name
   • the office sought
   • residence address of candidate
   • the candidate’s political party in three words or less and not using the word “non-
      partisan” or a major political party name.
   • an oath in the form prescribed by statute and space for the signature and signer’s
      residence address and birthdate.

County offices are non-partisan.
  • County Commissioner
  • County Attorney
  • County Sheriff
  • Soil & Water Conservation District Supervisor

Municipal, school district, and judicial offices are non-partisan.

                                                                                   13 | P a g e
2022 Election Dates

Primary Election: Tuesday, August 9th, 2022

General Election: Tuesday, November 8th, 2022

A Primary Election for a non-partisan office is only required if more than two candidates
file for the same office. The names of the candidates with the two highest vote totals in
the Primary Election will then be placed on the General Election ballot.

When no more than two candidates file for a non-partisan office, their names will not be
placed on the Primary Election ballot but instead will be placed on the General Election
ballot for that office.

Statements of Economic Interest:

In metropolitan area counties, a candidate for state or county elective office (other than
judicial office) must complete a Statement of Economic Interest within fourteen days of
filing an affidavit of candidacy. You will receive your Statement of Economic Interest
form when you file for office.

Candidates for state office return their Statement of Economic Interest to the Campaign
Finance and Public Disclosure Board.

         Campaign Finance & Public Disclosure Board
         190 Centennial Office Building
         658 Cedar Street
         St. Paul, Minnesota 55155-1603

Candidates for Washington County office return their Statement of Economic Interest to
the Washington County Elections Division.

         Washington County Elections
         14949 62nd St N
         Stillwater, MN 55082

Electronic Filing of Financial Reports

Financial reports required under Minnesota Statutes 211A.02 may be filed
electronically, subject to the approval of the filing officer. (MS 211A.02, Subd. 5).

                                                                                  14 | P a g e
190 Centennial Office Building, 658 Cedar St, St Paul, MN 55155                                   cfb.mn.gov

                                                              Statement of Economic Interest
                                          Appointed or elected local official in a metropolitan governmental unit

                                                                      Filing instructions
•      This form may be filed by email, mail, or fax sent to the metropolitan governmental unit.
•      Address questions to the governing body of the metropolitan governmental unit.

                           Individual information                                                                      Employment information
    Name                                                                                      Occupation

    Address at which you wish to receive mail from the metropolitan governmental unit (You    Name of employer - indicate if self-employed or not employed (You may need to include
    may use either a home or business address.)                                               your employer as a source of compensation on page 2)

    City, state, zip                                                                          Business address

    Telephone (daytime)                                                                       City, state, zip of business

    Email address

                                                                    Position information
    Name of metropolitan governmental unit                                                   Local official position

                                                  Period covered (check one and provide dates)
    Original statement
                                                            Calendar month before the month with effective date of appointment                 Year

    Annual statement                                                                        ,         to          December 31                  ,
                                                           January 1 or effective date of appointment or first date in elected office

    Amended statement
                                                                                         ,
                                                            Date of statement being amended

    Termination statement                                                                                   ,     to
                                                                                                 ,            Date last filed
                                                                                                 last date as local official

                                                                            Certification

I,                                                                , certify that the information contained on this form, including information
(print name)                                                 on the schedules, is complete, true, and correct.

Signature of local official                                                                      Date
Notice: Any person who signs and certifies to be true a statement which the person knows contains false information or
omits required information is subject to a civil penalty imposed by the Board of up to $3,000 and is subject to criminal
prosecution for a gross misdemeanor.
This document is available in alternative formats to individuals with disabilities by calling 651-539-1180; 800-657-3889; or through the
Minnesota Relay Service at 800-627-3529.
Sources of compensation
List all businesses from which you received more than $250 in compensation in any calendar month during the reporting
period. You should include any employer listed on the first page if it is a business as described below.

“Business” means an association, corporation, partnership, limited liability company, limited liability partnership, or other
organized legal entity. An individual acting alone in the individual's own capacity, such as in the form of a sole proprietorship,
is not a business for purposes of this statement, nor is a government agency.

"Compensation" means any payment for labor or personal services as a director, officer, owner, member, partner, employer,
or employee of a business. Compensation does not include payments that do not result from the performance of services,
such as rental income, social security payments, unemployment compensation, workers’ compensation, pension benefits, or
insurance benefits.
                                                                      - - - - - - - - - - - - - - - - - - Check each applicable box- - - - - - - - - - - - - - - - -
 Name of source                                                      Director        Officer        Owner         Member           Partner         Employer            Employee

                                                             Business ownership
If you own 25% or more of a business and received more than $250 in any month during the reporting period as an
employee of that business, list the business or professional activity category from page 4 that best describes the main
function of the business.

 Business or professional activity category (See page 4)

                                                           Independent contracting
If you received more than $2,500 for work as an independent contractor in the past 12 months, list the business or
professional activity category from page 4 that best describes the nature of that work.

 Business or professional activity category (See page 4)

                                    Honoraria (only report honoraria on an annual statement)
Report the sources of any honoraria worth more than $250 received during any month in the reporting period. An honorarium
is anything of value received for a service when there is no obligation on the part of the giver to pay. Examples of honoraria
could include payment for speeches, presentations, or articles.

                                                                     -2-
Securities
List all businesses whose securities valued at more than $10,000 you individually or jointly held at any time during the
reporting period. Use the definition of business from the Sources of compensation section on the previous page.

 “Securities” means stocks, shares, bonds, warrants, options, pledges, notes, mortgages, annuities, debentures, leases, and
commercial paper. “Securities” does not include shares of mutual funds, shares of exchange-traded funds, or defined benefit
pension plans. For stocks, list the name of the business- do not list the exchange symbol, total shares, or value.

For retirement accounts like IRAs or 401(k)s, list the individual investments items held through the account. For example, if
you have an IRA managed by Charles Schwab, do not list Charles Schwab – IRA. Instead, obtain an itemized listing of the
investments held in the IRA and report those investments which meet the definition of security and exceed $10,000 in value.

                             Name of business in which security is held                                                            Name of business in which security is held

                                                                                   Real property
Do not report your homestead. Report interests in all other real property located in Minnesota that you held individually or
jointly at any time during the reporting period. You must report the following interests: a fee simple interest (you are an
owner, even if you owe a mortgage), a contract for deed as a buyer or seller, or a mortgage that you hold as a seller.

Report an option to buy if the value of the option is more than $2,500 or if the fair market value of the optioned property is
more than $50,000 even if the value of the option itself is $2,500 or less. For each property list the county in which the
property is located. Also list the street address and city, or if the property does not have a street address, the section,
township, and range where the property is located and the approximate acreage.

Upon written request and for good cause shown, the Board may waive the requirement that an official disclose the address
of a secondary residence of the official. Contact Board staff if you want to request this waiver.
                                                                                         - - - - - - - - - - - - - - - - - - Check one - - - - - - - - - - - - - - - - - - -
                                                                                             Own             Contract for          Option to buy:           Option to buy:     Mortgage
                                                                                           (Even if          deed (As              Option value             Property value     (Only if   Acreage (If
 MN County                  Street address and city; or section, township, and range      paying a           buyer or              greater than             greater than       held as    applicable)
                                                                                          mortgage)          seller)               $2,500                   $50,000            seller)

                                                                     Pari-mutuel horse racing interests
Report any investment, ownership, or interest in property connected to pari-mutuel horse racing in the United States or
Canada, including a race horse. Include direct, indirect, partial or full interests held by you or an immediate family member.
                                   - - - - - - - Check one - - - - - - -

                                    Partial interest          Full interest   Description of interest (Horse, stable, etc.)

 Official direct interest

 Official indirect interest

 Family interest

                                                                                              -3-
Business and professional activity categories
Use these categories for the business ownership and independent contracting categories on page 2.

If you need more information to decide which category to use, please see the chart on the Internal Revenue
Service website at https://www.irs.gov/instructions/i1040sc#idm140495537003200.

Accommodation
Administrative and Support Services
Agriculture, Forestry, Hunting, & Fishing
Agriculture & Forestry Support Activities
Amusement, Gambling, & Recreation Industries
Broadcasting (except internet) & Telecommunications (including internet service providers)
Construction of Buildings
Construction - Heavy and Civil Engineering
Construction - Specialty Trade Contractors
Credit Intermediation & Related Activities
Data Processing Services (including internet publishing)
Educational Services
Food Services & Drinking Places
Health Care - Ambulatory Health Care Services
Health Care - Hospitals
Health Care - Nursing & Residential Care Facilities
Information (publishing industries except internet)
Insurance Agents, Brokers, & Related Activities
Manufacturing - Chemical
Manufacturing - Food
Manufacturing - Leather & Allied Product
Manufacturing - Nonmetallic Mineral Product
Manufacturing - Other
Mining
Motion Picture & Sound Recording
Museums, Historical Sites, & Similar Institutions
Performing Arts, Spectator Sports, & Related Industries
Personal & Laundry Services
Professional, Scientific, & Technical Services (Architectural, Engineering, & Related Services)
Professional, Scientific, & Technical Services (Computer Systems Design & Related Services)
Professional, Scientific, & Technical Services (Legal, Accounting, Payroll, & Tax Preparation Services)
Professional, Scientific, & Technical Services (Specialized Design Services)
Professional, Scientific, & Technical Services (Other)
Real Estate
Religious, Grantmaking, Civic, Professional, & Similar Organizations
Rental & Leasing Services
Repair & Maintenance Services
Retail - Building Material & Garden Equipment & Supplies Dealers
Retail - Clothing & Accessories Stores
Retail - Electronic & Appliance Stores
Retail - Food & Beverage Stores
Retail - Furniture & Home Furnishing Stores
Retail - Gasoline Stations
Retail - General Merchandise Stores
Retail - Health & Personal Care Stores
Retail - Motor Vehicle & Parts Dealers
Retail - Sporting Goods, Hobby, Book, & Music Stores
Retail - Miscellaneous Store Retailers
Retail - Nonstore Retailers
Securities, Commodity Contracts, & Other Financial Investments & Related Activities
Social Assistance
Transportation
Transportation (couriers and messengers)
Unclassified Establishments (unable to classify)
Utilities
Warehousing & Storage Facilities
Waste Management & Remediation Services
Wholesale Trade - Merchant Wholesalers (Durable Goods)
Wholesale Trade - Merchant Wholesalers (Nondurable Goods)
Wholesale Electronic Markets and Agents & Brokers

                                                                -4-
Campaign Financial Reporting

                         County, Municipal & School District

Campaign Finance Reports:

Minnesota Statute 211A generally regulates campaign reporting requirements of
candidates and committees supporting county, municipal, school districts or other
political subdivisions candidates for office and questions. Candidates and committees
supporting candidates for judicial office are not regulated by Chapter 211A.

Minnesota Statute 211B regulates a variety of campaign practices and applies to all
federal, state, and local candidates. It also regulates the activities of committees
formed to promote or oppose ballot questions and proposed constitutional amendments.

Candidates and their committees for elective office are responsible for adherence to the
provisions of Minnesota Statutes 211A and 211B regarding Campaign Financial
Reporting and Fair Campaign Practices.

Enclosed for your use are the following:

Minnesota Campaign Manual
This contains a digest and the text of
Chapters 211A and 211B.

Campaign Financial Report Forms.
These are to be filed as indicated by the provisions of M.S. 211A.02

As a candidate for county, municipal and school district elective offices, you are
responsible for fulfilling the requirements of Minnesota Statutes Chapter 211A
Campaign Financial Reporting.

                                                                               14 | P a g e
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                                  Candidate report                                    Period of time covered by report:
                       report                                   Campaign committee report
                                                                Association or corporation report
                                                                                                                    from                  to
                                                                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
Report

                       or occupation if self-employed, amount and date for these contributions.
                       CASH                                      $                                  TOTAL CASH-ON-HAND               $
                       IN-KIND                              +
                                                                 $
                       TOTAL AMOUNT RECEIVED                =
                                                                 $

                                                                                  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
Office

                                                                                                                            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
Name

                                                                                                                            TOTAL
For Office Use Only:

                       I certify that this is a full and true statement.
                                                                                              Signature                                  Date
                       Printed Name                                             Telephone                             Email (if available)
                       Address
Office of the Minnesota Secretary of State

     ELECTION CANDIDATE INFORMATION FORM (VOLUNTARY DISCLOSURE)

Instructions
Federal and State candidates are invited to complete this form in whole or in part. Submit it through the filing officer
or by sending it to the Secretary of State via email (elections.dept@state.mn.us) or mail:
180 State Office Building, 100 Rev. Dr. Martin Luther King, Jr. Blvd., St. Paul, MN 55155-1299
Information submitted on this form will be published on the Secretary of State’s web site. The Office of the
Secretary of State does not edit the information submitted. Additional sheets will not be published.

Candidate Information
Candidate Name
Office Sought
Political Party or Principle
Address
Preferred mailing address (if different)
Telephone                                                  Fax
E-Mail                                                    Web site
Occupation and Employer                                                                              Age
Current Office Held                                                      First Year Elected or Appointed
Previous Elected or Appointed Public Offices

Endorsements

Comments or Filing Statement (use this space only)

I certify that the information provided on this form is true.
Candidate Signature                                                                   Date

                                                                                                           Revised 3/2014
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                                  The municipal (city or town) clerk – same place where filed affidavit of candidacy
Park Districts                                      The county auditor or municipal clerk – same place where filed affidavit of candidacy
School Districts                                    School district clerk
Townships                                           Town clerk
Cities                                              City clerk
Soil & Water Conservation Districts                 County auditor
Counties                                            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                • 30 days after a general election or special election
• 10 days before the 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
A summary of several important dates regarding Campaign Financial Reporting related
to November General Election is as follows.

INITIAL REPORT
A committee or a candidate who receives contributions or makes disbursements of
more than $750 in a calendar year shall submit an initial report to the filing officer within
14 days after the candidate or committee receives or makes disbursements of more
than $750. Reporting dates for candidates and committees required after the initial
report are as follows:

TEN DAYS BEFORE THE PRIMARY ELECTION                               July 29th, 2022
(If candidate name is on primary ballot):

TEN DAYS BEFORE THE GENERAL ELECTION                               October 29th, 2022

CAMPAIGN FINANCIAL REPORT                                          November 15th, 2022
CERTIFICATION OF FILING

Each county, municipal or school district level candidate 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 no later than seven days after the general election.

A certificate of election will not be issued to a candidate who has not certified that all
reports required by Section 211A.02 have been filed.

30 DAYS AFTER THE GENERAL ELECTION                                 December 8th, 2022

The committee or candidate must file a report by January 31st of each year following
the year when the initial report was filed.

FINAL REPORT

A candidate or committee may file a final report when all debts have been settled and all
assets in excess of $100 in the aggregate are disposed of. The final report may be filed
at any time and must include the kinds of information contained in the financial
statements required by Section 211A.02 for the period from the previously submitted
report to the date of the final report.

NOTICE OF FAILURE TO FILE

If a candidate or committee fails to file a report on the date it is due, the filing officer
shall immediately notify the candidate or committee of the failure to file. If a report is not
filed within ten days after the notification is mailed, the filing officer shall file a complaint
under section 211B.32

                                                                                      15 | P a g e
Administrative Hearings Office to Address M.S. 211A and M.S. 211B Complaints

A complaint of violations under Minnesota Statutes 211A and 211B must be filed with
the Office of Administrative Hearings within one year of the alleged incident. (M.S.
211B.32, subd., 1 & 2)

Filings before the Office of Administrative Hearings must:
    1. be written
    2. submitted under oath, and
    3. detail the factual basis for the complaint.

The complaint must be accompanied by a $50.00 filing fee, except for required
complaints by filing officers. The fee may be waived upon request and may be refunded
to a complainant who prevails.

THIS IS ONLY A SUMMARY TO HELP INFORM YOU REGARDING REPORTING
DATES AND REQUIREMENTS. PLEASE REFER TO THE FULL TEXT OF
MINNESOTA STATUTES CHAPTER 211A FOR THE COMPLETE INFORMATION.

                       CAMPAIGN EXPENDITURE REPORTING
                              (State Offices)

State Office Candidates must complete and file all reports provided in the packet from
the Campaign Finance and Public Disclosure Board with that office. (MS 10A)

Follow the instruction in your packet provided for reports to be filed and when they are
due. Any question contact the Campaign Finance and Public Disclosure Board.

Campaign Finance and Public Disclosure Board
1st Floor, Centennial Office Building
St. Paul, MN 55155
651-296-5148

                                                                               16 | P a g e
STATE OF MINNESOTA
                             Office of Minnesota Secretary
                                  of State Steve Simon

February 25, 2022

To: All Candidates Filing for Office Subject: Campaign Cybersecurity

Cybersecurity is an important part of voters’ confidence in our democracy. In response
to the growing emphasis on secure elections, the Office of the Secretary of State
suggests consulting the following free resources and encourages candidates and their
campaigns to consider their recommendations:

The U.S. Department of Homeland Security offers a cybersecurity checklist for political
campaigns:
https://www.cisa.gov/sites/default/files/publications/dhs_campaign_checklist_final
_october.pdf

The FBI has produced the “Protected Voices” series of short videos for political
campaigns on the subject of cybersecurity: https://www.fbi.gov/
investigate/counterintelligence/foreign-influence/protected-voices

Researchers at Harvard University, in collaboration with bipartisan campaign
professionals, national security experts, and leaders in cybersecurity from the public
and private sector, created the Campaign Cybersecurity Playbook as a practical guide
for candidates. https://www.belfercenter.org/CyberPlaybook

Finally, Meta Inc. has established Facebook Protect, a program for political candidates
and their staffers to apply an extra level of security to their accounts:
https://www.facebook.com/gpa/facebook-protect

180 State Office Building | 100 Rev. Dr. Martin Luther King, Jr. Blvd. | Saint Paul, MN
55155-1299 Phone: 651-201-1324 or 1-877-600-8683 | Fax: 651-215-0682 | MN Relay
Service: 711
E-mail: secretary.state@state.mn.us | Web site: www.sos.state.mn.us

                                                                               17 | P a g e
Fair Campaign Practices

Minnesota Statute 211B governs fair campaign practices. Candidates must comply with
regulations concerning campaign contributions and spending, Election Day
campaigning, advertising, influencing voters, and other campaign activities.

Questions?

Call the Washington County Elections Division at 651-430-6790.

                                     Campaign Signs

Minnesota Statute 211B.045 states that in any municipality with an ordinance that
regulates the size of noncommercial signs, notwithstanding the provisions of that
ordinance, all noncommercial signs of any size may be posted 45 DAYS before the
state primary election, in a state general election year until ten days following the state
general election. Contact the clerk in any community where you will campaign if you
plan to post political signs and have any questions as to any local sign regulations.
Placing signs on State or County right-of-way is prohibited. Minnesota Statute 160.27
prohibits advertisements on highway rights-of-way. See attached letters from
Minnesota Department of Transportation and County Transportation Department. If
signs are to be placed on private property, permission must be obtained from the
landowner. Any signs that are in the highway right-of-way will be removed.

                                                                                  18 | P a g e
Washington county Letter

                           19 | P a g e
395 John Ireland Boulevard
                                                                                                      Saint Paul, Minnesota 55155

   May 7, 2020

   RE: Placement of Signs along Trunk Highways

   To All Candidates for Public Office:

   The Minnesota Department of Transportation reminds the public that placing signs, including campaign signs, along
   trunk highways is prohibited. State law (Minn. Stat. 160.2715) prohibits the placement, painting, printing or affixing
   of advertisements on any object within the limits of a trunk highway. This restriction includes driving lanes, inside and
   outside shoulders, ditches and sight corners at intersections. The trunk highway system includes state, U.S., and
   interstate highways in Minnesota.

   The Minnesota Outdoor Advertising Control Act (Minn. Stat. 173.15), which applies to land next to trunk highway
   right of way, prohibits placing advertising devices on private land without consent of the owner or occupant; on
   trees, shrubs, or public utility poles; or by painting on rocks or other natural features.

   These laws protect the safety of the traveling public and those who might place signs. They ensure Minnesota
   complies with federal highway beautification laws. Right of way is used for a variety of purposes, including providing
   a safe place for vehicles that leave travel lanes, snow storage, location for public utilities, draining excess water away
   from roads, vegetation growth for aesthetics and erosion control and even pollinator habitat. Unauthorized signs and
   people stopping to place signs within the limits of the highway can compromise these functions.

   County, city and township employees administer applicable laws on roads under their jurisdiction. MnDOT is
   responsible for the trunk highway system. Please contact local MnDOT offices for assistance when placing signs
   where trunk highway right of way cannot be clearly identified. Make sure those who place signs on your behalf know
   the law. Illegally placed signs will be removed by MnDOT employees and temporarily stored. Please contact local
   MnDOT offices promptly to retrieve signs that have been removed.

   Thank you for participating in the democratic process and thank you for your cooperation.

   Sincerely,

   Margaret Anderson Kelliher
   Commissioner

Placement of Campaign Signs in Trunk Highway Right of Way Notice to Candidates

                                                                                                                  20 | P a g e
Office of the Minnesota Secretary of State                                      Filing #

                                                     AFFIDAVIT OF CANDIDACY
                                                                                                                                Cash/Check #
                                                                                                                                Amount $
Instructions
All information on this form is available to the public. Information provided will be published on the Secretary of State’s website. If filing for
partisan office and not a major party candidate, you must file both an affidavit of candidacy and a nominating petition. (Minn. Stat. 204B.03)

Candidate Information
Name and Office
Candidate Name (as it will appear on the ballot)
Office Sought                                                                                                             District #
For Partisan Office, Provide Political Party or Principle
For Judicial Office, Provide Name of Incumbent
Residence Address
Do not complete if residence address is to be private and checkbox below is marked. All address and contact information is optional for federal,
judicial, county attorney, and county sheriff office candidates.
Street Address
City                                                                                               State                 Zip Code
       My residence address is to be classified as private data. I certify a police report has been submitted or I have an order for protection for my
       (or my family’s) safety, or my address is otherwise private by Minnesota law. I have attached a separate form listing my residence address.

Campaign Address and Contact
Candidate Phone Number (Required)
Campaign Contact Address (Required for those who have checked the box above):
Street Address
                                                                                                   State                 Zip Code
City
Website                                                                  Email

Affirmation
For all offices, I swear (or affirm) that this is my true name or the name by which I am generally known in the community.
If filing for a state or local office, I also swear (or affirm) that:
• I am eligible to vote in Minnesota;
• I have not filed for the same or any other office at the upcoming primary or general election (except as provided in M.S. 204B.06, subd. 1 (2) );
• I am, or will be on assuming office, 21 years of age or more;
• I will have maintained residence in this district for at least 30 days before the general election; and
• If a major political party candidate, I either participated in the party’s most recent precinct caucuses or intend to vote for a majority of that
    party’s candidates at the next general election.
If filing for one of the following offices, I also swear (or affirm) that I meet the requirements listed below:
• United States Senator – I will be an inhabitant of this state when elected and I will be at least 30 years old and a citizen of the United States for
    not less than nine years on the next January 3rd, or if filled at special election, within 21 days after the election.
• United States Representative – I will be an inhabitant of this state when elected and I will be at least 25 years old and a citizen of the United
    States for not less than seven years on the next January 3rd, or if filled at special election, within 21 days after the election.
• Governor or Lieutenant Governor – I will be at least 25 years old on the first Monday of the next January and a resident of Minnesota for not
    less than one year on election day. I am filing jointly with
• Supreme Court Justice, Court of Appeals Judge, District Court Judge, or County Attorney – I am learned in the law and licensed to practice law
    in Minnesota. My Minnesota attorney license number is                                       and a copy of my license is attached.
• State Senator or State Representative – I will be a resident of Minnesota not less than one year and of this district for six months on the day of
    the general or special election.
• County Sheriff – I am a licensed peace officer in Minnesota. My Board of Peace Officer Standards and Training license number is
                                             and a copy of my license is attached.
• School Board Member – I have not been convicted of an offense for which registration is required under Minn. Stat. 243.166.
• County, Municipal, School District, or Special District Office – I meet any other qualifications for that office prescribed by law.

Candidate Signature                                                                       _ Date                 _
Subscribed and sworn to before me this                day of                                         , 20            .

Notary public or other officer empowered to take and certify acknowledgement                                                           (Notary stamp)
White Copy – Filing Officer    Yellow Copy – CFPD Board        Pink Copy – Public Information      Goldenrod Copy – Candidate              Rev. 5/2015
Office of the Minnesota Secretary of State

                                        AFFIDAVIT OF WITHDRAWAL

Instructions
Generally, a candidate who has filed an affidavit of candidacy may remove his or her name from the ballot by filing
an affidavit of withdrawal by 5 p.m. no later than 2 days after the end of the filing period. The affidavit of withdrawal
is filed with the same filing officer where the original affidavit of candidacy was filed. The withdrawal affidavit
should include the candidate's name and office for which they filed and include a request to have their name
withdrawn from the ballot. See the Candidate Withdrawal webpage for details regarding U.S. Presidential and Vice
Presidential candidates, and candidates for State Constitutional Offices (Governor and Lieutenant Governor,
Secretary of State, Attorney General, and State Auditor).

Statement
I,
certify that I filed an affidavit of candidacy for the office of
on                                                       , 2022. I request that my name be withdrawn from the ballot,
pursuant to Minnesota Statutes 204B.12, subd. 1.

Signature                                                                                  Date

                                                                                                           Revised 2/2022
Office of the Minnesota Secretary of State
                                                       Map Order Form
Contact Information
Name
Address
City, State and Zip Code
Phone or email

Available Maps
Maps usually include congressional district, legislative district, county, city, township, and precinct boundaries,
and physical features such as roads, railroads, rivers and lakes, depending on scale.

NOTE: municipalities have until March 29 to establish precincts. A statewide precinct dataset will be compiled
after that. Precinct boundaries will not be included on maps until that is completed.

Please select from the following available maps and indicate quantity, size and desired jurisdiction, as applicable.
Available sizes are large (36” by 48”), medium (17” by 22”) and small (8.5” by 11”), unless otherwise indicated.
  •   Statewide legislative and congressional districts. Quantity and size
  •   Metropolitan area legislative and congressional districts (large size only). Quantity
  •   Individual congressional districts (large size only). Quantity and district(s)
  •   Individual state house or senate districts. Quantity, size and district(s)
  •   County, showing legislative districts (large size only). Quantity and county
  •   County, showing commissioner districts (large size only). Quantity and county
  •   Individual school district (large size only). Quantity and school district
  •   Individual city or town (large size only). Quantity and municipality
  •   Additional information

Cost, delivery and payment
  • Map prices are $11 per large map, $9 per medium map, and $7 per small map.
  • The State Office Building is currently closed to the public, so all orders will be shipped via UPS.
  • Full payment must be submitted with this request. Checks or money order are accepted via mail. Allow five to
    ten days for processing. Return completed form and payment to:
       Minnesota Secretary of State
       Elections Division
       180 State Office Building
       100 Dr. Rev. Martin Luther King, Jr. Blvd.
       Saint Paul MN 55155
  • For questions, call 651-215-1440 or email elections.dept@state.mn.us

Disclaimer
This document can be made available in large print by calling (651) 296-2803/Voice, or on our Web site at www.sos.state.mn.us. For
TTY communication, contact the Minnesota Relay Service at 1-800-627-3529 and ask them to place a call to (651) 215-1440. The
Secretary of State’s Office does not discriminate on the basis of race, creed, color, sex, sexual orientation, national origin, age,
marital status, disability, religion, reliance on public assistance or political opinions or affiliations in employment or the provision of
services.
Office of the Minnesota Secretary of State

                                          POLLING PLACE LIST REQUEST
Instructions
Use this form to request a list of polling places for an upcoming election. The list is provided electronically either in a pdf
format ready for printing, or in a comma-delimited text format which can be opened in most spreadsheet and database
programs. The report will be current as of the time the report is run. This office may take up to 10 days to produce the report.
Requestor Contact Information
Name
Street Address
City                                                                State              Zip Code
Email                                                               Phone
Report Information
Choose a geographic area for your report:
       Statewide ($46) – MUST CHOOSE TEXT FORMAT BELOW
       Single Jurisdiction ($30) – Specify name (of county, city, district, etc.)
Choose a specific election for your report:
       Next State Primary (available May before the primary)
          Next State General Election (available August before the election)
          Other Election (Specify Election Name & Date)
Choose a format for your report:
          PDF (ready for printing)
          Text (comma-delimited, for use in spreadsheets or databases)

Delivery Information
       Once processed, an email will be sent to the email above with a link to the requested voter data. This
       link will be active for seven days. The Secretary of State no longer provides this data on CD-ROM.

Payment Information
Total Cost
        Payment via cash (in-person orders only. Note: orders are not produced “while you wait”)
        Payment via check
          Payment via money order
Mail or hand-deliver your order to:
Office of the Secretary of State, First National Bank Building, 332 Minnesota Street, Suite N201, Saint Paul, MN 55101

OFFICE USE ONLY        Date - Fiscal    Date - Media Prod     Client Acct           Amt Paid      Work Order #        Rev. 10/2021
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