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o G :4 t <br />Form CPF R1: Itemization of Reimbursements <br />Commonwealth Municipal. Form <br />of Massachusetts <br />Office of Campaign and Political Finance <br />File with: <br />City or Town Clerk or Election Commission <br />Amount Purpose <br />Steigerwald, Jessie <br />Individual Being Reimbursed <br />Jessie Steigerwald for School Committee <br />Committee Name <br />$80.59 <br />Amount of Reimbursement <br />11/29/2012 <br />Date of Reimbursement <br />Signed under the penalties of perjury: <br />Candidates /Treasurer's signature (in ink) <br />Date Vendor Name and Address <br />3/5/2012 Staples <br />297 Great Road <br />Bedford, MA 01730 <br />1/4/2013 <br />Date <br />$80.59 Paper and Supplies <br />