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Form CPF M 102: Campaign Finance Report Municipal Form O1nce of Gantpalgn and I'o!lUcai Fhrance d Ma,u Filo with; City or Town Clerk or Election Commission Please print or type all information, except signatures. Fill in dates Mash Dap Yea Montt pate Yea Reporting Period Beginn Q c'3 l 2. Ending ► l Type of report: (Check one) 08th day preceding preliminary 08th day preceding election 0130 day after election ear -end report [dissolution Full N me of Candidate (if a pplicable) �Adticc Sought and A rict (� UC l t t � C� (` E S l` _);residential Address 1 Tel. No. (optional) Committee Name, , -1 N c) t4 L5.1 Name of Committee Treasurer Committee Mailing Address Tel. No. (optional) SUMMARY BALANCE INFORMATION: r I c Line 1: Ending balance from previous report $_JS' Line 2: Total receipts this period (page 2, line 11) $ I Line 3: Subtotal (line 1 plus line 2) $ Line 4: Total expenditures this period (page 3, line 14) $� Line S: Ending balance (lute 3 minus line 4) Line 6: Total in -kind contribution <s this period (pegs 4> $ C Line 7: Total (all) outstanding liabilities (page 4) $ t"') Line 8: Name of bank(s) used Lc =e' t tv e - linn ' - (Yt co-, '-4 Z e� rn 0 Affidavit of Conu dtta Treasurers I certify that I have examined this report including an"W schedules and it is, to rho beg of my knowledge and belief, a true and complete statowd of all campaign finance aNvity, including all contributions, loans, receipts, expenditures, di>burxernaus, in -kind contributions and liabilities for this reporting period and represaa the campaign linan o activity of ail persons acting under the authority or on behalf of this owanittoe in accordance with the reluiremenu of M.O.L c. SS. Signed under the penalties of perjuryt do A- t_tn FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELOW) davit of candidate: (dteek 1 box only) LZ Candidate with Committee and no activity hndependent of the eonunittee I ratify that I have examined this report including atuehed schedules and it is to the best of my knowledge and ballet; a true and complete statenwo of all campaign finance activity, of all persons acting under the autiority or on behalf of thin committee in accordanoe with the requirements of M.O.I.. a. 1$. 1 have not recaivod any oortributions, bwunvd try liabilities nor made any expenditures on my bahaif during this reporting period. Q Candidate Without Committee 0 Candidate with independent activity Ong separate report I certify that I have examined 04 retort including attached schedules and it Is, to the best of my knowledge and belief: a true and compleia s Miont of all campaign finame activity, including contributions, loans, receipts, expenditures, disbursernen* "ind contributions and liabilities for this reporting period and reprowo the campaign activity of aD pens" acting under the authority or on behaif of this eonunittee in accordance with the requirements of M.O.L c. 33. Signed under the penalties of perjury; � r a Candidate si ) Date