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Form CPF M 10240: Campaign Finance Report <br />Iblunicipal Form <br />Office of Campaign and Political Finance <br />commonwalt6 ' <br />of Mmach use ttc <br />City or Town of t%t ,QCA-Uq-� Candidate P- Office f' i <br />Please print or type all information, except signatures. <br />Fill in dates; Month <br />Day Year <br />Month <br />Day Year <br />Reporting Period Beginning 1 <br />i Z l i <br />Ending t 2> <br />1 Z L <br />Type of Report; (Check One) . <br />0 8th day preceding 0 8th day preceding election 30th day following election F 20th day of January <br />preliminary/primary (Town or Special) (Year -End Report)' <br />Pursuant to M.G.L., Chapter 55; <br />I, I certify that I am a candidate for or hold Municipal Office, <br />2, 1 certify that I have not received any contributions, made any expenditures, or incurred any obligations during this <br />reporting period, and do not have a campaign fund in existence. <br />3. I certify that I do not have a political committee, <br />DATE <br />1, SIGNATURE <br />Sig gd u der the penalties of perjury <br />II. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III, OFFICE SOUGHT <br />J <br />c�..a <br />11/97 <br />W <br />