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, r <br />emu: j! <br />Form CPF M 102: Campaign Finance Report <br />Commonwealth <br />of Massachusetts Office of Campaign and Political Finance <br />File with: <br />City or Town Clerk or Election Commission <br />Reporting Period: Beginning: 1/1/2012 Ending: 1/4/2013 <br />2013 J,r� 15 1,RH2Q3e33 <br />L <br />Type of Repo Dissolution <br />Charles Hornig <br />Full Name of Candidate <br />Planning Board /Lexington <br />office Sought/ District <br />75 Reed St <br />Lexington, MA 02421 <br />Residential Address <br />Char Hornig for Plannin Board <br />Committee Name <br />Thomas Griffiths <br />Name of Committee Treasurer <br />7 Volunteer Way <br />Lexington, MA 02420 <br />Committee Address <br />SUMMARY BALANCE INFORMATION <br />Ending balance from previous report: $328.98 <br />Total receipts this period: $50.00 <br />Subtotal: $378.98 <br />Total expenditures this period: $378.98 <br />Ending Balance: $0.00 <br />Total inkind contributions this period: $0.00 <br />Total outstanding liabilities: $0.00 <br />Name of Bank Used: TD Bank <br />Affidavit of Committee Treasurer: <br />I certify that I have examined this report, including attached schedules and it is, to the best of my knowledge and <br />belief, a true and complete statement of all campaign finance activity including all contributions, loans, receipts, <br />expenditures, disbursements, inkind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under the authority or on behalf of this committee in accordance with the <br />requirements of M.G.L. c. 55. <br />Signed under the penalties of erjury: <br />Treasurer's signature (in Ink) V I Date <br />Affidavit of Candidate (check 1 box only) : <br />c I andidate with Committee and no activity independent of the committee <br />certify that I have examined this report, and attached schedules and it is, to the best of my knowledge and belief, a <br />true and complete statement of all campaign finance activity, of all persons acting under the authority or on behalf of <br />this committee in accordance with the requirements of M.G.L. c. 55. 1 have not received any contributions, incurred <br />any liabilities nor made any expenditures on my behalf during this reporting period. <br />Candidate without Committee OR candidate with independent activity filing separate report. <br />❑ I certify that I have examined this report and attached schedules and it is, to the best of my knowledge and belief, <br />a true and complete statement of all campaign finance activity including contributions, loans, receipts, expenditures, <br />disbursements, inkind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under the authority or on behalf of this committee in accordance with the <br />requirements of M.G.L. c. 55. <br />Signed under the p enal tie per' ry <br />Date <br />Candi a e's sig re (in ink) <br />