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Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campalgn and Political Finance <br />COMNOnwalth <br />of mmachuunc - <br />City or Town of, �Kt l�-TO1'� Candidate Z-4- Office S L,�hl� i�1C4 <br />Please print or type all information, except signatures. <br />Fill in dates; Month Day Year Month Day Year <br />Reporting Period Beginning ( l 7 p Ending <br />Type of Report; (Check One) . <br />8th day preceding El 8th day preceding election 30th day following election 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, I 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 />I, SIGNATURE <br />Si ned under the penalties of perjury <br />II. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />C <br />i i <br />i <br />-Wo t - 1� °C <br />�� � �1�` �.1 l Q ct <br />LNJ <br />o <br />r °°} <br />Uj <br />2 <br />11 /y / <br />