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Fill in dates: <br />Month <br />Day Year nt Day <br />U 4/ <br />Year <br />Reporting Period Beginning <br />� _ <br />l / Ending �. <br />p <br />Type of Report: (Check One) . <br />® 8th day preceding 8th day preceding election 0 30th day following election 24th day of January <br />prellminary/primary (Town or Special) (Year -End Report)' <br />Pursuant to M,G,L,, Chapter 55: <br />1, I certify that I am a candidate for or hold Municipgl Office, <br />2. I certify that 1 have not received any contributions, made any expenditures, or Incurred any obligations during this <br />reporting period, and do not have a campaign hand in existence. <br />3. I certify that I do not have a political committee, <br />21 <br />