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File with: <br />City or Town Clerk or Election Commission <br />Please print or type all information, except signatures. <br />Fill in dates: Da:o Y ea M"A Due Y ear <br />Reporting Period Beginning . Ending 0 <br />Type of report: (Check one) <br />08th day preceding preliminary ❑8th day preceding election 030 day after election ❑year -end report ❑dissolution <br />Name of Committee Treasurer <br />Committee Mailing Address <br />Tel. No. (optional) <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending balance from previous report $ w ; <br />Line 2: Total receipts this period (page 2, line 11) $ f(1 t <br />Line 3 : Subtotal pine 1 plus line 2) <br />i <br />Line 4: Total expenditures this period (page 3, line 14) $� <br />mot, <br />h3„ <br />Line 5: Ending balance pine 3 minus line 4) $ t <br />- - <br />Line 6: Total in -kind contributions this period (page 4) $� 1 <br />Line 7: Total (all) outstanding liabilities (page 4) $ _ <br />Line 8: Name of bank(s) used <br />Affidavit of coanv: ittee Treasurer. <br />1 certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign <br />finance activity, including all omtributio s, loans, receipts, expenditures, disbursements, irAdnd contributions and liabilities for this reporting period and represents the <br />campaign finance activity of all persona acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. a SS. <br />Signed under the penalties of perjury: <br />Treasurees signature (in ink) Date <br />FOR CANDIDATE FILINGS ONLY: (CANDIDATE MUST SIGN BELO <br />Affidavit of C te: (check t bon only) <br />0 Candidate with Conma ttee and no activity independent of the committee <br />I certify that I have examined this repot including attached schedules and it is, to the best of my knowledge and belief; a true and complete statement of all campaign <br />finance activity, of all persona acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L a 33. I have not received any <br />contributions, incurred any liabititics nor made any expenditures on my behalf during this reporting period. <br />0 Candidate. without Committee OR Candidate with independent activity filing separate report <br />I certify that I have examined this report including attached schedules and it is, to the best of my know ledge lief a true and complete statement of all campaign <br />finance activity, including contributions, loam, receipts, expendi rssmmts, in -kind contributi liabilities for this reporting period and represents the <br />campaign finance activity of all persona acting under the authori or on talfof this committee in with the requirements of M.G.L c. S5 . <br />r Sl un er the des of perjury: <br />)/ <br />Date <br />