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Form CPF M 102: Campaign Finance Report <br />Municipal Form c ; <br />O m ce of Campaigrs and Political Finance <br />15 <br />ayes 10 L <br />File with: <br />City or Town Clerk or Elation Commission L E <br />Please print or type all information, except signatures. <br />Fill in dates: Mush Date Yaw Month Due Y ee <br />Reporting Period Beginnin a5 t ac> l3 Ending MQ1,6N \ a 10 <br />Type of report: (Check one) <br />08th day preceding preliminary 08th day preceding election 030 day after election 0year -end report Edissolution <br />F 11 Name of Candidate kif applicable) <br />ffice Sought and District <br />Tel. No. (optional) <br />d <br />Name of Committee Treasurer <br />mmittee Mailink Address <br />Tel. No. (optional) <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending balance from previous report <br />Line 2: Total receipts this period (page 2 line 11) $ t, a u t4 85 <br />Line 3: Subtotal (line 1 plus line 2) $ \ ,®A ao <br />Line 4: Total expenditures this period (page 3 line 14) $ \, oet - • -.® <br />Line 5: Ending balance (line 3 minus line 4) �- <br />------------------------------- --- <br />Line 6: Total in -kind contributions this period (page 4) $ -0- <br />Line 7: Total (all) outstanding liabilities (page 4) $ -0- <br />Line 8: Name of bank(s) used <br />Atridavit of Committee Treasurer. <br />I certify that I have examined this report including attached schedules and it is, to the bat of my knowledge and belief, a true and complete statement of all campaign <br />finance activity, including all cortributions, loan, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the <br />campaign fiasco activity of a�! persons acting under the authority or on bel"of this committee in accordance with the requirements of M.G.L. c. 33. <br />` Signed under the penalties of perjury: I r <br />signature (in <br />FOR CANDIDATE FILINGS ONLY (CANDIDATE MUST SIGN BELOW) <br />Amdavit of Candidate: (check I box only) <br />0 Candidate with Committee and no aedvity independent of the conunittee <br />I certify that I have examined this repot including attached schedules and it u, to the best of my knowledge and belie!; a true and complete statement of all campaign <br />finance activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 33. 1 have not received any <br />contributions, incurred any liabilities star made any expenditures on my behalfduring this reporting period. <br />0 Candidate without Committee OR Candidate pith Independent activity thirst separate report <br />I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief awe and complete statement of all campaign <br />finance activity, including contributions, loans, receipts, expenditures, disbunematts, u kind contributions and liabilities for this reporting peiod and represents the <br />can i <br />gn finances activity of all persas acting under the authority - on behalf of this committee in accordance with the requirements of M.G.L. c. 33. <br />1 <br />1/ / r n A Signed unq f"e penalties yF perlurz: 1 r <br />aitnatmm <br />