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Form CPT+' M 102.0: Campaign T'inauco Roport ' <br />Municipal T'ortn <br />bmee o1C.mpnlgn nna PollaeA Finance <br />CIMMOeYlllll ' <br />alluupnuu <br />City or Town of <br />�` � } � Candidate ,1 r s �� Office l • "rf � � f <br />pleaso print or typo all Information, except signatures, <br />i <br />111 in delesl Month Day Your M(muh Day Year <br />Reporting Period Beginning h 2 c Ending - <br />Type of Raportt (Che.ok Ono) <br />8th day preceding l7 81h day preceding election 30th day following election 20th day of Ja uary <br />prallminary/primary (Town or Special) (Year-End Roport)'. <br />Pursaent to MAL„ Chnptor 55; <br />I, 1 ceriff a thnt t am a candidate for or (told Munlolpgl Office, <br />2. 1 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 oxistonco, <br />3, 1 corilly ihafl do not have a politioal eomml0m. <br />DATB. <br />1,SIONATURE <br />SI nod under the penalties of perjury <br />IU PESIDBNTIALADDUSS <br />Street and Number) <br />Ill. OPp1CBSOU0 T <br />' <br />r <br />m- <br />y <br />G7 .� <br />s; <br />nrv� <br />tJ <br />ti <br />0 <br />c_ <br />A• <br />N <br />S� <br />j <br />I <br />i <br />