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_ Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance . <br />Commonwealth <br />ofMassachuseas <br />File with: City or Town Clerk or Election Commission <br />IFIII in Reporting Period dates: Beginning Date: Ending Date: <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ©mar -end report ❑ dissolution <br />Candidate Pull Name (if applicable) <br />ORice Sough[ and District <br />S c Si <br />Residential Address <br />Telephone Number (optional): <br />Line 1: Ending Balance from previous report <br />Lire 2: Total receipts this period (page 3, line 11) <br />Line 3: Subtotal (line 1 plus line 2) <br />Line 4: Total expenditures this period (page 5, line 14) <br />Line 5: Ending Balance (line 3 minus line 4) <br />Line 6: Total in -kind contributions this period (page 6) <br />Line 7: Total (all) outstanding liabilities (page 7) <br />Line 8: Name of bank(s) used: <br />O <br />G <br />x >< <br />o xA <br />N <br />Q <br />v <br />D 3"!�t x <br />b <br />C3 <br />Affidavit of Committee Treasurer: <br />I 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 ail campaign finance <br />activity, including all contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign <br />finance activity ofall persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. <br />Signed under the peualties of perjury: (Treasurers signature) Date: <br />FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) <br />Candidate with Committee and no activity independent o(the committee <br />I certify. that I have examined this report including attached schedules and it is, to the best army knowledge and belief, a tune and complete statement orals campaign finance <br />❑ activity, are][ persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any Contributions, <br />incurred any liabilities nor made any expenditures on my behalfduring this reporting period. <br />Candidate without Committee OR Candidate with Independent activity filing separate report <br />r,-, Leerhfy 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 contributions, loons, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the <br />campaign finance activity of all persons at ting c under the authority or on behalf of this committee in accordance with the requirements of M a .G.L. 55. <br />( <br />Signed under the penalties of perjury: l�` l' ��� (Candidate's signature) Date: <br />