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Pf1 <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />bmee of Campaign and Pomleal Finance <br />Gufneu116 ' <br />afMwnYeuw )l ,.( ' <br />CityorTownof: Candidate <br />Please print or type all Information, except signatures, <br />Office6 -7cHhh +1(x�� <br />Fill in dates: <br />Reporting Period Beginning__ <br />Month <br />Day Year <br />Month <br />Day <br />Year <br />� <br />Type of Report: (Check One) <br />8th day preceding 8th day preceding election 30th day following election ❑ 20th day of January <br />preliminary/primary (Town or Special) (Year -End Report) <br />Pursuant to M.G.L., Chapter 55: <br />1. 1 certify that I am a candidate for or hold Municipal Office. <br />2. 1 certify that t 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 existence. <br />3. 1 certify that I do not have a political committee. <br />cd <br />