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l <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />0m, of Campaign and Political Finance <br />Cammennullh ' <br />of AlwuhuNll <br />CityorTownof, LeXln%�dn Candidate C�t1_^ V'+t Offlcer wl <br />Please print or type all information, except signatures. <br />F n dates: M``onth Da Year Month Day Year <br />rting Period Beginning i'� Ending �h�.cY 24 ZS 1 <br />Type of Report: (Check One) <br />El 8th day preceding 8th day preceding election 30th day following election ❑ Yeah End of January <br />preliminary/primary (Town or Special) ( P ) <br />Pursuant to M.G.L., Chapter 55: <br />1. I certify that I am a candidate for or hold Municipal 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 existence. <br />3. 1 certify that I do not have a political committee. <br />DATE <br />I¢ <br />I. SIGNATURE <br />Signed under t penalties of perjury <br />11, RESIDENTIAL ADDRESS <br />,,((�� rT (Stree((t and Number) <br />11 <br />�S eo <br />11I, OFFICE SOUGHT <br />/� <br />04)% q dA rZ <br />i <br />—t r. <br />N <br />11197 <br />0 <br />