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Cinsavailth <br />arMwuivwu <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />office otCampaign and Political Finance <br />City or Town of: <br />L aXt114+-tf. <br />Candidate Net` ti• (/ mi l Office I— MA <br />Please print or type all Information, except signatures. <br />Fill in dates: Month Day Year Month Day Year <br />Reporting Period Beginning ( <br />i 2 91 Ending ) z_ 3 I 235 11 <br />Type of Report: (Check One) {, <br />o 8th day preceding 0 8th day preceding election 0 30th day following election Sd' 20th day of January <br />preliminary /primary (Town or Special) (Year -End Report)' <br />Pursuant to M.G.L., Chapter 55; <br />1, I certify that I am a candidate for or hold Municipal Office. <br />2. I certify that 1 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, I certify that 1 do not have a political committee. <br />DATE <br />I. SIGNATURE <br />Signed under the penalties of perjury <br />I1. RESIDENTIAL ADDRESS <br />(Street and Number) <br />(1I. OFFICE SOUGHT <br />IV�q <br />i' <br />m itee.s SC <br />LW <br />rn <br />__ <br />CO <br />i <br />Cs <br />C <br />11197 <br />c °a <br />