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CIY.,Fraln <br />of Meuel CHm <br />Form CPF M 102.0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />City or Town of LXteth /AJ <br />Candidate -1? (ly:1Of/ (1C Office 1—G4—/V,t/6/VQ-- <br />Please print or type all information, except signatures. <br />Fill in dates: Month Day <br />Reporting Period Beginning (flA. ly Ending t Z <br />Year Month Day Year <br />Type of Report: (Check One) <br />O 8th day preceding 0 8tit day preceding election 0 30th day following election 20th day of lanuary <br />preliminary/primary <br />(Town or Special) <br />(Year -End Report)' <br />Pursuant to M.G.L., Chapter 55: <br />a 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 tbnd In existence. <br />O. I certify that 1 do not have a political committee. <br />DATE <br />I. SIGNATURE <br />Signed under the penalties of perjury <br />11. RESIDENTIAL ADDRESS <br />(Street and Number) <br />Ili. OFFICE SOUGHT <br />P <br />)<c, <br />■ <br />1 <br />al <br />co <br />11/97 <br />0 <br />