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Guawetl0 <br />el Mautalwee <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />bmce o(Campslgn and Political Finance <br />City or Town of <br />Candidate <br />Please print or type all Information, except signatures. <br />Fill in dates: Month Day <br />Reporting Period Beginning <br />} <br />Year <br />Month Day Year <br />Ending ( <br />Type of Report: (Check One) <br />8th day preceding 0 8th day preceding election 0 30th day following election —Lj. 20th day of January <br />preliminary/primary <br />(Town or Special) <br />(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 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. I certify that I do not have a political committee, <br />DATE <br />I. SIGNATURE <br />Signed under the penalties of perjury <br />II. RESIDENTIAL ADDRESS <br />(Street and Number) <br />III. OFFICE SOUGHT <br />r— <br />--r+ <br />- `4` <br />_- <br />r:9 <br />1 <br />I <br />cn <br />11/97 <br />0 <br />