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Commonwealth <br />of Massachusetts <br />Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />File with: City or Town Clerk or Election Commission <br />Fill in Reporting Period dates: Beginning Date: <br />Ending Date: <br />1n ?I" itl <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election <br />❑ 30 day after election <br />p year -end report ❑ dissolution <br />cCtei 1JL 1\L IAIfir 111/1 <br />Candidate Full Name (if applicable) <br />(5 On I- N A ci(Y-LFdyT h <br />Office Sought and District <br />4 )ecu,LL-e( (1-- i Lex� l�n NI\ OV ?o <br />Residential Address V <br />Telephone Number (optional): <br />(AinlnrRer k ciIecf YFIIvIc lliwJfe» <br />Committee Name <br />1 Motu nel -et It. ialIthyin e' <br />Name of Committee Treasurer <br />Ijeock.kc (L Lc.)<;nc �I �ss alp 0241u <br />Committee Mailing \ddrcss <br />Telephone Number (optional): <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending Balance from previous report <br />Line 2: Total receipts this period (page 3, line 11) <br />Line 3: Subtotal (line 1 plus line 2) <br />Line 4: Total expenditures this period (page 5, line 14) <br />Line 5: Ending Balance (line 3 minus line 4) <br />1119 <br />Line 6: Total in -kind contributions this period (page 6) <br />Line 7: Total (all) outstanding liabilities (page 7) <br />Line 8: Name of bank(s) used: <br />0 <br />0 <br />L <br />(7 <br />(c,f\ 1L dC I) Ave (q. l <br />Affidavit of Committee Treasurer: <br />1 certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign finance <br />activity, including all contributions, loans, receipts, expenditt st disbursement@, in -kind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under the authority or o alfrtf this conlprittee in accordance with the requirements of M.G.L. c. 55. <br />1t a !'� Treasurers si nature Date: <br />Signed under the penalties of perjury: ( g ) <br />' 1 °fl -IS <br />FOR CANDIDATE FILINGS ONLY: Affidavit or Candidate: (check 1 box only) <br />Candidate with Committee and no activity Independent of the committee <br />] certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a tnte and complete statement of all campaign finance <br />❑ activity, of all persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions, <br />incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br />Candidate without Committee CM Candidate with Independent activity filing separate report <br />I certify that 1 have examined this report including attached schedules and it is, to the best of my knowledge and belief, a true and complete statement of all campaign <br />❑ finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this repotting period and represents the <br />campaign finance activity of all persons acting tinder the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. <br />Signed under the penalties or perjury: (Candidate's signature) Date: <br />