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Commonwealth <br />of Massachusetts <br />1' U1111 1-#11' 111 1V4• 1-#a111I/ClIgll 1' 1110.11GG 1\GIJVl t <br />Municipal Form <br />Office of Campaign and Political Finance <br />File with: Cih• or Town Clerk or Election Commission <br />Fill in Reporting Period dates: Beginning Date: 11/45txn, I tot 5 <br />Ending Date: <br />Jig sir LEIS <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary 8th day preceding election ❑ 30 day after election 9 year -end report 9 dissolution <br />1 (-k \r C,l &W-t, <br />VQA111.t- <br />arse <br />Candidate Full (if applicable) <br />Name of Committee Treasurer <br />C \ <br />l w <br />Committeailing Address <br />Office and District <br />Telephone Number (optional): 1 O.1 — Ro 1 — aggi& <br />��^^ I eSSought <br />. 1'O r >v 1 Tit - k- • - <br />t <br />t <br />Residential Address <br />Clo It 2. 1 <br />Telephone Number (optional): �E' -I _ 1tt1.(0 <br />eany■■klee L Rs.-- -Q \eck ic-ke - `1C_ k y ` <br />Committee Name <br />VQA111.t- <br />Name of Committee Treasurer <br />10 \'&o s ll S (s�(Cto <br />l w <br />Committeailing Address <br />)...c{Z -I <br />Telephone Number (optional): 1 O.1 — Ro 1 — aggi& <br />SUMMARY BALANCE INFORMATION: <br />Line 1: Ending Balance from previous report <br />Line 2: Total receipts this period (page 3, Tine 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 />Ib7G0, rj`I <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 />& fl <br />10 t ( rig <br />Affidavit of Committee Treasurer: <br />I 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, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign <br />finance activity of all persons acting under the authority or on behalf of this committeejn accordance with the requirements of M.G.L. c. 55. <br />Signed under the penalties of perjury: $ CL 1 (Treasurer's signature) Date: a-- <br />FOR CANDIDATE FILINGS ONLY: Affidavit of Cnndidate: (elieck 1 box only) <br />andidate with Committee and no activity independent of the committee <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 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 OR Candidate with independent activity filing separate report <br />I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a tune and complete statement of all campaign <br />" finance activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the <br />campaign finance 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. <br />Date: 1 z_ cO _ 20 I.5 <br />Sinned nnrler the nenaiapc of nerinn'! <br />