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Commonwealth <br />of Massachusetts <br />Form CPF R1: Itemization of Reimbursements <br />Municipal Form <br />Office of Campaign and Political Finance <br />File with: <br />City or Town Clerk or Election Commission <br />3/24/2015 <br />Diaz, Thomas <br />Individual Being Reimbursed <br />Tom Diaz for School Committee <br />Committee Name <br />$291.33 <br />Amount of Reimbursement <br />3/14/2015 <br />Date of Reimbursement <br />Signed under the penalties of pe ;jury: <br />Candidate's /Treasurer's signature (in ink) <br />Date <br />Date Vendor Name and Address Amount Purpose <br />3/2/2015 Costco <br />71 Second Ave <br />Waltham, MA 02454 <br />3/2/2015 Costco <br />71 Second Ave <br />Waltham, MA 02451 <br />3/2/2015 Dion's <br />119 River St <br />Waltham, MA 02453 <br />3/2/2015 Sevan Bakery <br />599 Mt Auburn St <br />Watertown, MA 02472 <br />$84.38 Party Supplies, Food <br />$26.19 Party Beverages <br />$107.88 Party Beverages <br />$72.88 Party Food <br />