Laserfiche WebLink
Commonwealth <br />of Massachusetts <br />29/5 ri'R 30 kH <br />UI'N C - at <br />LEXINGTON to <br />ar a <br />H• &l ice Form <br />& <br />lice of Campaign and Political Finance <br />a <br />File with: City or Town Clerk or Election Commission <br />Fill in Reporting Period dates: Beginning Date: <br />k- 23 -wt5 <br />Ending Date: <br />9-z- aot5 <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election j 30 day after election ❑ year -end report ❑ dissolution <br />-iele <br />Committee Name <br />Cr C.J. <br />Candidate FulltName (if applicable) <br />1,� <br />1 io Rung care Li(tirck 1K.4 <br />ge.—k-e-Ten (-eJ <br />Telephone Number (optional): 'J%1— 2191 _gygg <br />Office Sought and District <br />as i Foe.._e.s4t- ` -e_e\- 614_ * <br />nn� <br />1- 2i <br />Residential Address <br />Telephone Number (optional): 7 gl o g(4\ .. 15 4 Co <br />•m 1 • e -E a fit- r. ll - ( _5 <br />Committee Name <br />(dicl'n! bit- TS. U31 Ilia vu.s <br />Name of Committee Treasurer <br />1,� <br />1 io Rung care Li(tirck 1K.4 <br />Co ittee Mailing Address r oZfZiS <br />Telephone Number (optional): 'J%1— 2191 _gygg <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 />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 />O <br />d <br />L <br />it) 940/7f <br />d <br />O <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 e authorioor on behalf of this committeeri�n(a�ccordance with the requirements of M.G.L. c. 55. <br />� <br />Signed under the penalties of perjury: ( � ) (Treasurer's signature) Date: <br />FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) <br />4 Candidate 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 DR Candidate with independent activity filing separate report <br />❑ <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 <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 />