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Commonwealth <br />of Massachusetts <br />Form CPF M 102: Campaign Finance Report` ``_! <br />Municipal Form Mb 1Th �( <br />Office of Campaign and Political Finance <br />I <br />File with: <br />City or Town Clerk or Election Commission <br />Reporting Period Beginning: 1/1/2015 Ending: 12/31/2015 <br />Type of report: Year -end <br />1/5/2016 <br />Michelle Ciccolo Committee to Elect Michelle Ciccolo <br />Full Name of Candidate Committee Name <br />Selectman Margaret Counts -Klebe <br />Office Sought/ District <br />50 Shade Street <br />Lexington, MA, MA 02421 <br />Name of Committee Treasurer <br />8 Hancock Avenue <br />Lexington, MA 02420 <br />Residential Address Committee Address <br />SUMMARY BALANCE INFORMATION <br />Ending Balance from previous report: <br />Total receipts this period: <br />Subtotal: <br />Total expenditures this period: <br />Ending Balance: <br />Total inkind contributions this period: <br />Total outstanding liabilities: <br />Name of bank(s) used: TD Bank <br />$127.24 <br />$2,000.00 <br />$2,127.24 <br />$0.00 <br />$2,127.24 <br />$0.00 <br />$401.59 <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 <br />belief, a true and complete statement of all campaign finance activity including all contributions, loans, receipts, <br />expenditures, disbursements, inkind 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 committee in accordance with the <br />requirements of M.G.L. c. 55. <br />Signed under the penalties of perjury: <br />Treasurer's signature (in ink) Date <br />Affidavit of Candidate (check 1 box only) : <br />❑ Candidate with Committee and no activity independent of the committee <br />I certify that I have examined this report, and attached schedules and it is, to the best of my knowledge and belief, a <br />true and complete statement of all campaign finance activity, of all persons acting under the authority or on behalf of <br />this committee in accordance with the requirements of M.G.L. c. 55. I have not received any contributions, incurred <br />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 and attached schedules and it is, to the best of my knowledge and belief, <br />a true and complete statement of all campaign finance activity including contributions, loans, receipts, expenditures, <br />disbursements, inkind 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 committee in accordance with the <br />requirements of M.G.L. c. 55. <br />Signed under the penalties of perjury: <br />