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Form CPF M101: STATEMENT OF ORGANIZATION C'ANDIDATE'S COMMITTEE MUNICIPAL. FORME ` V Conunonwealth Office of Campaign and Political Finance of Massachusetts 2921 '' 27 P11 4: 02 File with: City/Town Cleric or Election Commission NOTICE IS HEREBY GIVEN in accordance with the provisions of General Laws,Chapter 55,as gatation of a candidate's committee as follows: CANDEDATE: FutIName: Larry Freeman Residential Address: 218 Lowell St City I State 1 Zip: Lexington MA 02420 E-Mail Address: Freeman4Lexington@gmail.com Phone#: 404 783-7563 Party Affiliation: (If applicable) OFFICE SOUGHT/PURPOSE: Title: Member- School Committee District: LEXINGTON COMMITTEE: Name of Committee: Committee to Elect Larry Freeman (The name of the committee must include the candidate's last name) Corntaittee Mailing Address: 8 Hancock Ave City/State/Zip: Lexington MA 02420 Phone#: 781-223-4417 OFFICERS: Chair: Matthew Cohen Treasurer*: Margaret Counts-Klebe Residential Address: 23 Tower Road Residential Address: 8 Hancock Ave City/state/Zip: Lexington MA 02421 City/state/Zip: Lexington MA 02420 Phone#: 781-640-8362 Phone#: 781-223-4417 Email: margck@yahoo.com "A public cm to ce mpy not serve as treasurer of an lLohticA committee Lsee reverse). Other Officertritle: Other Officer/Title: Residential Address: Residential Address: City I State I Zip: 78 City/State/Zip: Phone#: Phone#: (Complete and attach a Form CPF MA 101,if necessary,with other officers and(mance committee,if any.) I hereby consent to the filing of this committee. I understand that a candidate shall not give consent to the organization of more than one committee on his/her behalf. I am aware that candidates are required to keep detailed accounts and records of all campaign Finance activity for a period of six years from the date of the relevant election. SIGNED CINDER THE PENALTIES OF PERJURY: Date: C_ Candidate' sig ature I hereby accept the office of Treasurer of the above-named co mmi ee.I affirm that I am not a public employee as defined by M.G.L.c.55,s. 13.I understand that: 1)I am subject to certain duties and liabilities under M.G.L.c.55, including the timely filing of campaign finance reports and keeping detailed accounts and records of all campaign finance activity for a period of six years from the date of the relevant election;2)if atter my acceptance of this office I become an appointed public employee,I must resign this position and notify OCPF of my resignation;and 3)a candidate may not serve as treasurer of the political committee organized on his/her behalf. �r SIGNED UNDER THE PENALTIES OF PERJURY: Date: Treasurer's signature ' I hereby accept the office of Chairman of the above-named committee. SIGNED UNDER THE PENALTIES OF PERJURY: P� Chair's sN re Date: