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Commonwealth <br />of Massachusetts <br />Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance VI! <br />File with: City orTowinQie or' Elechon Cammissimr <br />Fill in Reporting Period dates: Beginning Date: <br />hanuary 1, 2016 <br />Ending Date: <br />(February 12, 2016 <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary <br />8th day preceding election ❑ 30 day after election ❑ year -end report ❑ dissolution <br />Suzie Barry <br />Candidate Full Name (if applicable) <br />Selectman <br />Office Sought and District <br />1159 Burlington Street, Lexington, MA 02420 <br />Telephone Number (optional): <br />Residential Address <br />(781) 862-5853 <br />(Committee to Elect Suzie Barry <br />Committee Name <br />(Kim Coburn <br />Name of Committee Treasurer <br />166 Liberty Avenue, Lexington, MA 02420 <br />Committee Mailing Address <br />Telephone Numbs (optional} <br />(781) 863-6285 <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 />649.02 <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 />100 <br />749.02 <br />200 <br />549.02 <br />0 <br />93.72 <br />ITO Bank <br />Affidavit of Committee Treasurer: <br />[certify that have examined this report including attached schedules and it is, to the best of my knowledge and belief, a hue and complete statement of all campaign finance <br />activity, including all contribution, 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 autlwril or o. this m m accordance with the w the requirements ofM.G.L c. 55. <br />Signed ender the penalties of perjury: % efrcasurets signature) Date:) 0%/,} r,ld <br />FOR CANDIDATE FILINGS ONLY: AffndaviisdCand[date: (check t box only) <br />Candidate with Committee and no activity independent of the committee <br />❑I certify that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a We 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 ofhiG 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 fling separate report <br />I certify that report t I have examined this rort 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, Inane rec expenditures, disbr finenls, in -kin, • tributions and liabilities for this reporting period and represents the <br />campaign finance activity of all persons actingun r the authority or on pf4�is cnn .. tee in accordance with the requirements of?ANL. e.55. <br />Signed ender the penalties of perjury': <br />(Candidate's signature) <br />Date: <br />