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Comma wealth <br />of Massachusetts <br />Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />City or Town of: <br />Reporting Period: Beginning: <br />oio,/ao/G <br />(MM /Dl /YYYY) <br />Please print or type all Information, except signatures. <br />Ending: <br />o Z©( <br />(Moll D /YY Y) <br />Type of Report: (Check One) <br />8th day preceding preliminary /primary 8Ut day preceding election <br />30th day following election (town or special) E3 20th day of January (Year -End report) <br />Pursuant to M.G.L. Chapter 55: <br />I. I certify that I am a candidate for or currently hold Municipal Office. <br />2. I certify that I have not received any contributions, made any expenditures <br />3. I certify that I do not have a political committee. <br />or incurred any obligations during this reporting period, and do not have a campaign fund in existence. <br />DATE <br />PRINT NAME <br />SIGNATURE <br />gned under the penalties of perjury <br />RESIDENTIAL ADDRESS <br />(Street and Number) <br />y7 /e%/ Asv r, /Cc, <br />OFFICE SOUGHT <br />