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l <br /> Form. CPF M 102: Campaign Finance Report <br /> lug <br /> Municipal Form <br /> Office of Campaign and Political Finance <br /> Commonwealth <br /> of Massachusetts <br /> File with: City or Town Clerk or T.Iectian Commission <br /> Fill in Reporting Period dates: Beginning Date: 01/01/2021 Ending Date: 12/31/2021 <br /> Type of Report: (Check one) <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election Q year-end report ❑ dissolution <br /> Eileen Jay Eileen Jay for SChool Committee <br /> Candidate Full Name(if applicable) Committee Name <br /> School Committee member Becky Barrentine <br /> Orfice Sought and District Name of Committee Treasurer <br /> 191 Waltham Street, Lexington, MA 02421 100 Bedford Street, Lexington, MA 02420 <br /> Residential Address Committee Mailing Address <br /> E-mail: E-mail: firstname.lastname@example.org <br /> Phone#(optional): Phone#(op(ional): <br /> SUMMARY BALANCE INFORMATION: <br /> Line 1: Ending Balance from previous report 1,115 <br /> Line 2: Total receipts this period(page 3,line 11) o <br /> ttia <br /> Line 3: Subtotal(line 1 plus line 2) 1,115rr ,`t <br /> - ,l <br /> Line 4: Total expenditures this period(page 5,line 14) <br /> Line 5: Ending Balance(line 3 minus line 4) 1,115 <br /> `1 <br /> Line 6: Total in-kind contributions this period(page 6) 0 <br /> ZN <br /> Line 7: Total(all)outstanding liabilities(page 7) 0 <br /> Line 8: Name ofbank(s)used: Citizens, PayPal <br /> Affidavit of Committee Treasurer: <br /> 1 certify that l have examined this report including attached schedules and it is,to itue best of my knowledge and belief,a true and complete statement 0f811 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 or on behalf of this committee in accordance with the requirements of M.G.L.c.55. <br /> Signed under the penalties of perjury. (Treasurer's signature) Date: <br /> FOR CANDIDATE FILINGS ONLY; Affidavit of Candidate:(check 1 box only) <br /> Candidate with 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 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 /> h' P h' q Y <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period that are not otherwise disclosed in this report. <br /> Candidate without Committee <br /> rryt I certify that I have examined this report including attached schedules and it is,to the best of my knowledge and bel€ef,a true and complete statement of all campaign <br /> L�!J finance activity,including contributions,loans,receipts,expenditures,di5pursements,in-kind contributions and liabilities for this reporting period and represents the <br /> campaign finance activity or all persons acting undo the autho oro ehalf of this candidate in accordance with the requirements of M.G,L.c.55. <br /> Signed under the penalties of perjury: cw (Candidate's signature) Date: <br /> 1 <br /> L <br />
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