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Form CFF M 102; Campaign Finance Report <br /> Municipal Form <br /> Office of Campaign and Political Finance <br /> Commonwealth 'r F { <br /> of Massachusetts <br /> File with: City or Town Clerk or Election Commission <br /> Fill in Reportin ril3tl dWS: ' ginning Date: l 6 Ending Date: �. <br /> Type of Report: ( In A <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election ❑ 30 day after election ❑ year-enol report ❑ dissolution <br /> !►�' j �t'�i�„ oltd"` ri � ' <br /> Candidate Full Name(ifapplicubte) Committee Name <br /> Office Sought and District Name of Committee Treasurer- <br /> 277 <br /> reasurer279 WbburoLv sT ►A►��*wAK 7 <br /> Residential Address <br /> Committee Mailing Address <br /> E-mail: E-mail: ii 1t «A 4Jr 40*' <br /> Phone#_(optional): phone#(uplional): <br /> SUMMARY BALANCE INFORMATION: <br /> Line 1: Ending Balance from previous report QI <br /> Line 2: Total receipts this period(page 3, line 11) r ro, <br /> Line 3: Subtotal(line 1 plus line 2) ,, C <br /> Line 4: Total expenditures this period(page 5, line 14) <br /> Line 5: Ending Balance(line 3 minus line 4) <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 /> 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 belief,a true and complete statement of all 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 autho ' o of behalf of this committee in accordance with the requirements of M.G.L,c.55. <br /> Signed under the penalties of perjury: (Tfeasurers signature) Date: p2/Y � <br /> FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate:(check l box only) <br /> Candidate with Committee <br /> ❑ I certify that i have examined this report including attached scheduics 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, 1 have not received any contributions, <br /> incurred any liabilities nor made any expenditures on my behalf during this reporting period that are not otherwise disclosed in this report. <br /> Candidatt withuut Committee <br /> ❑ I certify that I have examined tris rep031 including artaet�ed schaiulcs and it is,to the best of my knowledge and belief,a true and complete statement of all campaign <br /> fnance activity,including contributions,loans,receipts,expenditures,disbursements,in-kind contributions and liabilities for this reporting period and represents the <br /> campaign finance activity of all persons acting under the authority or on behalf of this candidate in accordance with the requirements of M.G,t.,e.55, <br /> Signed under The penalties of perjury; Date: <br /> {Candidate's signature} <br />