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M Form CPF M 102: Campaign Finance Report <br /> Municipal Form <br /> office of Campaign and Political Finance <br /> commonwealth <br /> of Massachusetts File will]: C ur lbwlt "I rk or El ctiun Cun]mi5siuu <br /> ---- ' Ending Date'.Filln Reporting Period dates: Beginning Date: / <br /> Type of Report: (Check one} <br /> ❑ 8th day preceding preliminary ❑ 8th day preceding election �3o day after election year-end report ❑X dissolution <br /> Candidate Full Name(if appiicablc) <br /> Committee Name <br /> Office sought and District mac ol'Cammince Treasurer <br /> Residential Address L{/ Cummitice-Mailing Address <br /> E•mnil:rE-mail: <br /> Phone M(optional]: Phunc J(optional): <br /> SUMMARY BALANCE INFORMATION: <br /> FLine : Ending Balance <br /> -1 IT previous report <br /> n.a <br /> Line Z: Total receipts this period(page 3,line 1 1) //IN <br /> a �4� <br /> Line 3: Subtotal (kine 1 plus line 2) <br /> Line 4: Total expenditures,this period(page 5, line 14) '3 <br /> 1 K•- <br /> Line 5: Ending Balance(line 3 minus line 4) z o'; �, _ .., Y M r <br /> Line 6: Total in-kind contributions this period(page G) l O <br /> c: <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 repur(incluling attached schedules and it is,Iv the hest vi'm, knuwledpc and bclief.:i true and cui»plvte statemcnl of all campaign firranc'c <br /> activity,including all contributions,loans,receipts.expcnditures,disburseoieius.in-kind cuniributions and liabilities fur this mpurting period and reprvscnts the cumpuign <br /> finance activity of all persons acting under the nuthuru rF ehalt'of is comma accordnnce with the requirements of M.G.L.c.55. �� a j z� <br /> �r Datc: <br /> (1?ensurers cignahirc) <br /> Signed under the penalties of perjury:FOR ANDIDATE F1 a -� <br /> N : Affidavit of Candidate.(check I box only) <br /> Candidate with Committee <br /> ❑ I certify that 1 have examined this report including attaches!schcdules and it is,to the best of niv knowledge and belief,a true and complete,tatement of all campaign fmancc <br /> activity,of all persons acting under the authority or on hchall'of this committee in accordance with the requirements of M.G.L.C.SS. I have not received any contributions, <br /> incurred any liabilities nor made any expenditures on illy behalf during this reporting:per <br /> iod that are nc>t uthenvisc disclnscd in this rcpurt. <br /> Candidate without Commiltee p,ig <br /> I certify that I have exaniinW this report including attached schcdules and it is,to the best UI my knowledge and belief,n true and camptctc sdac=nrnt of all cam u n <br /> Ej1'ranee activity,including contributions,loans,receipts,cxpcnditures,disbursements,in-kind contributions and iiabilitius for this rcportin4 period and represents the <br /> campaign finance activity of all persnns acting under tate authority or on behall'of this caadidate in accordance with the requirements of M.G.L,c.55. <br /> Date:(f'andidute's signuturcl "-- <br /> signed under the penalties of perjury; --- ___ <br />