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Comm —we l <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: <br />Beginning: <br />Please print or type all information, except signatures. <br />Ending: <br />Type of Report: (Check One) <br />Sth day preceding preliminary/primary liaftaday preceding election <br />th day following election (town or special) 0 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 />2.1 certify that I have not received any contributions, made any expenditures, or incurred any obligations during this reporting period, and do not have a campaign fund in existence. <br />3.1 certify that 1 do not have a political committee. <br />SIGNATURE RESIDENTIAL ADDRESS <br />DATE PRINT NAME Signed under the penalties of perjury (Street and Number) OFFICE SOUGHT <br />3 JAI <br />1 ) 67 <br />l d o et k C. ?KO tJn <br />:7 <br />� <br />✓ d1-1/7 <br />rt7);„,, <br />ii % lab, ‘A,soi a <br />mod eido✓. <br />