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Commonwealth of Massachusetts Municipal Form Office -a ampaign and Political Finance 1111.1 -6 Ail ICI: ti'3 File with: City or Town Clerk or Election Commission Fill in Reporting Period dates: Bee(ni itiiArptjtgj;i` Ending Date: I `j-" ?7 \ ZO l6 Type of Report: (Check one) �/ El 8th day preceding preliminary ❑ 8th day preceding election El 30 day after election year -end report ❑ dissolution RthP e- - 3. -Ke \1e y Candidate Full Nwne (if applicable) le r*tnoc'\ Office Sought and District �c+ �r�,, 9 C�rZeS-V & • 1.-24. \ I G._ X4-2 -1 l Residential Addres Telephone Number (optional): '781- 51(o \ - k5 'AL Con ittee Mailing Address • iL at 1 • - - - .- .•1 -so wn Committee Name jINDiA ^3. 03(tl,a Name of Committee Treasurer 1 /o RfL55e 11 . neohm, (x(l0,0aME70 Telephone Number Con ittee Mailing Address (optional): 1 7sI - salp 1 - air tig SUMMARY BALANCE INFORMATION: Line 1: Ending Balance from previous report Line 2: Total receipts this period (page 3, line 11) Line 3: Subtotal (line 1 plus line 2) Line 4: Total expenditures this period (page 5, line 14) Line 5: Ending Balance (line 3 minus line 4) A 1096, r7 of Line 6: Total in -kind contributions this period (page 6) Line 7: Total (all) outstanding liabilities (page 7) Line 8: Name of bank(s) used: I o1(o. rl`+ 0 0 r1(o • 1 of 0 Affidavit of Committee Treasurer: 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 activity, including all contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign 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. Signed under the penalties of perjury: • �uL)l.�L- 7--),I L_2 (Treasurer's signature) Date: 1 -1- 90 11 FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check 1 box only) /Candidate with Committee and no activity independent of the committee Syr . certify that I have examined this report including attached schedules and it is, to are best of my knowledge and belief, a true and complete statement of all campaign finance 1J 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, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Committee QR Candidate with independent activity filing separate report 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 activity, including contributions, loans, receipts, expenditures, disbursements, in -kind contributions and liabilities for this reporting period and represents the campaign 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. 11- I-20lq 1