2016-12-31-Andersen-OCPF - Laserfiche WebLink

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Commonwealth of Massachusetts Form CPF M 102: Campaign Finance Report Municipal Forni Office of Campaign and Political Finance j,l °l O i. >. File Ci e all: }'�or 1'ow "n CidR o I(?,ilecu n Con 551011 Fill in Reporting Period dates: Beginning Date: Jan 1, 2016 Ending Date: D.ec 31, 2016 Type of Report: (Check one) 8th day preceding preliminary 0 8th day preceding election ❑ 30 day after election Ej year -end report ❑ dissolution [Mark Andersen Candidate Full Name (if applicable) School Committee member Office Sought and District 2 Thoreau Rd, Lexington, MA 02420 Telephone Number (optional): Residential Address Campaign to Elect Mark Andersen Committee Name 'Daniel P. Blake Name of Connuittee'freasurer 2 Thoreau Rd, Lexington, MA 02420 Committee Mailing Address Telephone Number (optional): Line I: Line 2: 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) 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: 'citizens Bank SUMMARY BALANCE INFORMATION: Ending Balance from previous report Total receipts this period (page 3, line 11) 0 100 100 100 0 0 0 . \Mari( of Committer Treasurer: I certify that 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, inch ding all contributions, loans, receipts, expenditures, disbursemey s, in- td contributions and liabilities for this relenting period and represents the campaign finance activity of all persons acting under the aulho, rik inrin lelwl IhigJcyfim e in accordance with the requirements of NULL. c. 55. Signed under the penalties of perjury: (Treasurer's signature) Date: /7/ FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only) Candidate with Committee and no activity independent of the committee 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. of all persons acting under the authority or on behalf of this committee in accordance with the requirements of c. 55. 1 have not received any contributions, incurred any liabilities nor made any expenditures on my behalf during this reporting period. Candidate without Committee OR Candidate with independent activity filing separate report I cedily that I have examined this report including attached schedules and it is, to the best of my knowledge and belief, a hue 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 persona aging under the aidhority or on behalf of1his committee in accordance with the requirements of M.G.L. c. 55. Signed under the penalties of perjury: (Candidate's signature) Date: