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2016-12-31-Andersen-OCPF
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2016-12-31-Andersen-OCPF
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Commonwealth <br />of Massachusetts <br />Form CPF M 102: Campaign Finance Report <br />Municipal Forni <br />Office of Campaign and Political Finance <br />j,l °l O i. >. <br />File Ci e all: }'�or 1'ow "n CidR o I(?,ilecu n Con <br />551011 <br />Fill in Reporting Period dates: Beginning Date: <br />Jan 1, 2016 <br />Ending Date: D.ec 31, 2016 <br />Type of Report: (Check one) <br />8th day preceding preliminary 0 8th day preceding election ❑ 30 day after election Ej year -end report ❑ dissolution <br />[Mark Andersen <br />Candidate Full Name (if applicable) <br />School Committee member <br />Office Sought and District <br />2 Thoreau Rd, Lexington, MA 02420 <br />Telephone Number (optional): <br />Residential Address <br />Campaign to Elect Mark Andersen <br />Committee Name <br />'Daniel P. Blake <br />Name of Connuittee'freasurer <br />2 Thoreau Rd, Lexington, MA 02420 <br />Committee Mailing Address <br />Telephone Number (optional): <br />Line I: <br />Line 2: <br />Line 3: Subtotal (line 1 plus line 2) <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: 'citizens Bank <br />SUMMARY BALANCE INFORMATION: <br />Ending Balance from previous report <br />Total receipts this period (page 3, line 11) <br />0 <br />100 <br />100 <br />100 <br />0 <br />0 <br />0 <br />. \Mari( of Committer Treasurer: <br />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 <br />activity, inch ding all contributions, loans, receipts, expenditures, disbursemey s, in- td contributions and liabilities for this relenting period and represents the campaign <br />finance activity of all persons acting under the aulho, rik inrin lelwl IhigJcyfim e in accordance with the requirements of NULL. c. 55. <br />Signed under the penalties of perjury: <br />(Treasurer's signature) <br />Date: <br />/7/ <br />FOR CANDIDATE FILINGS ONLY: Affidavit of Candidate: (check I box only) <br />Candidate with Committee and no activity independent of the committee <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. 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, <br />incurred any liabilities nor made any expenditures on my behalf during this reporting period. <br />Candidate without Committee OR Candidate with independent activity filing separate report <br />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 <br />finance 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 persona aging under the aidhority or on behalf of1his committee in accordance with the requirements of M.G.L. c. 55. <br />Signed under the penalties of perjury: <br />(Candidate's signature) Date: <br />
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