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Form CPF M 102 -0: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />City or Town of: <br />o .,,1 A <br />Reporting Period: Beginning: <br />O 4 s,r\�TE <br />OI I IIE <br />IMM/DD/YYYY) <br />Please print or type all Information, except signatures. <br />Ending: <br />Type of Report: (Check One) <br />❑ 8th day preceding preliminary /primary ❑ 8th day preceding election ❑ 30th day following election (town or special) 20th day of January (Year -End report) <br />Pursuant to M.G.L. Chapter 55: <br />•/ 1. I certify that I am a candidate for or currently hold Municipal Office. <br />2. I 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. I certify that I 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 />IA 11111 <br />rlg u1Jbit M. kG4IV <br />`11 .A.& ., 1244k, <br />1'- t►ect(Pt 40 r Mile- <br />-tit Isia6. A oaT <br />z-- <br />