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Form CPF M 102: Campaign Finance Report <br />Municipal Form <br />Office of Campaign and Political Finance <br />Commonwealth <br />of Massachusetts <br />File ry ttr City or Town Clerk or Election Commission <br />r r� <br />Fill In Reporting Beginning Date: I —a7 -7_0)I Ending Date: —,2,0I% <br />Type of Report: (Check one) <br />❑ 8th day preceding preliminary ❑ 8th day preceding election 0 day atter election ❑ year-end report tssolution <br />Candidate Full Name (if applicable) <br />Office Sought and District <br />Residential Address <br />Telephone Number (optional): <br />BALANCE <br />Committee Name <br />miN 7 a <br />Name of Committee Treasurer <br />ihbrea�. S fit .< <br />Committee Mailing Address <br />Telephone Number (optional): <br />Line 1: Ending Balance from previous report <br />Line 2: Total receipts this period (page 3, line 11) <br />Line 3: Subtotal (line I 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 />TION: <br />W <br />Line 6: Total in-kind contributions this period (page 6) ( 3 0 5 <br />Line 7: Total (all) outstanding liabilities (page 7) �— <br />Line 8: Name of bank(s) used: <br />certify 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 <br />ictivity, including all contributions, loans, receipts, expenditures, disbursements, in-kind contributions and liabilities for this reporting period and represents the campaign <br />!nonce activity of all persons acting under the fo <br />autho or on behaI foftt'h'is committee in accordance with the requirements of M.G.L. c. 55. 7 <br />signed under the penalties of perjury: // 6-1J� (Treasurers signature) Date: <br />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 ander 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, <br />incurted 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 />E]1 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 al I 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 persons acting under the authority or on behalf of this committee in accordance with the requirements of M.G.L. c. 55. <br />under the penalties of perjury: <br />signature) Date: <br />